Self-harm: understanding it

This is the most common reason. When feelings build up and there seems to be no other outlet, self-harm can feel like a release valve. It can briefly ease tension or panic, or distract from emotional pain.

The trouble is that the relief fades quickly and the feelings come back, often with shame added on top. Learning other ways to ride out big feelings is a key part of recovery.

Some people self-harm to feel a sense of control when other parts of life feel unmanageable, such as family problems, school or work pressure, or things that happened to them.

Finding healthy ways to take back some control, like setting small goals, having a say in decisions, or building routines, can help over time.

Low self-esteem and harsh self-blame are common. Some people turn anger or disappointment inward, towards themselves. Research supports self-punishment as one of the main reasons people give.

A therapist can help you notice that harsh inner voice and slowly build a kinder one. Nobody deserves to be hurt, including you.

Some young people describe feeling empty, lonely or worthless, and self-harm briefly changes that feeling. Others want a short escape from distress.

Numbness is often the mind’s way of protecting itself after too much stress or hurt. Therapy can help you reconnect with your feelings safely, a little at a time. See the “Trauma: what it is & how it affects you” guide if this sounds familiar.

Sometimes self-harm is a way of showing distress, or a call for help. That is not “attention-seeking” in a bad way. Wanting people to notice that you are struggling is completely understandable.

Many people who self-harm hide it carefully. Whether someone hides it or not, the message underneath is the same: “I am in pain and I need care.”

Childhood abuse, trauma, bullying, parents separating and difficult family relationships were among the most common risk factors researchers found in young people.

Self-harm is more common among people with a history of trauma or abuse. When pain has nowhere else to go, the body can become the place where it shows up.

In the 2023 review, depression and anxiety were among the factors with the strongest evidence of a link to self-harm. Substance use also came up often.

Cleveland Clinic also lists experiences like autism, eating difficulties, trauma responses, sleep problems and intense mood changes as linked to self-harm. Getting support for what’s underneath is part of healing.

This doesn’t mean everyone with these experiences self-harms, or that self-harm means someone has a particular condition. Only a qualified professional can understand what is going on for a person.

People who feel isolated or rejected have higher rates of self-harm. Lacking friends was one of the common risk factors in the 2023 review.

Being around others who self-harm, in person or online, is also linked to a higher chance of self-harming. That is not anyone’s fault. It is one more reason why safe, supportive company matters.

Lesbian, gay, bisexual and queer people have higher rates of self-harm. The review authors advise professionals to pay particular attention to young people who are LGB.

The risk comes from how people are treated, not from who they are. Acceptance at home, at school and in the community is powerfully protective. The LGBTQ+ mental health guide has more.

A 2019 review of 48 studies found that people who find it hard to manage their emotions had roughly two to three times the odds of self-injuring. This link held across settings, ages and sexes.

The strongest links were with feeling there are few ways to calm down, being hard on yourself for having feelings, and acting on impulse when upset. The good news: these are skills that can be learned. See “Building emotion skills” in the Coping with urges to self-harm guide.

Good relationships with family and friends were the protective factor researchers found most often.

Things that help protect

• At least one trusted adult or friend to talk to
• Feeling accepted for who you are
• A school, team, club or faith group where you belong
• Knowing where to get help, and being able to reach it
• Kinder ways to cope with big feelings
• Being gentle with yourself

Someone may stay covered up all the time, even in warm weather, or find reasons to avoid activities where skin is visible. They may give vague explanations for marks or injuries.

Of course, people cover up for lots of reasons, including comfort, culture, faith or body image. One sign on its own doesn’t tell you much. Look at the bigger picture.

Repeated injuries with no clear explanation can be a sign. The person may seem uncomfortable or change the subject if you ask.

Signs of depression, like low mood, tearfulness, losing interest in things, sleep changes or low energy, are common. Some people have outbursts of anger or argue more.

You may also notice self-blame, feeling worthless, or saying things like “I’m not good enough”.

Withdrawing from people and avoiding conversations can be a sign that someone is carrying something heavy. They may spend long periods alone in their room or the bathroom.

Staying in gentle contact matters, even if they don’t want to talk yet. A text, a snack, or sitting together quietly can say “I’m here”.

Talk of ending things or not wanting to go on is a sign to act straight away. Take it seriously every time, even if it is said casually.

Asking honestly and lovingly about suicide is far more likely to help keep someone safe than to put the idea in their head.

People self-harm for many reasons, and many keep it secret. Calling it attention-seeking makes people feel ashamed and less likely to ask for help.

If someone does want people to notice they are struggling, that is a very human need. They deserve care, not judgement.

Brushing self-harm off as “just puberty” or “a phase” can leave a young person feeling dismissed. Self-harm is a sign that something else is going on.

Getting help early, before things reach crisis point, is better for everyone.

Self-harm is often talked about in teen girls, but it affects people of every gender, including non-binary and transgender people, and adults of all ages.

Boys and men may be less likely to be noticed or to ask for help. Everyone deserves to be asked kindly how they are doing.

