Coping with urges to self-harm

Tell yourself you’ll wait five or ten minutes, and notice what you’re feeling. Urges often peak and then ease. If you get through ten minutes, try another ten.

Each time you delay, you learn that you can ride out the feeling. That builds confidence over time.

Doing something harmless and absorbing can carry you past the urge. Go for a walk, listen to music, or do something that needs your full attention.

Ideas

• Call or message someone about anything at all
• Go somewhere public, like a café or library
• Play a game, do a puzzle, or cook something
• Watch something funny
• Tidy or organise one small space
• Play with a pet

Strong emotions live in the body. Changing what your body is doing can turn the volume down. A DBT skill called TIPP uses Temperature, Intense exercise, Paced breathing and Progressive muscle relaxation.

Try

• Splash cold water on your face
• A short burst of movement, like jumping jacks or a fast walk
• Breathe out for longer than you breathe in
• Tense and then relax each muscle group, one at a time

Calming activities can ease anxiety. Some people make a self-soothe box with things that comfort their senses.

Ideas for a self-soothe box

• A soft blanket or jumper
• A favourite smell, like a hand cream or tea
• Photos or notes that make you smile
• A playlist that calms you
• A stress ball or fidget toy
• A list of people to contact

Writing, drawing or recording a voice note can help you release what you’re feeling. Your writing can stay private. Nobody else needs to read it.

Over time, a mood diary can help you notice patterns: which feelings, places or times bring urges. You can then plan ahead for them.

Talk to someone you trust: a friend, family member, teacher, school nurse, youth worker, doctor or a trained volunteer.

You don’t have to talk about self-harm if you’re not ready. Just being with someone can make the urge easier to bear.

Outside triggers are events or situations, like an argument, a hurtful message, a bad grade, being left out, an anniversary of a loss, or seeing self-harm content online.

You can’t avoid every trigger, and you shouldn’t have to. But knowing your common ones means you can plan support around them, like texting a friend after a tough class.

Inside triggers come from within: a harsh thought like “I always mess up”, a painful memory, or a feeling such as shame, loneliness or emptiness. Noticing whether particular feelings tend to lead to urges is a useful first step.

Naming the feeling, even just in your head (“this is shame”), can turn the volume down a little and give you a moment to choose what to do next.

Feelings hit harder when your body is running low. Many people notice urges are stronger late at night, when they are exhausted, hungry, unwell, or on their own.

Small basics, like regular meals, enough sleep and not being alone at your hardest times of day, can make the whole chain weaker.

In DBT, people often keep a diary of emotions and actions to spot patterns, and bring it to therapy. Looking back at the steps that led to an urge helps you find where to break the chain next time.

Questions to ask yourself

1. What was happening just before?
2. What did I think and feel?
3. What did I notice in my body?
4. What did I do, and what happened afterwards?
5. Where in the chain could I try something different next time?

Keep your plan somewhere easy to reach, like your phone, your wallet or by your bed. Some people take a photo of it so it is always with them.

Sharing it with someone you trust means they know how to help when you need it.

Making your space safer, especially during stressful times or when urges are strong, is part of a good safety plan. A doctor or mental health provider can help you think this through.

It is okay to ask someone you trust to keep certain things for you for a while. That is a strong, caring choice, not a failure.

After a hard moment or a setback, look back at what helped and what didn’t, and add what you learned. Maybe you need a new idea, an earlier warning sign, or one more person to call.

Some people who self-harm also have thoughts of suicide at times. A safety plan, and getting support early, can make a real difference.

Emotion regulation, one of the four DBT skill areas, starts with becoming more aware of your emotions and understanding them. A vague, stormy feeling is harder to handle than one with a name.

Research also links unclear or confusing feelings with self-injury. Practising names, like “hurt” versus “angry”, or “lonely” versus “bored”, can help you work out what you actually need.

Try this

• Check in with yourself three times a day: “What am I feeling right now?”
• Notice where you feel it in your body
• Rate how strong it is from 0 to 10
• Ask: “What is this feeling trying to tell me?”

Being hard on yourself for having feelings, like thinking “I shouldn’t feel this way”, was one of the patterns most strongly linked to self-injury in research. Fighting a feeling often makes it bigger.

Allowing a feeling doesn’t mean you like it or that you must act on it. It means saying, “This is here, it makes sense, and it will pass.” Feelings rise and fall like waves.

Mindfulness means being fully aware of the present, rather than dwelling on the past or worrying about the future. It is a core DBT skill.

You don’t need to sit still for an hour. Try noticing five things you can see, or really tasting your next sip of tea. Short, regular practice on calm days makes it easier to use on hard days.

Interpersonal effectiveness, another DBT skill area, is about asking for what you want and need and setting boundaries, while respecting yourself and others.

Many urges grow out of feeling unheard. Being able to say “I need some space” or “Can you just listen?” can ease pressure before it builds up.

A simple way to ask

• Describe what is happening: “I’ve had a really hard day.”
• Say how you feel: “I’m feeling overwhelmed.”
• Ask clearly: “Could we sit together for a bit?”
• Say why it helps: “It would help me feel calmer.”

A 2021 review of 18 studies found that people with more self-compassion tended to self-injure less. The link was small, and more research is needed, but researchers see self-compassion as something that could be built up to help.

