What Is Self-Harm and Why Is It Done?

Factors Contributing to Self-Harm

Self-harm isn’t usually the first way people try to manage strong emotions and cope with pain. People may even seek treatment but ultimately not get the relief they need. And since self-harm can offer momentary relief or distraction, stopping may sound pointless and daunting—why quit something that works? Fear can then contribute to repeated self-harm: fear of giving up potentially the only coping tool you have.

Treating underlying conditions, beginning treatment as soon as possible, and catching the signs early can prevent self-harm and the fear of letting it go. 

Emotional Distress and Mental Health Disorders

Conditions like depression, anxiety, trauma, and borderline personality disorder can contribute to and cause self-harm as a symptom. Here’s why:

• Depression causes low mood and apathy⁴, which can lead to self-harm as a solution to intense emotional pain and numbness. 
• Anxiety also causes intense emotional pain, plus a sense of being out of control⁵. Someone with anxiety may self-harm as a way to regain control and mute emotions with physical pain.
• Trauma can cause flashbacks, emotional pain, and numbness. Post-traumatic stress disorder (PTSD) can lead to self-harm⁶ as a way to cope with symptoms, break out of numbness, and stop flashbacks (since self-harm serves as a distraction).
• Borderline personality disorder (BPD) can cause highly irregulated and intense emotions, along with dissociation. Someone with BPD may self-harm to reduce dissociation⁷ and control intense emotions like rage, grief, and even suicidality.

Pre-existing mental health conditions can largely contribute to and cause self-harm, but so can your environment, the people around you, and the media you take in.

Environmental and Social Influences

Bullying, family dynamics, and peer pressure can lead to self-harm. Media may also create curiosity around self-harm, which could lead to experimentation, and then a habit that becomes hard to break. Some TV shows and movies geared toward teens vividly show (and often romanticize) self-harm. This can prompt teens to replicate the behavior or see it as the only way to deal with negative emotions. 

Similarly, and especially for teens in middle or high school, being in a peer environment where self-harm is normalized and romanticized can lead to experimentation. Teens may self-harm to fit in, to relate to their friends, or to gain sympathy from classmates (which is often a genuine cry for help). Bullying can cause self-harm as a way to cope with emotional pain and as a form of self-punishment.

Signs and Symptoms of Self-Harm

If you’re worried about a loved one or a friend self-harming, you can keep a few warning signs in mind as you note their physical and emotional changes. If you do notice any signs, try to keep your questions gentle and centered on concern. Make sure your emotional state invites vulnerability. Though distressing, self-harm and the causes behind it are treatable.

Warning Signs of Self-Harm

If you’re a parent, a teacher, a sibling, or a concerned friend, you can keep a lookout for the following signs of self-harm in someone you care about.

1. Suddenly spending time alone, usually in a shut or locked room. This could be their bedroom, bathroom, or another area of your house. 
2. Unexplained injuries, cuts, or burns.
3. Taking or hoarding first-aid supplies. 
4. Finding blood on their clothes, sheets, and used first-aid supplies (like gauze or bandages).
5. Wearing full-coverage clothes and seeming particular about not revealing their arms, legs, stomach, or other areas they’re normally okay with showing. This may be especially noticeable in the summertime (like wearing a hoodie in hot weather). 
6. Items like razor blades, knives, lighters, or other self-harm tools going missing in your home. You may find them tucked away into a hiding place in their room or bathroom. School lockers can also hide supplies.
7. Behavioral changes like seeming down, tearful, and hopeless.
8. Acting withdrawn and unfocused in social and family situations.
9. Flinching or seeming in pain when certain parts of their body are bumped or touched. 

Starting The Conversation and Next Steps

Remember: noticing these signs may mean your loved one needs help, but with that help, they’ll learn to heal. Keep that in mind as you bring your concerns to light. You can start with gentle questions about their behaviors and items you may have noticed go missing, like self-harm tools and first-aid supplies. You may ask something like,

“I’ve noticed you seem very down and that you spend a lot of time in your room. I’ve also found band-aid wrappers hidden in the trash. You aren’t in trouble if you say yes, but I want to know if you are hurting yourself.”

If your loved one answers yes, they have been hurting themselves, you may need to see the wounds to make sure they don’t need medical attention. If they’re unwilling to show you but agree they need treatment, you can offer to take them to urgent care or the emergency room. 

If they don’t need immediate medical treatment, you can discuss getting help in other ways. Acknowledge and validate their pain, avoid judgment, and encourage them with the vast array of treatments available to people who self-harm (like therapy, peer support groups, virtual care, outpatient care, and even residential rehabs). When they’re ready, you can help them take the first steps into treatment.

Depending on your relationship, you may be able to control their environment in the meantime. If you’re the parent of a child who self-harms, for example, you may gather and hide all your knives, razors, lighters, and other self-harming tools as a preventive measure. You can also set rules about alone time (like limiting it to an hour a day, keeping their door open, or requiring frequent check-ins) to keep a closer eye on them and their behaviors. 

