Self-Harm

Self-harm means hurting yourself on purpose, and often there is no wish to die behind it. Clinicians call that non-suicidal self-injury.

In some countries the word is used more broadly. It then covers overdoses, and acts where the wish to die is unclear. If that is closer to your situation, the crisis resources below apply to you. So does the suicide prevention page.

An overdose needs urgent medical assessment even if you feel physically fine. Contact emergency services. People also use the word for persistent self-punishing or self-critical patterns, without physical injury. The same principle applies: understanding what the pattern does for you.

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What self-harm is, and what it is not

Non-suicidal self-injury means deliberate damage to the surface of the body, done without suicidal intent, where the person expects only minor or moderate physical harm. That definition comes from the DSM-5-TR, the manual clinicians use to describe and classify mental health conditions.¹

The absence of suicidal intent is what defines it; a person who self-harms is not, in that moment, trying to die. If you are not sure what you wanted then, that uncertainty is itself a reason to talk to someone.

Self-harm and suicide are still connected.

Self-harm is also not an official diagnosis. The DSM-5-TR lists Nonsuicidal Self-Injury Disorder under conditions for further study, where it appears as proposed criteria and not as an established diagnosis. The proposed threshold is self-injury on 5 or more days in the last year.¹

Nobody needs to meet that threshold before asking for help, and you do not have to wait for a formal label.

Self-harm is usually private and often hidden, which does not fit the common charge that self-harm is attention-seeking. Clinicians more often see the opposite: shame about the marks, and effort to conceal them.

Why people self-harm: what it does for the person

The DSM-5-TR lists what people usually expect from the act: relief from a negative feeling or thought, an end to a conflict with someone close, or a positive feeling. The relief tends to come during or shortly after the injury, and over time the pattern can come to look like dependence.¹

The manual also describes what tends to come first in the period just before the act:

• depression or anxiety
• tension or anger
• generalised distress
• self-criticism

Many people are also preoccupied with the act beforehand and find that hard to control.¹ The act is not random but follows a build-up, and that build-up is what help can work on.

Gunderson and Hoffman describe the immediate relief some people feel after self-injury; pressure eases, and emotional balance returns. In people with borderline personality disorder, they found, the trigger is almost always a real or perceived loss of a relationship: a separation, or an abandonment.²

Most people who self-harm do not have borderline personality disorder. This is one well-described group among several.

Why the relief happens is not settled, and the same authors say so plainly. Some people report stopping when they begin to feel pain, while others stop at the first sight of the injury.

One suggested explanation is psychological (relief of guilt through self-punishment) and another is physical. Self-injury may trigger the body's own pain-relieving chemicals, and one study found altered levels of these natural opioids in people who self-injure.²

That relief is real, which is why telling someone to just stop rarely works, and why help starts instead with understanding what the self-harm does for the person.

Self-harm and trauma

Self-harm and trauma often go together, but not always. The DSM-5-TR lists the conditions that often occur alongside non-suicidal self-injury:¹

• post-traumatic stress disorder
• substance use disorders, especially involving alcohol
• borderline personality disorder
• eating disorders
• adjustment disorders

In post-traumatic stress disorder, it notes self-injury occurring in connection with flashbacks.¹ So self-harm can be part of coping with the after-effects of trauma, though it does not prove trauma happened. Many people with a trauma history never self-harm.

If you are trying to make sense of your own self-harm, trauma is one common factor among several rather than the single cause.

Does self-harm mean someone is suicidal?

Usually not in that moment: the intent is not to die, but self-harm does raise the risk of suicide over time. The absence of a wish to die is what makes it non-suicidal, but intent is not the whole of the risk.¹

The risk is highest for people who reach hospital after self-harm. NICE, the UK's health-guidance body, puts the increase in suicide risk in the year after a hospital presentation at 30- to 50-fold.⁵ Most people who self-harm are never admitted to hospital for it; the figure belongs to that highest-risk group.