How visible or serious an injury looks doesn’t tell you how much someone is hurting inside. Even small amounts of self-harm can be a sign of a lot of pain.

Most people who self-harm are not trying to end their life. But the two are linked, so always take self-harm seriously and ask gently about suicidal thoughts.

Pressuring someone to stop, or threatening to take away their independence, can increase shame and push self-harm further into hiding.

What helps is listening, understanding the feelings underneath, and getting support to learn new ways of coping.

Pediatricians list this as one of the most common myths they hear. Asking directly, calmly and with love shows someone it is safe to talk.

The same is true for suicide: asking honestly about it is far more likely to help keep someone safe than to give them the idea.

Most young people who self-harm stop as they move into adulthood. That is real hope. But the pain underneath still deserves care, and self-harm that goes on for a long time raises the risk of suicidal thoughts.

Treating both the self-harm and whatever is going on underneath, like depression or anxiety, is important.

Treatment is available, and both physical and emotional recovery is possible. Many people find other ways to cope and go on to live full lives.

Teens are the age group most affected by self-harm. Fast changes in the brain and body, plus pressure from school, friends, family and social media, can leave young people feeling overwhelmed or alone.

There is real hope here too. Most young people who self-harm stop as they move into adulthood, especially when they have support.

Adults self-harm too, sometimes for the first time later in life and sometimes after years of keeping it private. Money worries, relationship problems, grief, illness, work stress and contact with the justice system can all play a part.

Adults may feel extra shame because self-harm is seen as a “teen thing”. It isn’t. Talking therapies work for adults, and it is never too late to get support.

Self-harm is often talked about in girls, but boys and men self-harm too. In a 2022 global review, about one in five teen boys had self-injured in the past year.

Boys and men may be less likely to be noticed or to ask for help. Everyone deserves to be asked kindly how they are doing.

People of every gender, including transgender and non-binary people, can self-harm. Self-harm also crosses every culture, faith and income level.

Some groups face higher rates because of how they are treated, such as rejection, discrimination or bullying, not because of who they are.

There is no test for self-harm. Instead, a professional will talk with you about what has been happening, how you feel, and what is going on in your life, such as money worries, grief, school trouble, bullying or a breakup.

You may be asked about

• What led up to the self-harm and how you felt afterwards
• Your relationships and where you live
• Anything you have already tried that helped
• Any injuries that need care
• Whether you have thoughts of ending your life
• Alcohol or drug use

Depending on what you need, you might meet a social worker, an occupational therapist, a counselor, a mental health nurse, a psychiatrist, or a psychologist or therapist.

If what’s underneath includes grief, abuse, sexual assault or eating difficulties, you may be connected with a specialist service for that too.

A trained therapist will keep what you tell them about your feelings and experiences confidential. Teens can ask for private time with their doctor.

If someone is at serious risk, professionals may need to share information to keep people safe. You can always ask, “Who will you tell, and what will you tell them?” at the start.

If the first person you speak to doesn’t help, your feelings are still valid. You can try other support, like a school nurse, a different doctor or a helpline.

You are allowed to ask questions about your care, to bring someone with you, and to say if something isn’t working.

DBT teaches practical skills to manage intense emotions, get through crisis moments, and handle relationships. Self-harm is one of the main things it was designed to help with.

The teen version (DBT-A) often includes individual therapy, skills groups with parents, and phone coaching for both young people and parents.

In a major U.S. study of teens at high risk, self-harm was about one-third as likely after six months of DBT as with a comparison therapy. A large research review found DBT-A was the therapy with the best evidence for reducing repeated self-harm in young people.

CBT helps you spot painful thinking patterns, understand what triggers urges, and practise new ways to solve problems and respond to stress.

For adults, research shows CBT-based therapy can reduce repeated self-harm, with benefits seen 6 and 12 months later. Health guidance recommends short, person-centred CBT-informed therapy for adults who self-harm.

For young people, the evidence for CBT on its own is less clear so far, and researchers are working to adapt it.

MBT helps people understand what is going on in their own minds and in other people’s, especially in close relationships. This can make big feelings less confusing and less overwhelming. It is one of the talking therapies offered to young people who self-harm.

For adults, research found positive effects on repeated self-harm. For teens, the evidence is still uncertain, and more studies are needed.

Therapy can include family or a partner when that helps. Guidance says families and carers should get clear information and, where appropriate, help with safety planning.

You get a say in who is involved. The Supporting someone who self-harms guide is a good place for loved ones to start.

Depending on what is going on, you may also see a counsellor, social worker, psychologist or specialist service, such as support for grief, abuse or eating difficulties.

Care should not be withheld because of a diagnosis or because someone also uses alcohol or drugs.

Trained counselors listen and help you through the moment. You don’t have to be thinking about suicide to reach out. You can also contact them if you are worried about someone else.

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 or mental health services. Teens can ask for private time with their doctor.

Staying calm, listening and letting someone know you care helps far more than pressure or ultimatums. Caring for yourself matters too.

Urges often ease with time. Delaying, changing your body state, soothing yourself and reaching out can carry you through the hardest moment.

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.