Self-Harm | TherapyRoute

Self-harm is when you intentionally hurt yourself without wanting to die. It's also called self-injury, self-mutilation, or cutting. People self-harm to cope with overwhelming emotions, stress, or trauma. It's not attention-seeking behaviour - it's a sign that someone is struggling and needs support.

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Table of Contents

What Is Self-Harm?
Types of Self-Harm
Why People Self-Harm
Risk Factors for Self-Harm
Warning Signs of Self-Harm
The Cycle of Self-Harm
Immediate Safety and First Aid
Getting Help for Self-Harm
Healthy Alternatives to Self-Harm
Recovery from Self-Harm
Supporting Someone Who Self-Harms
Self-Harm in Different Populations
Prevention of Self-Harm
Myths and Facts About Self-Harm
Crisis Resources
Related Terms

What Is Self-Harm?

Self-harm involves deliberately causing physical pain to yourself. It's usually done in private and often kept secret. People who self-harm aren't trying to kill themselves, though they may be at higher risk for suicide. Self-harm provides temporary relief from emotional pain, but it doesn't solve underlying problems.

Self-harm affects people of all ages, backgrounds, and genders. It often starts in adolescence but can begin at any age. About 15-20% of teenagers and 5-6% of adults have self-harmed at some point.

Key characteristics:

Intentional injury to yourself
Done to cope with emotional pain
Usually kept secret
Provides temporary relief
Not the same as suicide attempts
Often becomes a pattern or habit

Types of Self-Harm

Common Methods

Physical ways people hurt themselves:

Cutting with sharp objects
Burning skin with cigarettes, matches, or hot objects
Hitting or punching yourself or objects
Scratching until you bleed
Picking at wounds to prevent healing
Pulling out hair
Biting yourself
Inserting objects under skin

Less Obvious Forms

Self-harm that may not be recognised:

Excessive exercise
Restricting food or overeating
Deliberately putting yourself in dangerous situations
Preventing wounds from healing
Taking too much medication
Drinking or using drugs excessively
Staying in abusive relationships

Digital Self-Harm

Online forms of self-harm:

Posting negative content about yourself
Seeking out cyberbullying
Engaging in online arguments
Sharing self-harm images
Joining pro-self-harm communities

Why People Self-Harm

Emotional Reasons

Common emotional triggers:

Overwhelming sadness or depression
Intense anger or rage
Anxiety and panic
Feeling numb or empty
Guilt and shame
Loneliness and isolation
Feeling out of control

Coping Functions

What self-harm does for people:

Releases emotional tension
Provides sense of control
Expresses pain that can't be put into words
Punishes yourself for perceived failures
Feels real when everything else feels numb
Distracts from emotional pain
Provides temporary relief

Psychological Functions

Deeper reasons for self-harm:

Way to communicate distress
Attempt to feel something when numb
Self-punishment for guilt or shame
Trying to regain control
Expressing anger turned inward
Coping with trauma memories

Risk Factors for Self-Harm

Mental Health Conditions

Conditions associated with self-harm:

Depression
Anxiety disorders
Borderline personality disorder
Eating disorders
PTSD and trauma
Substance use disorders
Bipolar disorder
Autism spectrum disorders

Life Experiences

Experiences that increase risk:

Childhood abuse or neglect
Bullying or harassment
Family conflict or dysfunction
Academic or social pressure
Loss or grief
Relationship problems
Identity struggles
Discrimination or marginalisation

Personal Factors

Individual characteristics:

Difficulty expressing emotions
Poor coping skills
Low self-esteem
Perfectionism
Impulsivity
Social isolation
History of trauma

Environmental Factors

Situations that increase risk:

Exposure to self-harm in others
Social media and online content
Stressful life events
Lack of support system
Access to means of self-harm
Cultural or peer acceptance

Warning Signs of Self-Harm

Physical Signs

Visible indicators:

Unexplained cuts, burns, or bruises
Scars in patterns
Wounds in various stages of healing
Wearing long sleeves or pants to cover injuries
Frequent "accidents" or injuries
Finding sharp objects or other tools

Behavioural Signs

Changes in behaviour:

Spending long periods alone
Avoiding activities that expose skin
Making excuses for injuries
Wearing inappropriate clothing for the weather
Increased secrecy
Withdrawal from friends and family

Emotional Signs

Mood and emotional changes:

Increased depression or anxiety
Mood swings
Expressing feelings of worthlessness
Talking about being a burden
Increased irritability
Emotional numbness

Social Signs

Changes in relationships:

