Self-Harm: Signs, Causes, & Finding Help

What Is Self-Harm?

Self-harm is any purposeful self-injurious act not motivated by suicidal intentions. Most people who self-harm engage in cutting, burning, or inflicting wounds. However, many different behaviors can reflect self-harm, such as restricting food, exercising too much, pulling hair, or even picking scabs.^1,3,4

Researchers have long debated the definition of self-harm, with some arguing risky or impulsive behaviors (i.e., substance use, risky sexual behaviors, or self-sabotaging) should also be considered self-injurious.^3,4 These acts are certainly harmful but self-harm most commonly describes more direct and immediate harm to one’s body.^1,5

People may refer to self-harm as self-injury (SI), self-inflicted violence (SIV), self-injurious behaviors (SIB), and nonsuicidal self-injury (NSSI). Difficult emotions from frustrating or stressful external situations can trigger self-harm as a coping mechanism.^1,4

How Self-Harm Affects the Brain

Self-harming or self-mutilating affects the brain similarly to substances. When people engage in self-harm, the brain releases neurochemicals that serve a purpose for the body–endorphins have a numbing effect, serotonin brings a calming sensation, and dopamine provokes a feeling of pleasure. Because of this, cutting yourself may help you feel better temporarily and cope with emotions, even though self-harm behavior is dysfunctional and unhealthy.⁶

Types of Self-Harm

Specific types of self-harm pose a lower or higher risk for physical injury than others. Researchers often classify self-injurious behavior based on the motivation, degree of harm caused, and social acceptability.^1,3 For instance, getting a tattoo or piercing your ears would not be considered because they involve motivations besides coping or causing intentional self-harm.

Examples of self-harm may include:^1,3,4

• Skin picking, scratching, nail-biting, hair-pulling, or not allowing wounds to heal
• Itching or rubbing skin excessively to the point of creating wounds
• Cutting, biting, or burning the skin to create superficial or deep wounds
• Hitting or punching areas of the body
• Restricting food, excessive exercise, or over-exerting oneself
• Ingesting, inserting, inhaling, or swallowing a dangerous object or substance
• Severing parts of the body or performing self-surgery
• Constricting an area of the body, strangling oneself, or restricting blood flow
• Breaking bones

Symptoms & Signs of Self-Harm

Cutting is the most common form of self-harm.¹ Some people cut their wrists, while others cut themselves in places that are easier to hide, like their upper legs, stomach, or feet. Seeing several linear cuts or scars on a person is often a clear sign of self-harm.

Some forms of self-inflicted wounds have fewer physical signs and indicators. Often, the symptoms of self-harm are more psychological and behavioral. For example, someone may isolate themself, lose enjoyment in activities or hobbies, or appear uncharacteristically sad.⁴

Symptoms and signs of self-harm may include:⁴

• Wearing long pants and sleeves even when it is hot outside
• Having unexplained bites, cuts, bruises, scabs, or scars
• Being secretive or evasive when asked about a scar or wound
• Having a lot of knives, razors, or other sharp objects around
• Having bald spots or missing patches of hair
• Frequent reports of accidents and injuries
• Burning or cutting scars

Why Do People Self-Harm?

The reasons for self-harm vary depending on the person, but research indicates a lack of emotional, behavioral, or impulse control behavior is a common cause.^1,2,5,7 Frustrating situations or events can be initial triggers, causing the person to experience intense distress. Strong emotions can create destructive impulses, and acting on these urges can provide a temporary sense of relief or release.^1,2,4

Possible risk factors and causes of self-harm include:^1,7

• Coping with distress or calming themselves down when upset
• Seeking help or attention from another person
• Self-punishment
• Stop dissociation, feeling “numb,” or “feeling nothing”
• Preventing or reducing urges to commit suicide
• Cleansing or purifying the body
• Distraction from emotional pain with physical pain
• Releasing or expressing emotional pain
• Expressing anger toward others, themselves, or a situation
• Pressures at home, school, or work
• Financial stress
• Coping with the loss of a relationship
• Coping with racism, homophobia, or related biases
• Coping with trauma
• Gain a sense of control

What Causes Self-Harm Behavior?

