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Learn more about crisis issues like suicide, self-harm, and depression, including how to get help.

Self-Harm and Self-Injury: Everything from statistics to alternatives to how to help


What is self-harm?


Self-harm, also known as deliberate self-harm, self-injury, self-mutilation, or more method-specific terms like cutting or burning, is the act of purposely causing physical harm to oneself. It usually happens without the intent to die — that is, not as a suicide attempt, and is classified by the Statistical and Diagnostic Manual of Mental Disorders (DSM-5) as nonsuicidal self-injury disorder (NSSID).

People who hurt themselves most often start as teens or young adults, with adolescent rates of nonsuicidal self-injury being tracked at rates from 15% to 40% depending on the study. One extensive study from Sweden reports that girls are more likely to meet NSSID criteria “perhaps [because] boys traditionally are less inclined to acknowledge the emotional and motivational aspects of the diagnosis.” Because people who self-injure frequently hide their injuries from others, it can be difficult to identify.

There are many different types of self-harm, which cause varying degrees of damage. All forms should be taken seriously.

Types of Self-Injury

The Mayo Clinic lists a number of common types of self-injury. These include, but are not limited to:

  1. Cutting

  2. Scratching

  3. Burning

  4. Carving words or symbols into the skin

  5. Hitting or punching oneself (including banging one’s head or other body parts against another surface)

  6. Piercing the skin with sharp objects such as hair pins

  7. Pulling out hair

  8. Picking at existing wounds and interfering with the healing process

Why Do People Self-Harm?

Self-harming behavior can be triggered by a number of factors. Understanding the reason someone is hurting themselves is often an important step to supporting them. Examples of reasons include:

  1. Coping with stress or negative feelings. For some people, self injury becomes a way of dealing with negative emotions, anxiety, depression, and major life transitions, allowing for temporary relief.

  2. Finding distraction. Deliberate self-harm is used by some people as one method of taking their minds off overwhelming emotions.

  3. To feel something physical. People who feel numb, often from trauma, may also exhibit NSSID tendencies to experience the physical sensation it causes.

  4. Sense of control. Individuals who feel their lives are out of their own control might hurt themselves because self-mutilation is something they feel they can control.

  5. Self-punishment. People experiencing extreme shame or guilt may turn to self-harm to give themselves the pain they feel they deserve.

  6. Expressing emotions. Some people find their emotions so painful that they struggle to put them into words. Other people feel that they shouldn't express their emotions because they have been socialized not to do so. These individuals may use self-injury to show others how they're feeling rather than telling them.

  7. Induce a “positive feeling state.” More recent studies show that pain-offset relief can stimulate a positive effect versus a negative one.

Symptoms of Self-Harm

While many people keep their self injurious behavior a secret from friends and loved ones, if you suspect your friend is harming themselves there are some warning signs to look for:

  1. Scars

  2. Fresh cuts, burns, scratches, or bruises

  3. Rubbing an area excessively to create a burn

  4. Having sharp objects on hand

  5. Wearing long sleeves or long pants, even in hot weather

  6. Difficulties with interpersonal relationships

  7. Persistent questions about personal identity

  8. Behavioral and emotional instability, impulsiveness, or unpredictability

  9. Saying that they feel helpless, hopeless, or worthless

These symptoms are adapted from the Mayo Clinic.

Non-Suicidal Self-Injury Diagnosis

According to the DSM-5, the diagnostic criteria for Non-Suicidal Self-Injury include:

  • Intentional self-mutilation to the body “with the expectation of physical harm, but without suicidal intent” for 5 or more days in the past year.

  • Self-injuries motivated by relief from negative thoughts, as a means of resolving a conflict, or to evoke positive feelings.

  • Harmful behavior preceded by interpersonal difficulty or negative feelings and thoughts (including depression or anxiety); a preoccupation with self injury; frequent urges to harm oneself.

  • Behavior itself that is “not accepted by society” (acceptable behavior would include tattooing, nail biting, occasional scab picking and body piercing).

  • The harmful behavior distresses the person and cannot be explained by another mental or medical condition.

A mental health professional can help with both diagnosing and developing a treatment plan for NSSI.

Risks and Side Effects of Self-Injury

Self injuring has a number of physical, emotional, and social effects.

Physical Effects of Self-Harm

  • Permanent scars

  • Uncontrolled bleeding

  • Infection

Emotional Effects of Self-Harm

  • Guilt or shame

  • Diminished sense of self, including feeling helpless or worthless

  • Addiction to the behavior

Social Effects of Self-Harm

  • Avoiding friends and loved ones

  • Becoming ostracized from loved ones who may not understand

  • Interpersonal difficulty from lying to others about injuries

The risk of accidental death by self-injury is very real, and varies based on the method.

Alternatives to Self-Harm

In the short-term, it’s important to have a few alternative actions to take when you feel the need to self-mutilate. We’ll look at long-term treatment and recovery below, but if you need to get to a cool calm in the moment, consider The Three Ds: Delay, Distract, Divert (adapted from SANE Australia).

  1. Delay: Find someone to talk to before you act — call a friend, talk to a teacher, or text your therapist. You can always text HELP to 741741 to talk to a trained Crisis Counselor with Crisis Text Line.

  2. Distract: Find another activity to capture your attention. Physical activity, like going for a walk, doing some jumping jacks, or playing an active game, will give you a healthy dose of endorphins and adrenaline.

  3. Divert: Find an activity that will give you the same physical sensation as self-injury, but in a safer environment. Taking a boxing class, punching a pillow, or drawing on your arm are all safe alternatives.

Treatment and Recovery: How Do You Stop Self-Harming?

It's normal to want to quit self-harming, but feel unable to. Even knowing the risks, many struggle to break themselves away from the cycle. But it is possible. Here are some of the key steps:

  • Name your reason for hurting yourself, and your reason for quitting. Ask yourself: "What do I feel before, during, and after self-injury? Which of those emotions do I actively seek out, and which are harmful?"

  • Identify other ways of achieving the same result. For example, if you self-harm for the physical sensation, seek other ways of releasing endorphins, like exercise. If you self-harm to express your emotions, practice expressing them in words by writing them down.

  • Tackle the underlying emotions. Explore the feelings that lead you to want to hurt yourself. If it's guilt, where is that guilt coming from?

  • Tell someone you trust. Let a friend, family member, or trusted adult know what you're going through and that you need their support.

  • Text Crisis Text Line. We're here to listen, never to judge. Text Crisis Text Line at 741741 in the US or 686868 in Canada.

How to Help a Friend who Self Harms

  • Encourage them to find help. Be supportive in your loved one’s work towards mental health while recognizing that you should not be their therapist.

  • Suggest versus direct. Help your friend find options versus telling them what they should do.

  • Ask for help for yourself. If you believe your friend is in immediate danger, call 911. If the danger is less immediate, you can also text Crisis Text Line at 741741 in the US or 686868 in Canada.

Calm Harm For: Teens | App | Service | Timed activities to help resist or manage self-harm urges with ability to log completed activities and tracks progress.
Cornell Research Program on Self-Injury and RecoveryFor: All Ages | PDF | Informative | Lists numerous distraction techniques and alternative coping skills for dealing with self-harm.
Help Guide on Cutting and Self-HarmFor: All Ages | PDF | Informative | Provides information on cutting and self-harm, including identifying triggers, finding new coping techniques, and how to support a loved one who cuts or self-harms.
To Write Love on Her ArmsFor: All Ages | Website | Support | Finds help for people struggling with depression, addiction, self-injury and suicidal thoughts..
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