Self-Harm and Non-Suicidal Self-Injury

If you or someone you know is struggling with self-harm or thoughts of suicide, contact the 988 Suicide & Crisis Lifeline by calling or texting 988, available 24/7. You do not have to face this alone.

What Is Self-Harm?

Self-harm, also called non-suicidal self-injury (NSSI), refers to the deliberate act of hurting yourself without the intent to die. Common forms include cutting, burning, hitting, scratching, or picking at skin, though it can take many other forms. NSSI is not a suicide attempt, but it is a serious signal that someone is experiencing emotional pain they do not know how to manage in other ways.

It is important to distinguish NSSI from suicidal behavior. While both involve self-inflicted harm, the underlying intent differs significantly. A person engaging in NSSI is typically trying to cope with overwhelming emotions, not trying to end their life. That said, NSSI does increase the risk of suicidal thoughts and behaviors over time, which is why early intervention matters.

Self-harm is more common than many people realize. Research published in the Journal of Abnormal Psychology estimates that approximately 17 percent of adolescents and 5 percent of adults have engaged in NSSI at some point in their lives. It occurs across all demographics — every age, gender, socioeconomic background, and culture — though it is most prevalent among adolescents and young adults.

Self-harm is not attention-seeking behavior. Most people who self-injure go to great lengths to hide it. Understanding this is essential to approaching the topic with compassion rather than judgment.

Signs and Symptoms

Self-harm can be difficult to detect because most people who engage in it are secretive about it. However, there are warning signs to watch for:

• Unexplained injuries: Frequent cuts, burns, bruises, or scars, often in patterns or on areas typically covered by clothing such as the forearms, thighs, or abdomen.
• Wearing concealing clothing: Insisting on long sleeves or pants even in warm weather to hide marks.
• Possession of sharp objects: Keeping razors, knives, or other implements that do not have an obvious everyday purpose.
• Behavioral withdrawal: Increased isolation, spending long periods alone, or withdrawing from friends and activities.
• Emotional instability: Expressions of hopelessness, worthlessness, or feeling out of control, often alongside difficulty managing emotions.
• Blood stains: Finding blood on clothing, towels, bedding, or tissues without a clear explanation.
• Making excuses for injuries: Attributing wounds to accidents or pets repeatedly.
• Difficulty with relationships: Interpersonal conflict, fear of abandonment, or trouble expressing emotions verbally.

If you notice these signs in someone you care about, approaching them with compassion and without judgment is critical. Expressing concern — rather than alarm or anger — creates a safer space for honest conversation.

Why Do People Self-Harm?

This is one of the most important questions to understand, and the answer challenges many common misconceptions. People do not self-harm because they want attention or because they are "crazy." NSSI serves real psychological functions, and understanding those functions is key to effective treatment.

Emotional Regulation

The most commonly reported reason for self-harm is to manage overwhelming emotions. When someone experiences intense feelings — grief, rage, shame, anxiety, numbness, or emotional pain — and lacks the skills to process them, physical pain can provide temporary relief. Research shows that self-injury triggers the release of endorphins, the body's natural painkillers, which can create a brief sense of calm or emotional release.

Feeling Something When Numb

Some people who self-harm describe a pervasive emotional numbness or dissociation. Physical pain can serve as a way to "feel real" or reconnect with their own body and emotions. This is particularly common among individuals with a history of trauma.

Self-Punishment

Many people who self-harm carry deep feelings of shame, guilt, or self-loathing. Self-injury becomes a way to punish themselves for perceived failures or flaws. This is often linked to childhood experiences of criticism, neglect, or abuse.

Communication of Distress

When someone feels unable to express their pain in words — whether because they lack the vocabulary, fear being dismissed, or have learned that their emotions are not welcome — self-harm can become a way to externalize internal suffering. This is not the same as attention-seeking; it is a desperate attempt to make invisible pain visible.

Control

In situations where someone feels powerless — whether due to an abusive environment, life circumstances, or their own emotional chaos — self-harm can provide a sense of control. It is something they choose to do, on their own terms.

What Causes Self-Harm?

There is no single cause of self-harm. It typically results from a combination of risk factors:

• Mental health conditions: Depression, anxiety disorders, PTSD, borderline personality disorder, eating disorders, and substance use disorders are all associated with higher rates of NSSI.
• Trauma and adverse childhood experiences: Physical, emotional, or sexual abuse, neglect, bullying, and household dysfunction significantly increase the risk.
• Emotional dysregulation: Difficulty identifying, understanding, and managing emotions — sometimes called low distress tolerance — is one of the strongest predictors of self-harm.
• Social factors: Peer self-harm, social isolation, family conflict, and exposure to self-harm content online can contribute.
• Invalidating environments: Growing up in an environment where emotions are dismissed, minimized, or punished can leave a person without healthy coping strategies.
• Neurobiological factors: Some research suggests that differences in how the brain processes emotional pain and physical pain may play a role in vulnerability to NSSI.
• Perfectionism and self-criticism: Holding impossibly high standards and responding to perceived failure with harsh self-judgment can drive self-punitive behavior.

It is worth noting that self-harm can become habitual. Over time, the brain associates self-injury with relief, making it an increasingly automatic response to distress. This is why early intervention and learning alternative coping skills are so important.