Most people who self-harm have another mental health condition. Personality disorders (especially borderline personality disorder), eating disorders, mood disorders, and impulse control disorders are most common in connection with self-harm.^1,2,3

Those who struggle to regulate their emotions or control impulses are also more likely to engage in self-injuring behavior.^1,2,3,4 Cutting or injuring themselves offers temporary relief from emotional pain but does not address the root issues. Over time, self-harming can become more serious and dangerous, even increasing the likelihood of suicide.^{4, 7}

Risk factors associated with self-harm include:^1,2,3,4,7,8

• Histories of childhood trauma or abuse
• Histories of psychiatric hospitalizations
• Having friends who self-harm (for kids and teens)
• Histories of self-mutilation or self-injury
• High stress and low support
• Poor coping skills
• Avoidance coping
• Attention-deficit/hyperactivity disorder (ADHD)
• Autism
• Substance use
• Low self-esteem
• Eating disorders
• Mood disorders
• Personality disorders
• Anxiety disorders
• Bullying
• Post-traumatic stress disorder (PTSD)
• Gender dysphoria

Possible Side Effects of Self-Harm Behaviors

The long-term outcomes of severe self-harm can be grave. While many of these effects depend on the method someone uses to self-wound, the consequences can be far-reaching, extending to every aspect of their life.

Possible complications of self-harm include:^9,10,11

• Suicide risk: Self-cutting and other self-injurious behaviors do not necessarily involve suicidal intention. However, the risk of attempting or completing suicide can be significantly higher for those who self-harm.
• Declining mental health: Self-harm often occurs alongside numerous mental conditions like borderline personality disorder, depression, and anxiety. Thus, failing to address these concerns can worsen symptoms and lead to a psychological decline.⁴
• Low self-esteem: Low self-esteem and non-suicidal self-harm often have a bidirectional relationship. People with poor self-appraisal are at risk for self-harming behaviors, while those who habitually self-injure feel guilt and shame that further diminishes their self-esteem.
• Relationship problems: Individuals who self-harm tend to isolate from friends and family. Self-harmers fear being judged by others and become withdrawn, ultimately impacting relationships and interactions with those closest to them.
• Physical implications, conditions, and permanent scars: Habitual non-suicidal self-injury can eventually result in infections, permanent or severe scarring, and nerve damage.
• More severe injuries: Self-harm can become a way of coping and regulating emotions. Over time, this maladaptive pattern worsens and becomes more frequent, thus leading to grave injuries and medical complications.

Treatments for Self-Harm

Self-harm is usually related to an underlying mental health condition. Most people who cut, burn, or injure themselves struggle with mood, personality, eating, or impulse control disorders.¹ Seeking treatment for the underlying condition allows individuals to address the root causes of self-harm. Therapy, sometimes alongside medication, can greatly improve symptoms.

Therapy for Self-Harm

Therapy is considered a frontline treatment for most mental health conditions, including self-injurious behavior. Several options are available, but some may work better depending on your needs and preferences.

Consider seeking professional support if you struggle with inflicting self-harm or thoughts of hurting yourself. A therapist can help you uncover the reasons behind your behavior and develop positive coping strategies to support overall well-being.

Below are some of the more commonly used types of therapy for people who self-harm:⁴

• Cognitive behavioral therapy (CBT): CBT is an evidence-based treatment for many common mental health issues. In CBT therapy sessions, people learn how their thoughts, feelings, and behaviors relate. People who self-harm can develop impulse control skills or better ways of coping with feelings or urges to self-harm.
• Dialectical behavioral therapy (DBT): People in DBT learn a wide range of skills to help them regulate their emotions, improve distress tolerance, and communicate their feelings and needs more effectively. These skills can directly reduce the risk of self-harm by refocusing attention away from distressing thoughts, feelings, and urges.
• Family therapy: Family therapy involves a person and one or more family members having joint sessions with a therapist. Because many people who self-harm are younger, family involvement can help address core issues contributing to self-injurious behavior.