Isolation from friends
Avoiding social activities
Conflict with family
Problems at school or work
Loss of interest in activities
Difficulty maintaining relationships

The Cycle of Self-Harm

The Build-Up

Before self-harm occurs:

Emotional distress increases
Feeling overwhelmed
Unable to cope with feelings
Thoughts of self-harm begin
Urges become stronger

The Act

During self-harm:

Temporary relief from emotional pain
Sense of control
Release of tension
May feel calm or numb
Physical pain replaces emotional pain

The Aftermath

After self-harm:

Initial relief may fade quickly
Guilt and shame about self-harm
Fear of discovery
Worry about scars or injuries
Return of original emotional pain
Cycle may repeat

Immediate Safety and First Aid

If Someone Is Self-Harming

Immediate steps:

Stay calm and don't panic
Ensure immediate safety
Provide basic first aid if needed
Don't leave them alone if actively harming
Call emergency services if injuries are severe
Get professional help

Basic First Aid

For minor injuries:

Clean wounds gently
Apply pressure to stop bleeding
Cover with clean bandages
Monitor for signs of infection
Seek medical care if needed
Document injuries if appropriate

When to Seek Emergency Help

Call 911 or go to emergency room if:

Injuries are deep or severe
Bleeding won't stop
Signs of infection
Person is in immediate danger
Suicidal thoughts or plans
Overdose or poisoning

Getting Help for Self-Harm

Talking to Someone

First steps in getting help:

Choose someone you trust
Pick a time when you won't be interrupted
Be honest about what's happening
Ask for specific support
Don't expect them to fix everything
Be patient with their reaction

Professional Help

Types of professional support:

Therapists and counsellors:

Specialises in self-harm and emotional regulation
Provide safe space to explore feelings
Teach healthy coping strategies
Address underlying issues

Medical professionals:

Treat physical injuries
Assess for medical complications
Coordinate with mental health providers
Monitor overall health

Psychiatrists:

Evaluate for mental health conditions
Prescribe medications if helpful
Provide specialized treatment
Work with therapy team

Treatment Approaches

Dialectical Behaviour Therapy (DBT):

Teaches emotional regulation skills
Focuses on distress tolerance
Provides alternative coping strategies
Very effective for self-harm

Cognitive Behavioural Therapy (CBT):

Identifies triggers and patterns
Changes thought patterns
Develops healthy coping skills
Addresses underlying depression or anxiety

Trauma-focused therapy:

Addresses underlying trauma
Processes traumatic experiences
Reduces trauma symptoms
Helps develop safety and stability

Healthy Alternatives to Self-Harm

Physical Alternatives

Safe ways to get physical sensation:

Hold ice cubes
Take cold shower
Exercise intensely
Squeeze stress ball
Punch pillows
Snap rubber band on wrist

Emotional Release

Ways to express emotions:

Scream into pillow
Cry
Write in journal
Draw or paint
Listen to music
Talk to someone

Distraction Techniques

Activities to redirect attention:

Call a friend
Watch funny videos
Play games
Do puzzles
Clean or organize
Go for walk

Self-Soothing Activities

Gentle ways to comfort yourself:

Take warm bath
Use soft blankets
Pet animals
Drink warm tea
Use aromatherapy
Practice deep breathing

Creative Expression

Artistic outlets:

Draw on yourself with red marker
Write poetry or stories
Make music
Dance
Photography
Crafts or building

Recovery from Self-Harm

The Recovery Process

What recovery looks like:

Learning to recognise triggers
Developing healthy coping skills
Addressing underlying issues
Building support system
Reducing frequency of self-harm
Eventually stopping completely

Challenges in Recovery

Common obstacles:

Urges may continue for a while
Setbacks are normal
Scars may be permanent reminders
Others may not understand
Finding new ways to cope takes time
Addressing underlying problems

Building Resilience

Strengthening ability to cope:

Learn emotional regulation skills
Practice stress management
Build healthy relationships
Develop sense of purpose
Improve problem-solving abilities
Create safety plans

Relapse Prevention

Preventing return to self-harm:

Identify warning signs
Have plan for difficult times
Remove or limit access to tools
Build strong support network
Continue therapy and treatment
Practice self-care regularly

Supporting Someone Who Self-Harms

How to Respond

If someone tells you they self-harm:

Stay calm and don't panic
Thank them for trusting you
Listen without judgment
Don't make them promise to stop
Encourage professional help
Take care of your own emotions

What to Say

Helpful responses:

"Thank you for telling me"
"I'm here for you"
"You're not alone"
"Let's find help together"
"Your feelings are valid"
"You deserve support"