Evidence-Based Treatments

Recovery from self-harm is absolutely possible. Several therapeutic approaches have strong evidence supporting their effectiveness.

Dialectical Behavior Therapy (DBT)

DBT is widely considered the gold standard treatment for self-harm. Originally developed by Marsha Linehan for borderline personality disorder, DBT directly targets the emotional dysregulation and distress intolerance that drive self-injury. The treatment consists of four core skill modules:

• Mindfulness: Learning to observe and describe emotions without reacting to them impulsively.
• Distress Tolerance: Building skills to survive crisis moments without resorting to self-harm — techniques like holding ice, intense exercise, or the TIPP skill (Temperature, Intense exercise, Paced breathing, Progressive relaxation).
• Emotion Regulation: Understanding and managing emotions more effectively, reducing vulnerability to intense emotional states.
• Interpersonal Effectiveness: Communicating needs and setting boundaries in relationships.

Multiple randomized controlled trials have demonstrated that DBT significantly reduces self-harm frequency. A landmark study in the American Journal of Psychiatry found that DBT reduced self-harm episodes by approximately 50 percent compared to treatment as usual. If in-person DBT is not accessible, online DBT therapy is also an effective option.

Cognitive Behavioral Therapy (CBT)

CBT helps people identify and challenge the thought patterns that contribute to self-harm — beliefs like "I deserve to be hurt" or "This is the only way to cope." By restructuring these thoughts and developing alternative behavioral responses, CBT can break the cycle of self-injury. CBT also incorporates behavioral strategies such as developing a personalized list of alternative coping activities.

Safety Planning

A safety plan is a structured, written document created collaboratively between a therapist and client. It outlines warning signs that a self-harm urge is building, coping strategies to try, people to contact for support, and ways to make the environment safer (such as removing access to implements). Safety planning is not a standalone treatment, but it is an essential component of care.

EMDR (Eye Movement Desensitization and Reprocessing)

When self-harm is rooted in trauma, EMDR can be highly effective at processing traumatic memories that fuel emotional pain. By addressing the underlying trauma, the need for self-harm as a coping mechanism often diminishes.

Medication

There is no medication specifically approved for NSSI. However, medications that treat co-occurring conditions — such as SSRIs for depression or anxiety, or mood stabilizers for emotional volatility — can reduce the emotional intensity that drives self-harm.

Mentalization-Based Treatment (MBT)

MBT focuses on improving the ability to understand your own mental states and those of others. Research shows that MBT can reduce self-harm, particularly in people with borderline personality disorder, by helping them make sense of their emotions before acting on them.

Why Do People Cut Themselves?

Cutting is the most commonly reported form of NSSI, particularly among adolescents. People often ask this question with genuine confusion — the idea of deliberately causing yourself physical pain seems counterintuitive. But for someone in extreme emotional distress, cutting can feel like the only option available.

The reasons mirror those described above: managing overwhelming emotions, breaking through numbness, punishing oneself, or regaining a sense of control. The physical sensation of cutting often provides an immediate, concrete focal point that temporarily displaces emotional suffering. Some people describe it as "letting the pressure out."

Understanding this does not mean accepting it as a healthy strategy. It means recognizing that the person is in pain and needs support, not shame. Shame only reinforces the cycle.

The Path to Recovery

Recovery from self-harm is not about willpower or simply deciding to stop. It is a process of learning new ways to manage emotions and gradually building a life where self-harm is no longer needed. Key elements of recovery include:

• Building a therapeutic relationship: Working with a therapist who understands NSSI and approaches it without judgment is foundational.
• Learning alternative coping skills: Replacing self-harm with strategies like journaling, intense physical exercise, holding ice cubes, drawing on the skin with a red marker, calling a trusted friend, or practicing breathwork.
• Addressing underlying issues: Treating co-occurring depression, anxiety, trauma, or other conditions that contribute to the urge to self-harm.
• Reducing access: Making the environment safer by removing or restricting access to implements used for self-harm.
• Developing emotional vocabulary: Learning to name and express emotions verbally, which reduces the need to express them physically.
• Building a support network: Connecting with people who are trustworthy, nonjudgmental, and willing to help during difficult moments.

Relapses can happen, and they do not mean failure. Recovery is rarely linear. What matters is returning to the skills and support systems that help, and continuing to move forward.

When to Seek Help

Seek professional support if you or someone you know:

• Is engaging in any form of self-harm, even if it seems minor
• Has urges to self-harm that are becoming more frequent or intense
• Is using self-harm as a primary way to cope with emotions
• Has injuries that require medical attention
• Is expressing feelings of hopelessness, worthlessness, or suicidal thoughts
• Has co-occurring symptoms of depression, anxiety, trauma, or an eating disorder

You do not need to be in crisis to reach out. A therapist who specializes in NSSI, particularly one trained in DBT, can help you develop healthier coping strategies before the situation escalates. If outpatient care is not providing enough support, learn about the signs you may need a higher level of care. For teens specifically, residential treatment programs can provide a structured, supportive environment.

If you are in immediate danger, call 911 or go to your nearest emergency room. You can also contact the 988 Suicide & Crisis Lifeline by calling or texting 988 at any time.

Frequently Asked Questions