Medication for Self-Harm

The FDA has not approved specific medications for self-harm, but many people may benefit from medication for underlying mental health conditions like anxiety or depression (i.e., SSRIs).⁴ Medication should always be taken as prescribed by a licensed medical provider and combined with therapy for best results.

Can Self-Harm Be Prevented?

Preventing someone from self-harming is difficult, but specific strategies can help mitigate the urge and enable the person to cope when difficult feelings arise. Support is crucial in combating self-harm behavior so the person can take the necessary steps to prevent their self-injurious patterns.

Below are ways to help prevent self-injurious behavior:

• Encourage therapy: Self-harming is a serious issue that warrants professional attention to reduce urges and foster healthier coping skills. As such, encourage therapy to explore underlying triggers and ways to work through unpleasant emotions in a safe and non-judgmental setting.
• Educate yourself about self-harm: Many people misunderstand cutting and self-harm. Thus, educating yourself on the topic is crucial. Learning about its underlying emotional and mental health components can help you approach the situation with wisdom and empathy.
• Offer support and help: Feeling mixed emotions is normal if someone close to you self-harms. However, you can still voice your concerns while validating their emotions and letting them know you will support them when they need you.
• Explore the impacts of social media: Social media can be detrimental, particularly among youth. Help your loved one explore possible triggers online that may encourage self-injuring behaviors.
• Don’t blame them for their behavior: Recognize that many people who intentionally hurt themselves seek emotional relief. Do not blame them for not finding ways to manage their distress. Simply offer support and model healthier alternatives.
• Don’t panic: Knowing someone you care about is self-injuring can be heart-wrenching and make you feel confused or frustrated. Try not to panic when uncertain about what to do–sometimes being there for them is sufficient.
• Remain empathetic and patient: Seeing a loved one harm themselves is hard. Do not lose sight of what underlies this behavior–emotional dysregulation, poor coping skills, a call for help, etc. Doing so can help you remain compassionate and patient.
• Ask them how you can help: Your loved one likely has difficulty expressing their emotions. As such, ask how you can help to provide the right support.
• Remind them of their positive qualities: People who self-harm often have low self-esteem that is further affected by the shame of their actions. Reminding them of their strengths and qualities can provide them with some perspective.

How to Get Help for a Child or Teen

Loved ones should seek treatment for a child or teen who self-harms. Many kids benefit from therapy, sometimes in addition to medication. Having their parent or caregiver actively involved in their treatment is proven to improve treatment success, so parents should be willing to attend sessions and support the work their child is doing in therapy.

When & How to Get Emergency Treatment for Self-Harm

Serious self-harm can result in injury and, in some cases, even death. If a person has injured themselves to the point of becoming unconscious, has lost a lot of blood, or you’re concerned for their safety, the best course of action is to call 9-1-1 or take them to an emergency room.

Even when there isn’t a medical emergency related to self-mutilation or injury, a person may need emergency psychiatric care. If a person makes suicidal threats or you have reasons to believe they are at risk of suicide, it may be necessary to get them emergency help.

Calling 9-1-1 to ask for a CIT officer or a “welfare check” may be the right course of action. Calling 2-1-1 is also a way to get direct contact with health and human services in many states and is an option for people needing immediate mental health assistance.

Also, people who believe someone is a danger to themselves or others can file an involuntary commitment order with their local magistrate. This order enables the police to transport the person (even against their will) to a local psychiatric facility for evaluation.

Once evaluated, they may be held for a certain time if deemed a danger to themselves or others. This action should only be taken as a last resort when you have concrete reasons to believe someone is unsafe. It is always best for a person to get treatment voluntarily when possible.