Quick Guide to Self-Harm

Self-injury, or self-harm, is about deliberately hurting yourself to alleviate some kind of emotional distress or to induce a positive mood. The most common form of self-injury is cutting or scratching the skin, but young people also self-harm by burning themselves, picking at skin and wounds, or hitting themselves. A person who self-harms intends for the wounds to be at the surface level, not to kill themselves. That’s why experts call it NSSI — nonsuicidal self-injury.

Some think that they deserve punishment and report feeling a sensation of relief when injuring themselves. Others feel numb, so they self-harm to try to feel something. Self-harm is more common in girls than boys, and onset is often around puberty.

Common areas for self-injury are the underside of the forearms and the front of the thighs. For example, a teen who self-harms might make a series of short, parallel cuts on their arm with a razor blade, drawing blood but without causing serious injury. That said, the wounds can become infected or be worse than they intended. They could also use a needle, knife, burning cigarette end, or repeated rubbing with an eraser to hurt themselves. Signs include:

• Talking about self-injury
• Suspicious-looking scars
• Wounds that don’t heal or get worse
• Cuts on the same place
• Increased isolation
• Collecting sharp tools such as shards of glass, safety pins, nail scissors, etc.
• Wearing long-sleeved shirts in warm weather
• Avoiding social activities
• Wearing a lot of Band-Aids
• Refusing to go into the locker room or change clothes in school

If you discover a teen has been hurting themselves, it’s important to have them evaluated by an experienced mental health professional to find out why they are self-harming and what emotional difficulties they may be experiencing. Even if they say that they self-harmed only once or a few times, or tried it because their friends did it, or they saw it on social media, the practice is dangerous and warrants getting them help.

The clinician will check whether the behavior is better explained by a disorder such as trichotillomania (hair pulling) or excoriation (skin picking). They will also evaluate if the young person has a disorder with which self-harm is associated, such as eating disorders, substance use disorder, borderline personality disorder, or depression.

Treatment for self-harm depends on the root cause of the behavior, and it can involve therapy or medication.

Therapy

• Dialectical behavior therapy (DBT): In this treatment a psychologist works with your child to help them learn distress tolerance skills — how to handle uncomfortable feelings like anger, anxiety, and rejection without resorting to cutting.
• Cognitive behavioral therapy (CBT): In CBT, a psychologist teaches the child to recognize and challenge negative, distressing thoughts, and train themselves to think outside of them.
• Family therapy: If there are distressing things going on at home — conflict, job loss, a death — family therapy may be helpful.

Medication
If there is another disorder involved, a doctor may prescribe medication to treat that condition.

Someone who self-injures isn’t necessarily suicidal. They hurt themselves with the intent to feel better, not to end their life. But people who self-harm are at higher risk for suicide, in part because the two conditions share common risk factors such as high emotional sensitivity or a history of trauma or abuse. Experts aren’t sure what distinguishes those who self-harm and never attempt suicide from those who do. But research has found that those who self-injure more frequently and use multiple methods to hurt themselves are more at risk for suicidal behavior.