Self-Harm

If you are struggling right now

• Call or text 988 (US) to reach the 988 Suicide and Crisis Lifeline, available 24/7, free and confidential. You can also chat at 988lifeline.org.
• Text HOME to 741741 to reach the Crisis Text Line.
• Call 911 if you are injured or in immediate danger.
• Tell someone you trust: a friend, family member, teacher or doctor.
• Put distance between you and the means of self-harm if you can.

What self-harm is

Self-harm includes any deliberate act of hurting oneself. Non-suicidal self-injury describes self-harm without the intention to die, but intentions can be mixed or change over time. Every act of self-harm deserves care and compassion.

Common forms:

• cutting or scratching the skin
• burning
• hitting or punching oneself or objects
• pulling out hair
• picking at skin or wounds to stop healing
• swallowing harmful substances or overdosing on medicines
• inserting objects into the skin

Why people self-harm

People describe self-harm as a way to:

• cope with overwhelming emotions such as sadness, anger, shame or anxiety
• feel something when they feel numb or disconnected
• feel in control when life feels chaotic
• express pain that is hard to put into words
• punish themselves because of guilt or self-hatred
• stop intrusive thoughts or memories

Self-harm often brings brief relief, followed by guilt or shame, which can make the cycle continue.

Risk factors

• Depression and anxiety
• Trauma, abuse or neglect, and PTSD
• Bullying, including online
• Eating disorders
• Borderline personality disorder
• Alcohol and drug use
• Low self-esteem, perfectionism
• Family conflict, relationship breakdown or loss
• Identity-related stress, including being LGBTQ+ in an unsupportive environment
• Knowing others who self-harm, including via social media

Warning signs

• Unexplained cuts, burns, bruises or scars, often on the arms, thighs or stomach
• Wearing long sleeves or trousers in hot weather
• Avoiding swimming or changing in front of others
• Keeping sharp objects, lighters or medicines hidden
• Spending long periods alone, especially in the bathroom or bedroom
• Withdrawal, low mood, irritability or changes in eating and sleep
• Statements of worthlessness or hopelessness

Self-harm and suicide

Most people who self-harm are not trying to end their life at that moment. However, self-harm is one of the strongest predictors of future suicide, and the risk is highest in the months after an episode. Thoughts of suicide should always be asked about directly; asking does not put the idea in someone's head. See suicidal ideation.

Getting help and treatment

Assessment

A doctor or mental health professional will treat any injuries, ask about what led to the self-harm, check for depression, anxiety, trauma and substance use, and assess suicide risk. NICE guidance stresses a respectful, non-judgmental approach and a full psychosocial assessment after each episode.

Talking therapies

• Dialectical behavior therapy (DBT): teaches skills for managing intense emotions, tolerating distress and improving relationships. It has strong evidence for reducing self-harm, especially in adolescents
• Cognitive behavioral therapy (CBT): helps change thought patterns and develop alternative coping
• Mentalization-based therapy and family therapy for young people

Treating underlying conditions

Depression, anxiety, PTSD, eating disorders and substance use are treated as part of care. Medicines may help these conditions but are not a direct treatment for self-harm.

Safety planning

A safety plan lists warning signs, coping strategies, people to contact, crisis numbers and steps to reduce access to means. Keeping only small amounts of medicines at home and locking them away reduces overdose risk.

Coping strategies to use instead

These do not replace treatment but can help ride out an urge:

• hold ice cubes or take a cold shower
• squeeze a stress ball or tear paper
• do intense exercise for a few minutes
• draw on your skin with a red marker where you might hurt
• write down your feelings, then rip up the page
• call or text someone, or contact 988
• use a delay: wait 15 minutes and do something absorbing; urges often pass

How to help someone who self-harms

• Stay calm and listen without judgment or shock
• Tell them you care and want to help
• Ask directly whether they have thoughts of suicide
• Avoid ultimatums, punishment or demanding they stop immediately
• Help with first aid if needed
• Encourage professional help and offer to go with them
• For a young person, involve a parent, school counselor or doctor
• Look after your own wellbeing

Wound care

For minor cuts: wash with clean water, apply pressure to stop bleeding, and cover with a clean dressing. Seek medical care for deep, gaping or dirty wounds, burns, signs of infection, or if your tetanus vaccination is not up to date.

Frequently asked questions

What are the signs of self-harm?

Signs include unexplained cuts, burns, bruises or scars, wearing long sleeves in hot weather, avoiding situations where skin is exposed, hiding sharp objects, spending long periods alone, and changes in mood, eating or sleep.

Why do people self-harm?

Most people self-harm to cope with overwhelming emotions such as sadness, anger, anxiety, shame or numbness. It can bring brief relief or a sense of control, but the relief does not last and the underlying distress continues.

Is self-harm a suicide attempt?

Not usually. Most self-harm is a way of coping rather than an attempt to die. However, people who self-harm have a higher risk of suicide, so it always needs to be taken seriously and suicidal thoughts should be asked about directly.

How can I stop self-harming?

Talk to someone you trust and seek professional help. Therapies such as DBT and CBT teach other ways to manage emotions. In the moment, try delay, cold ice, intense exercise or contacting a crisis line such as 988.

How do I help someone who self-harms?

Stay calm and listen without judging. Show you care, ask about suicidal thoughts, help with first aid if needed, and encourage professional support. In an emergency, call 911. Do not try to force them to stop on their own.