Escalation, going further over time, is one warning sign, and repetition matters too.

One explanation, from Joiner, is that repeated pain can raise the body's tolerance for harm. If suicidal thoughts do come, a person may then be less held back from acting on them.³ A long-standing pattern is a reason to seek help, not evidence that things are stable. And a serious injury needs urgent medical care, whatever the intent behind it.

How common is self-harm?

Swannell and colleagues combined the results of many international studies, all of them looking at people outside clinical care. They found that 17.2% of adolescents, 13.4% of young adults and 5.5% of adults reported non-suicidal self-injury.⁴ Self-harm is not rare, and it is not confined to teenagers.

The review is equally clear about its limits. Published estimates vary widely, and how the studies were done explained over half of the variation between them. After adjusting for those differences, the review found no evidence that self-injury had increased over time.⁴

Treat any single percentage, including these, as an estimate rather than an exact count.

If you are hurting yourself right now

If you have injured yourself and the wound is serious, get urgent medical care. The same holds if you cannot tell how serious it is. That is true whatever you feel about the injury, or about how it happened. You do not have to explain everything to be treated.

If you feel close to hurting yourself, use the crisis resources in the box near the top of this page. The same applies if your thoughts have moved towards suicide. You can also contact your local emergency services.

This page gives no advice on managing wounds at home. Serious injury needs medical care, not instructions.

Getting help for self-harm

Telling one person is a workable first step. That can be a doctor or a therapist, or someone you trust enough to help you reach a professional.

If you are young and worried about who will be told, it is fair to ask at the start what stays private. The answer varies by country and situation, and a good professional will explain it plainly.

You do not need the right words. Saying that you have been hurting yourself and want help is enough. If you have told someone before and it went badly, that was a failure of the response, not of the telling, and it is worth trying a different person.

Treatment starts from what the self-harm does for you. It then works on the feelings and situations that come before the urge, and on other ways of managing them. Treatment can help, and a setback does not undo progress already made.

TherapyRoute lists registered mental health professionals by country and city. If you are ready to look for one, start with how to find the right therapist.

Supporting someone who self-harms

Self-harm is usually hidden, so you may notice only indirect signs: unexplained injuries, covered skin in warm weather, or growing withdrawal. If someone tells you they self-harm, or you find out, stay calm. The injuries are usually the visible sign of distress the person has kept hidden.

What helps:

• Listen without judgement.
• Do not demand a promise to stop. Self-harm brings the person real relief. A promise made under pressure usually leads them to hide it, rather than stop.
• Encourage professional help, and offer to help them find it.
• If they talk about suicide, take it seriously and use the crisis resources above. If you are worried they may be suicidal, ask them directly and plainly. Asking does not put the idea in their head, and it may be what lets them speak.
• If an injury is serious, treat it as a medical matter and get urgent care.

Look after yourself too, because supporting someone through this is hard and you cannot be their therapist. Steadiness, honesty and patience help more than saying exactly the right thing.

Related reading

• Emotional Regulation: managing difficult feelings
• Coping Skills: other ways to handle distress
• Dialectical Behaviour Therapy: a structured talking therapy
• Borderline Personality Disorder
• Depression
• Trauma
• Suicide Prevention
• Crisis Intervention

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References

1. [1] American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision (DSM-5-TR). Section III, Conditions for Further Study: Nonsuicidal Self-Injury, proposed criteria.
2. [2] Gunderson, J. G. & Hoffman, P. D., eds. (2005). Understanding and Treating Borderline Personality Disorder. American Psychiatric Publishing.
3. [3] Joiner, T. (2005). Why People Die by Suicide. Harvard University Press.
4. [4] Swannell, S. V., Martin, G. E., Page, A., Hasking, P. & St John, N. J. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide and Life-Threatening Behavior, 44(3), 273-303. doi.org/10.1111/sltb.12070.
5. [5] National Institute for Health and Care Excellence. Self-harm: assessment, management and preventing recurrence (NICE guideline NG225), Context.