Self-harm involves intentionally inflicting bodily harm or injury to yourself, usually during times of extreme distress. [1][2][3] Self-harm is more common among teens and young adults struggling with underlying conditions such as mood, personality, eating, anxiety, or impulse control disorders. [3] Therapies that teach people healthier ways to regulate difficult emotions and cope with stress can help people who engage in self-harm. [4]
- Self-harm involves intentionally cutting, burning, or otherwise injuring your body, and is often a sign of an underlying mental health condition.
- Self-harm is an unhealthy coping strategy people use to regulate intense emotions, cope with stress, or seek support from other people.
- Finding healthier ways to cope with stress and difficult emotions is possible, and therapies like CBT, DBT, and ACT are often helpful to people who self-harm.
What is self-harm?
Self-harm describes the act of intentionally cutting, burning, or physically injuring yourself. People who self-harm are not attempting suicide, but instead may be seeking relief or release from strong and difficult emotions like sadness, anger, or anxiety. Cutting is the most common type of self-harm, but other types can include burning, scratching, bruising, picking at wounds, or pulling out hair. [1][2][5]
Other terms that are synonymous with self-harm include self-injury, self-injurious behavior (SIB), self-mutiliation, and nonsuicidal self-injury. [3] Specific types of self-harm can also be referred to by name. For example, cutting is a common type of self-harm that involves intentionally cutting the skin.
Who self-harms?
Most people who engage in self-harm are struggling with an underlying mental health condition. Mood disorders like depression and bipolar disorder are linked to self-injury, and so are anxiety, eating disorders, PTSD, and personality disorders like borderline personality disorder. [3] Many people who self-harm struggle with impulsivity and may be diagnosed with an underlying impulse control disorder that makes it difficult to control strong urges and emotions. [2][3]
While people of any age can self-harm, it’s a much more common problem in teens and young adults. Research estimates that about 15% of teens engage in self-harm, and rates are higher in girls than in boys. [2][5] People who self-harm typically are struggling with emotional distress and have poor coping skills. Low self-esteem, poor emotion regulation, and low impulse control are also closely linked to self-harm. [1][2][3][5]
Why do people self-harm?
According to studies, the vast majority of people who self-harm are diagnosed with at least one mental health disorder. Mood and anxiety disorders, impulse control disorders, PTSD, personality disorders, and eating disorders are common diagnoses associated with self-harm. [2][3] These disorders share certain characteristic patterns, including struggles with self-esteem, emotional regulation, and impulse control, which may provide clues about the reasons why people self-harm.
Emotion regulation and relief model
Because most people self-harm during times when they are emotionally distressed, it’s probable that self-harm behaviors are being used as an unhealthy method of coping. [3][5]
People who self-harm often describe that cutting or injuring themselves helps them to feel calmer, less upset, and provides a degree of relief or release from tension and stress. Others view self-harm as a way to distract themselves from emotional pain by instead focusing on physical pain. While this can be difficult to understand, intense emotions can create strong, destructive impulses, and acting on them can bring some temporary feelings of release.
Also, injuring oneself can trigger the release of certain mood-regulating and pleasure-inducing chemicals like endorphins, serotonin, and dopamine. [6] Self-harm can also be an attempt to ‘cry for help’ and get attention, care, and emotional support from other people. [1][3]
Trauma, abuse, and dissociation as drivers
Traumatic experiences like childhood abuse increase the likelihood of developing a mental illness later in life. Some people who self-harm have a history of trauma that causes them to dissociate from their bodies or experiences when they are upset or triggered. For example, feeling numb, empty, or disconnected can be signs of dissociation. For these individuals, the act of self-harm may be an attempt to interrupt dissociation and remain present in their bodies and experiences. [3]
Social and cultural factors
Many experts have speculated that media and social media could play a role in encouraging self-harming behavior, especially in teens. TV or media content that glorifies self-harm may sway impressionable young people to try the behavior themselves. Children and teens may also be exposed to self-harm via their peer groups, including through posts or content on their social media feeds. [7]
Is self-harm an addiction?
Self-harm is not a diagnosable addiction, but it does share some similar features and risk factors. For example, both compulsive drug use and self-harm are triggered by strong and self-destructive impulses. Also, stress and difficult emotions like shame, anger, and loneliness can be triggers for both self-harm and substance use, which may be used as an unhealthy method of coping. [3]
Recognizing signs & how family, friends, and schools can help
If you notice some of the signs of self-harm, like unexplained cuts and injuries or bruises, you can have a private conversation with the person and ask them if they’re willing to talk about what happened. Approaching them with care and concern rather than criticism or judgment helps to improve the chances they’ll open up to you.
If they disclose that they have been self-harming, it’s important to encourage them to seek mental health treatment. Providing information or resources about treatments available in their community can help them access the treatment they need.
