Simply put, self-harm is any act in which one physically harms their body in an effort to alleviate negative effects. Please note that there are a multitude of terms used for this purpose, including self-harm, self-mutilation, non-suicidal self-injury. For the purpose of clarity, we use the term self-harm in this article, but any of these terms can be used interchangeably. A common misconception about self-harm is that someone who is engaging in self-harming behaviors is experiencing suicidality. Though there is a relationship between self-harm and suicide, it is more correlative than causative. That is to say that many young people self-harm without ever experiencing pronounced suicidality. The vast majority of self-harm is superficial, the nature of the injuries themselves are benign. Certainly though, any act of self-harm should be taken seriously by adults. Self-harm invariably originates through emotional suffering and dysregulation.
Why do people Self-harm?
People engage in self-harming behaviors for myriad reasons, but some of the more commonly reported reasons are:
- To cope with emotional pain, frustration, or intense anger.
- A sense of release to bottled emotion.
- To feel something after a period of emotional numbness.
- As a distraction from emotional pain.
- As a means of self-expression.
- To punish oneself.
Equally varied are the ways in which individuals choose to self-harm. Oftentimes self-harming is synonymous with cutting, but self-harm can take many forms, including but not limited to: burning, excessive skin picking, headbanging, pulling hair out, and disrupting medical care (such as deliberate mismanagement of diabetes).
Types of Self-harm
Equally varied are the ways in which individuals choose to self-harm. Oftentimes, self-harming is synonymous with cutting, but self-harm can take many forms, including but not limited to:
- Cutting
- Burning
- Excessive skin picking
- Pulling out hair
- Headbanging
- Deliberately starting a fight with someone in order to be injured
- Hitting something repeatedly with the intent to hurt oneself
- Purposeful mismanagement of medical care, such as diabetes.
Whatever the reason or method, know that emotions are temporary, can be worked on, and recovery from self-harm is possible.
Who is most likely to Self-harm?
Approximately 17% of all adolescents and 15% of all college students engage in self-harm (Muehlenkamp et al., 2012). Of these youth who report self-harm, approximately half will have self-harmed only once. Many researchers attribute these isolated incidents of self-harm to developmentally consistent social contagion and impulse inhibition. Due largely to the media’s portrayal, many individuals consider self-harming behaviors to be unique to upper-middle class White teenage girls. Despite this trope, adolescent boys account for 35% of individuals who engage in self-harming behaviors (Whitlock, 2010). Researchers suggest this number may be even higher, as the manifestation of self-harm in young men can look quite different than the traditional presentation. Some examples of more male-specific self-harming behaviors are intentionally instigating a physical altercation to be hurt by another or striking something repeatedly in an attempt to deliberately injure oneself. As caregivers and providers are often unaware of these trends, many young men’s self-harming behavior is significantly under-diagnosed. Self-harm appears to be evenly distributed throughout race and socioeconomic status, though in the United States, there are mild differences according to region (Whitlock, 2010). One aspect of identity which substantially impacts self-harm is sexual orientation. LGBTQ+ identifying youth are six times more likely to engage in self-harming behaviors than their straight peers (Batejan et al., 2015). One identity group within the LGBTQ+ community that is particularly susceptible to self-harming behaviors are cis-female adolescents who identify as bisexual, approximately 43% of which engage in self-harming behaviors. The average age of onset for self-harming behavior is approximately thirteen years old.
There are also psychosocial stressors which correlate to an elevated risk of self-harming: loss of a caregiver, chronic medical conditions, parental substance use, childhood neglect or abuse, a history of trauma, a lack of strong familial attachment, a lack of impulse control, and low self-worth (Briere and Gil, 1998; CSP, 2014). This list is certainly not exhaustive, but merely the most common contributors to increased risk.
Signs of Self-harm
As previously mentioned, low mood and emotional dysregulation are often precursors to self-harming. How do these feelings of depression manifest? Oftentimes these young people may appear withdrawn or “closed off.” Conversely, they may begin to exhibit seemingly unwarranted irritation, becoming easily upset. You may notice they’re smiling less or appear to be somewhat less animated. Perhaps they suddenly decide to stop participating on a sports team, report that they no longer enjoy a hobby that they were passionate about before, or begin to decline in their academic performance. The most pronounced signs of self-harm are inexplicable wounds, or suddenly wearing seasonally inappropriate clothing which conceals their skin. Some of these warning signs are developmentally appropriate and are perfectly typical of a teenager. For instance, beginning to isolate when they’re home, spending more time in their bedroom.
If you are concerned, be aware of patterns of behavior or additional warning signs.
- Scars, often in patterns
- Low mood, or sadness
- Irritability, impulsivity, and unpredictability
- Showing less emotion/smiling less
- Disinterest in old hobbies or activities
- Poor academic performance
- Ending friendships/relationships unexpectedly
- Being more socially isolated
- Wearing clothes that are more concealing than usual
- Fresh cuts, scratches, marks, bruises, or other inexplicable wounds
- Excessive rubbing of an area to create a burn
- Frequent reports of an injury resulting from an “accident”
- Statements of feeling hopeless, helpless, or worthless
What to do if you’re concerned that someone that you love is self-harming?
If you discover that someone you love is self-harming, the most important action that you can take is educating yourself. Remember, that although the behavior may be alarming or upsetting to you, it is rendered by emotional distress. Try to focus on the feelings that the person may be experiencing instead of the behavior itself. That will enable you to cultivate empathy, and begin to address the underlying issues which may be contributing to self-harm. Be as clear and kind in your communication as possible, validating their feelings while discouraging the behavior. Do not use stigmatizing, threatening, or sensationalizing language, and try to discuss the behavior as neutrally as possible. Explain that although you’re really invested in their recovery, they should consider seeking professional help.
Other Ways to Help your Young Person
Be clear and kind. It is important to have an honest, non-threatening and non-judgemental conversation with your friend or loved one about staying safe:
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- Tell your loved one that you really appreciate their honesty.
- Tell them that you wish they weren’t having such a hard time.
- Tell them you understand they’re struggling but you are really worried about them.
- Consult with your pediatrician or other health care provider who can provide an initial evaluation or a referral to a mental health professional.
- Encourage them to reach out to any trusted adult if they are not comfortable talking with you (another caregiver, teacher, school counselor, coach, medical professional, or another adult they trust) to help navigate these feelings and get the help that is needed to ensure they are safe and cared for.
- If your loved one has injured themselves severely and you believe the injury may be life-threatening or an attempt at suicide, do NOT leave them alone and call 911 immediately.
- Call a suicide hotline. In the U.S., call the National Suicide Prevention Lifeline at 1‑800‑273‑TALK (8255) or use their webchat on www.suicidepreventionlifeline.org/chat
Getting Treatment
Two of the most effective treatments for addressing self-harm are forms of psychotherapy and are:
- Cognitive Behavioral Therapy primarily focuses on learning to identify and gradually modify thought patterns in order to generate behavioral changes.
- Dialectical Behavioral Therapy incorporates components of cognitive behavioral therapy with additional strategies like mindfulness, acceptance, and emotion regulation. If you are seeking a provider, it is important to ensure that they specialize in an evidence-based modality that is proven to address the treatment concern.
More Resources
National Suicide Prevention Lifeline
1‑800‑273‑TALK (8255) | Or webchat: www.suicidepreventionlifeline.org/chat
Crisis Text Line
Text ANY word to 741741 | www.CrisisTextLine.org
National Alliance on Mental Illness
Call 1(800) 950-NAMI(6264) | www.NAMI.org