What Not to Say

Avoid these responses:

"Just stop doing it"
"You're being selfish"
"It's just for attention"
"There are people worse off"
"Promise me you'll stop"
"I don't understand why you do this"

Ongoing Support

Long-term ways to help:

Continue to check in regularly
Learn about self-harm and mental health
Encourage treatment and recovery
Be patient with the process
Take care of your own mental health
Don't try to be their therapist

Setting Boundaries

Healthy limits:

You can't fix or cure them
Don't enable the behaviour
Seek support for yourself
Know when to involve professionals
Don't take responsibility for their choices
Maintain your own well-being

Self-Harm in Different Populations

Adolescents

Self-harm in teens:

Often starts around age 12-14
May be influenced by peers or media
Related to identity development
Academic and social pressures
Family conflict
Experimentation with coping

Helping teens:

Take it seriously
Don't dismiss as "phase"
Involve parents appropriately
Consider school counselling
Address peer influences
Focus on healthy identity development

Adults

Self-harm in adults:

May have started in adolescence
Often related to trauma or mental illness
Maybe more hidden
Can affect work and relationships
May involve substance use
Requires comprehensive treatment

LGBTQ+ Individuals

Higher risk factors:

Discrimination and rejection
Identity struggles
Family rejection
Bullying and harassment
Minority stress
Lack of support

People with Disabilities

Unique considerations:

May have limited communication
Different forms of self-harm
May be misunderstood as behavioural
Need specialized approaches
Sensory considerations
Communication adaptations

Prevention of Self-Harm

Individual Prevention

Building protective factors:

Develop emotional regulation skills
Learn healthy coping strategies
Build strong relationships
Address mental health issues
Practice self-care
Find meaning and purpose

Family Prevention

How families can help:

Create supportive environment
Teach emotional skills
Model healthy coping
Address family problems
Seek help when needed
Reduce risk factors

School Prevention

Educational approaches:

Mental health education
Emotional skills training
Anti-bullying programs
Early identification
Counseling services
Peer support programs

Community Prevention

Broader prevention efforts:

Reduce stigma around mental health
Increase access to services
Train professionals
Media guidelines
Support programs
Crisis resources

Myths and Facts About Self-Harm

Common Myths

Myth: Self-harm is just attention-seeking
Fact: Self-harm is a coping mechanism for emotional pain, not attention-seeking

Myth: People who self-harm are trying to kill themselves
Fact: Self-harm is usually not suicidal, though it may increase suicide risk

Myth: Only teenage girls self-harm
Fact: People of all ages and genders can self-harm

Myth: Self-harm isn't serious if the injuries are minor
Fact: Any self-harm is serious and indicates emotional distress

Myth: If you ignore it, it will go away
Fact: Self-harm usually requires professional help to stop

Crisis Resources

Immediate Help

If you're thinking of harming yourself:

National Suicide Prevention Lifeline: 988
Crisis Text Line: Text HOME to 741741
Self-Injury Outreach & Support: www.sioutreach.org

Self-Harm Specific Resources

To Write Love on Her Arms: www.twloha.com
Self-Injury Foundation: www.selfinjuryfoundation.org
LifeSIGNS: www.lifesigns.org.uk
SAFE Alternatives: www.selfinjury.com

Apps for Support

Calm Harm: Helps resist urges to self-harm
MindShift: For anxiety and mood
PTSD Coach: For trauma symptoms
DBT Coach: For emotional regulation skills

Related Terms

Emotional Regulation - Skills for managing emotions
Coping Skills - Healthy ways to handle stress
Dialectical Behaviour Therapy - Effective treatment for self-harm
Borderline Personality Disorder - Often involves self-harm
Depression - Common co-occurring condition
Trauma - Often underlying cause
Suicide - Related but different behaviour
Crisis Intervention - Immediate help for self-harm

Sources:

International Association for the Study of Pain. (2023). Self-Injury and Pain.

American Psychological Association. (2023). Self-Injury in Adolescents.

National Institute of Mental Health. (2023). Self-Harm: Information for Young People.

Klonsky, E. D., et al. (2014). The functions of nonsuicidal self-injury. Clinical Psychology Review, 34(4), 282-297.

Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6, 339-363.

Remember: If you're struggling with self-harm, please reach out for help. Call 988 (National Suicide Prevention Lifeline) or text HOME to 741741 (Crisis Text Line). You deserve support and there are people who want to help.

This information is for educational purposes only and is not a substitute for professional medical advice. If you or someone you know is self-harming, please seek immediate professional help.