Self-compassion has three parts: being kind to yourself instead of harsh, remembering that everyone struggles (you are not alone), and noticing painful feelings without getting swept away.

Some people find it easier to write a note, send a message or talk online first. Practising what you want to say can help too.

You could start with

• “Can we talk? I’ve been struggling and I need some help.”
• “I’ve been hurting myself to cope with how I feel.”
• “This is hard to say, so I wrote it down.”
• “I don’t need you to fix it. I just need you to know.”

It can help to decide ahead of time how much you want to share. You don’t have to show anyone injuries or scars, although a health professional may need to check them in case you need treatment.

You can let them ask questions without answering everything straight away. If it gets too much, you can pause and pick it up another day.

If the first person you tell doesn’t help, your feelings are still valid.

Try someone else you trust, like a school nurse, a doctor or a helpline. You deserve to be heard.

Being open with a doctor helps, even if you don’t know why you self-harm. They can treat injuries, suggest support and refer you for an assessment if needed.

Schools and colleges often have their own mental health support and can help connect young people to care. Staff see students every day and can notice changes.

Anti-bullying work and inclusive, welcoming schools help everyone feel safer.

A doctor can talk with you about self-help or support groups. Hearing from others who have been there can reduce shame and offer hope.

For many people, faith or cultural communities offer comfort, purpose and people who care. A trusted faith leader or elder can listen and help you find professional support too.

See the Faith & mental health guide for more.

When communities talk about self-harm with understanding instead of judgement, people feel safer asking for help sooner.

You can help by using kind language, gently challenging myths like “attention-seeking”, and sharing where to find help.

Health services advise talking to a doctor if you are hurting yourself, having thoughts about it, or worried about an injury. A doctor can treat injuries and connect you with support for what’s underneath.

Self-harm can lead to infections, nerve damage and lasting scars, so getting proper care matters, whatever the injury looks like.

Health guidance is clear that people who self-harm deserve compassionate, respectful care. You are allowed to say “I’m feeling really low and I hurt myself.”

Being honest helps them help you properly. You can bring a friend or family member with you for support.

Go to the emergency room or call 911 if an injury is serious, if you feel unwell, or if you feel in danger of hurting yourself further.

Emergency staff see people in crisis every day. You deserve care just as much as anyone else in the waiting room.

Some people feel self-conscious about scars. Your past does not define you. A doctor can talk with you about scars and how to care for your skin.

You get to decide who you tell, and how much you share. “It was a hard time, and I’m getting support” is a complete answer.

Many teens fear that if they tell someone, they will be punished, lose their phone, or be watched all the time. A good response focuses on understanding and support, not punishment.

If someone reacts badly when you tell them, that says more about them than about you. Try again with someone else you trust.

Regular meals, enough sleep, exercise and time with loved ones all help with wellbeing. Teens need about 8 to 10 hours of sleep a night.

When you are tired or hungry, feelings hit harder. Small, steady habits give you a stronger base. The Sleep & mental health and Self-care basics guides have more ideas.

Being mindful of what you see online is part of recovery. Some content can make urges stronger.

Ideas

• Mute or unfollow accounts that leave you feeling worse
• Avoid content that shows or talks about self-harm in detail
• Follow accounts that are calming, funny or hopeful
• Keep phones out of the bedroom at night if you can

Being kind to yourself is part of long-term recovery. When the harsh inner voice shows up, try asking: “What would I say to a friend who felt this way?”

It can help to notice your positive qualities, or to ask people you trust what they value about you.

If you need medical attention, or an injury might be infected, see a doctor or urgent care. Doctors are not there to judge you. Be honest so they can help properly.

See “Looking after injuries” for more on getting help without shame.

After a setback, the harsh inner voice can get loud: “I’ve ruined everything.” But guilt and shame are part of what keeps the cycle going. Meeting yourself with kindness helps you get back on track sooner.

Kinder things to tell yourself

• “One hard moment doesn’t erase my progress.”
• “I was in a lot of pain. That makes sense.”
• “I can learn from this.”
• “I deserve care, especially now.”

It can be tempting to hide a setback. Telling a trusted person, your therapist or a crisis line means you get support when you need it most.

If the first person you tell doesn’t respond well, your feelings are still valid. Try someone else, like a school nurse, doctor or helpline.

When you feel calmer, look back at what led up to it, with curiosity rather than blame. Was there a trigger? Were you tired or alone? Which coping ideas did you try?

Then update your urge plan or safety plan with what you learned. Maybe you need a new distraction, an earlier warning sign, or one more person to call.

Recovery often looks like urges becoming less frequent, less intense, or easier to ride out, and like reaching out sooner. Those are all real wins, even if setbacks still happen sometimes.

Try noting three things you are proud of each day. Small wins add up.

Trained counselors listen and help you through the moment. You don’t have to be thinking about suicide to reach out.

Spanish services and support for Deaf and hard of hearing people are available.

A live, trained volunteer crisis counselor will text back. Texting can feel easier when talking out loud is hard. Message and data rates may apply.

Trained counselors support LGBTQ+ young people in crisis, any time, for free.

A doctor can listen, treat injuries and connect you with talking therapy. If you already have a therapist, tell them about urges and setbacks. That is exactly what they are there for.

Find A Helpline is a free directory of verified, confidential helplines in many countries, with phone, text and chat options.

In an emergency, call your local emergency number.