Upwards of 13-17% of teenagers and young adults engage in self-harming behaviors each year in the United States alone (Cornell 2023). This means that urges to self-harm are more common than we realize. Self-harm refers to intentional actions and behaviors that injure or harm the body. Self-harm can range from cutting, pricking, burning the skin, or even ingesting harmful substances. Non-suicidal self-injury (NSSI) can be an expression or release of deep and painful emotions.
Many individuals can overcome self-harm with support. Learning to recognize signs of distress and understanding some common myths is important in helping us respond with compassion rather than fear.
Signs of self-harm can show up in several ways. Unexplained injuries, often on the arms and thighs, and wearing long sleeves or extra clothing in hot weather can be some important clues. Less obvious, there may also be withdrawing socially, verbal expressions of self-rage, or constant blaming themselves and other signs of low self-esteem. Changes in weight or other signs of depression can also be warning signs for self-harm.
Risk factors include a history of trauma, neglect or abuse. The overwhelming emotions coming from hurtful traumas can lead to unhealthy coping such as self-harm. While not everyone who self-harms has trauma, there is usually “more to the story”.
MYTH: It’s for attention. While self-harm can definitely be a cry for help, many times it is hidden and a source of shame for the person. Recognizing harm as a physical manifestation of emotional pain, we can respond with compassion and concern. Accusing someone of attention-seeking may cause them to further hide their self-harm, which makes healing even harder.
MYTH: They want to die. Unfortunately, self-harm can often go too far and result in serious injury of death. Other times a person’s pain will lead them to make desperate decisions such as suicide. However, self-harm can exist as a painful expression of life rather than of death. Part of the person may be fighting very hard to live, in spite of how it looks from the outside.
MYTH: They need to promise to stop. Unfortunately, asking someone to just quit self-harm may be an impossibility. We might feel better or that we are keeping them safe, but ultimately the root of the problem—working through the deep emotion and finding new coping—can be a much longer and more complicated journey. There may even be elements of addiction to the self-harm which releases high levels of endorphins that act as a drug to the person engaging in self-harm.
Helpful responses include checking in and asking someone how they are doing, and really listening. This can mean holding our own fears and emotions in check, really going back to the basics of listening. The first step to usually comes with a trusted friend or adult. Encouraging a person that they are not alone and therapists and doctors can help builds and important bridge. A person may have given up on feeling better or have no idea where to start. The National Crisis Text Line or hotline 988 are available 24/7 for individuals who need to reach out. Ongoing support with a psychiatrist and counselor may be additional support.
Sources include the National Alliance on Mental Illness (2023) and the American Psychological Association (2023).