In some cases, alone time may not be safe in any sense. Consider going to the emergency room to get admitted to a psychiatric hospital, where your loved one receives continuous monitoring in a safe environment. 

Support and Treatment Options

Many forms of treatment and therapy can help you or your loved one heal from self-harm and its underlying causes. 

Professional Help and Therapies

Behavioral therapies address the unhealthy or inaccurate thoughts and emotions leading to behaviors like self-harm. Examples include:

• Cognitive behavioral therapy (CBT), which addresses and challenges the emotions causing self-harm, like anger, shame, and grief. Using CBT, a therapist will help their patient determine the validity of their thoughts, prevent spiraling, and reshape their thought patterns. 
• Dialectical behavioral therapy (DBT) helps manage intense emotions and teaches tools for coping and resilience. Rather than challenging or changing thoughts, DBT helps patients accept the thought and manage how they respond to it. For example, someone experiencing intense emotions may respond with a coping tool they learned in therapy, not with self-harm.
• Problem-Solving Therapy⁸ uses skill and attitude training to see problems as solvable, promote rationalization, and reduce impulsivity. This therapy can be especially helpful for adolescents with depression, suicidality, and self-harming behaviors.

Self-Care Strategies and Coping Mechanisms

Alongside professional help, you can also practice self-care strategies and at-home coping mechanisms for self-harm. Here are a few of those strategies and practices you can try:

• The ice-cube method: Hold an ice cube in your hand (or your mouth) when emotions become intense and overwhelming. The cold ice cube serves as a neurological distraction⁹ and can give you mental clarity. Relief and clearer thinking can then prevent self-harm.
• Exercise: Fitness can serve as a distraction⁸ and an action. Let out emotions through weight-lifting, boxing, running, or taking a walk. 
• Drawing/doodling: Making shapes, lines, or drawings can release emotions and give a sense of accomplishment. You can make angry slashes with your pen over the page, slowly color in shapes, or draw lines over and over. You can even add words and combine journaling with doodling.
• Busy your hands: Whether you have to sit on them, play with a fidget toy, or simply run them over textured fabric, keeping your hands busy can help distract you until the urge to self-harm fades.
• Tear something apart: Rip up paper, food, or something you’re okay with tearing. This serves as a distraction and an emotional outlet, which can prevent self-harm by satiating the need to do so.
• Tell someone: Let a trusted friend or family member know when you feel the urge to self-harm. They can keep you company (even virtually) and keep you accountable by checking in. You don’t even have to specifically mention self-harm, just let them know you need support.
• Remove yourself from your environment: Physically step away from your current environment and the potential self-harm tools within it. Ideally, you could go on a walk to get outside and separate from your home or other living environment. If you can’t, move to another room or seek company with a family member.
• Make your environment as safe as you can: As you feel able, remove, destroy, or throw away self-harm tools. Give your stash to someone to get rid of. Tell a trusted family member to hide or lock up other self-harm tools in your home. These could include knives, shaving razors, and other sharp tools.
• Be kind to yourself: The recovery journey for self-harm isn’t a straight line. You may go one, two, even 10+ days (or months) without self-harming, but end up doing it again. That’s okay. Don’t see it as failing, rather as a bump in your road to recovery—and you’re still on the road. Remind yourself of that often.

Self-care strategies can reduce your overall stress and promote wellness day-to-day. Here are a few techniques you can try:

1. Set aside time to relax and do something you enjoy. Schedule yourself an hour each night (or however long you can) to read, meditate, craft, or call a friend.
2. Stay hydrated and incorporate more whole foods into your diet to fuel and nourish your body.
3. Get outside to soak in sunlight and Vitamin D—try walking through your neighborhood, taking your dog to a park, or sitting on your balcony.
4. Prioritize good sleep. Follow a nighttime routine and try to wake up at the same time each morning to even out your sleep cycle.
5. Move your body through exercise, yoga, playing with a pet, or taking walks. You could also take up new sports or hobbies like hiking, swimming, and rollerblading.

Prevention and Building Resilience

Changing the narrative around self-harm and offering education can prevent teens and adults from using it as a coping tool. To combat the glamorization of self-harm, schools, peers, and teachers can instead educate vulnerable teens on the realities of self-harm and what it means for their health. 

Knowing your treatment options can also serve as a prevention tool, as someone may not feel drawn to self-harm if other sources of relief are readily available (like therapy, support groups, or crisis services). The earlier schools and other organizations can make these resources available, the better.

Find Help and Hope

Understanding self-harm is the first step towards offering the necessary support and compassion to those in need. It’s about looking beyond the behavior and recognizing the underlying pain, offering a helping hand in their journey toward healing. Remember, with the right approach and resources, recovery is not just a possibility but a reality. 

If you or someone you know is struggling with self-harm, seek help from a professional to navigate the path to recovery together. You can also find rehabs with self-harm treatment by browsing Recovery.com.