Responding to self-harm: Risk assessment and immediate next steps
Even when self-harm involves non-serious injuries, it is still considered a serious sign of emotional instability that requires the involvement of a licensed mental health professional. This is especially true because self-harm is almost always indicative of an underlying mental health condition that requires professional treatment. Self-harm is also concerning because it is linked to a higher risk of suicide and suicide attempts. [2]
When a person has self-harmed, it’s important to assess their level of medical and psychiatric risk and determine if they need immediate help. The steps you need to take will vary depending on whether the priority concerns are medical or psychiatric in nature, and depending on how urgent and serious the concerns are.
Immediate medical and psychiatric response
If there are serious or potentially life-threatening injuries resulting from self-harm, the best course of action is to call 911, go to the nearest emergency room, or seek immediate medical care.
If there are no serious medical injuries, the best course of action is usually to seek mental health treatment. Depending on the urgency and severity of psychiatric symptoms, setting up an appointment with an outpatient mental health provider may be an appropriate step. During this initial appointment, the provider will be able to perform a diagnostic evaluation, assess for risk and safety concerns, and make a recommendation for treatment and next steps.
Here are first-aid and safety planning steps that may be important to consider:
- If a person has uncontrolled bleeding or serious or potentially life-threatening injuries because of self-harm, call 911 or go to the nearest hospital emergency room.
- If there are no serious or life-threatening injuries, a licensed mental health provider will be able to provide support during a formal and structured appointment.
- Do not leave the person alone if they are in extreme distress or express an intention to harm themselves.
- Remove or restrict access to potentially dangerous items like controlled medications, weapons, and sharp objects.
- Ask the person to come up with a plan of what coping strategies they will use if they get upset or have urges to self-harm, including the names of people or agencies they can call for help and support.
- Monitor for additional signs of self-harm and regularly check in with the person to ensure they are safe and inquire about their well-being.
Basic wound care for minor self-harm injuries
When there are minor wounds or injuries that do not require immediate medical assistance, basic first-aid and wound care at home may be sufficient. For instance, cleaning out the wound and applying antibiotic ointment and/or bandages can be an effective at-home strategy.
Safety planning and ongoing risk evaluation
Licensed mental health professionals are skilled and experienced in creating detailed and individualized safety plans with people at risk for self-harm and suicide. These are written contracts created in collaboration with the person, and include specific triggers, coping skills, and support people or agencies that can be contacted during a crisis.
In addition to creating a written safety plan or contract, mental health professionals will also conduct ongoing risk and safety assessments to gather information about:
- The person’s desire or urges to harm themselves, including when, where, and how these show up.
- The person’s plan (if any) to harm themselves, including what they plan to do and how they plan to do it.
- The person’s intention to act on their plan, including whether or not they can commit verbally and/or in writing, not to act on their plans.
- The person’s personal risk level, which includes an evaluation of any history of self-harm or suicidal attempts, access to healthy coping strategies and support systems, and history of utilizing these skills and supports.
- The person’s general mental health and psychological stability, including a consideration and review of their diagnoses, active symptoms, and current treatment supports.
Harm-reduction strategies and safer alternatives
There are a number of healthier and safer alternatives to self-harm that can help people who are distressed feel calmer. Usually, urges to self-harm come in waves along with strong emotions. Pausing before acting can help give these urges a chance to surge up and die down, similar to a wave rising and cresting. Once the urge has passed, it’s much easier to make a smarter and safer choice.
Here are some alternative coping strategies that can help:
- Distract yourself from difficult thoughts and feelings by getting busy with a task, going outside for a walk, or calling a friend.
- Express your emotions in healthier ways by talking to a trusted support person, scheduling a therapy session, or journaling.
- Find ways to care for or pamper your body, like a warm bath, a cup of tea, shopping for a new outfit, or getting a massage.
- Reset your mindset by making a list of personal accomplishments, goals, and dreams, or listing things you’re grateful for.
- Get present by doing a guided meditation or using mindfulness to become more aware of your surroundings, or using your 5 senses to connect with the present moment.
- Try Emotional Freedom Techniques (EFT) tapping as a method to distract yourself from difficult thoughts, stimulate your body in a healthy way, and regulate your emotions.
Treatments and supports
Therapy is a frontline treatment for many of the underlying mental health conditions that are linked to self-harm. While there are no specific medications or types of therapy that are considered evidence-based treatments for self-harm, there are many different types of therapy that can target underlying issues like self-esteem, impulsivity, and emotion regulation. Some of the therapies that could be helpful to people who self-harm include: [4]
- Cognitive behavioral therapy (CBT)
- Acceptance and commitment therapy (ACT)
- Trauma-informed therapies like EMDR, ART, or CPT
- Dialectical behavior therapy (DBT)
- Family therapy
Recovery
Recovery from self-harm may not be an immediate or linear process, but instead one that involves some trial and error, successes, and setbacks. Engaging in regular and consistent therapy can make a person more likely to overcome self-harm, providing needed support during times when the person experiences a lot of distress. As healthier coping strategies are developed, the risk for subsequent self-harm will decrease.
-guide-detail.jpg?v=1722503251)
-guide-detail.jpg?v=1722503242)