ConditionMental health & sleep
Self-Injurious Behavior (Self-Harm)
Self-injurious behavior, often called self-harm, means deliberately hurting your own body, for example by cutting, burning, scratching or hitting yourself. In teenagers and adults it is usually a way of coping with intense emotional pain, not an attempt to die, which is why it is called non-suicidal self-injury. But it does raise the risk of suicide and needs compassionate support. In people with autism or intellectual disability, repetitive self-injury such as head-banging often signals pain, distress or difficulty communicating. Effective help is available.
Also called: Self-harm, self-injury, non-suicidal self-injury (NSSI), SIB, deliberate self-harm
At a glance
- What it is
- Intentionally injuring oneself, most often to cope with emotional distress.
- Who
- Most common in teens and young adults, but occurs at all ages; also in some people with autism or intellectual disability.
- Why
- To relieve unbearable feelings, numbness, anger or self-hatred, or to communicate distress.
- Risks
- Infection, scarring, accidental serious injury, and increased risk of suicide.
- Help
- Talking therapies (DBT, CBT), treating depression or trauma, safety planning and support.
- Crisis
- Call or text 988 (US) any time.
When to get help
Call 911 or go to the ER
- Thoughts of suicide, a plan, or feeling unable to stay safe: call or text 988 (US), or call 911
- An injury that is bleeding heavily, very deep, gaping, or exposes fat, muscle or bone
- A burn larger than the palm of the hand, or any burn to the face, hands, feet or genitals
- Swallowing pills, chemicals or objects, even if you feel fine
- A head injury from head-banging with drowsiness, vomiting or confusion
See a doctor within a day or two
- A wound that is red, hot, swollen or oozing pus, or with fever
- Self-harm that is becoming more frequent or more severe
- A child or adult with autism or intellectual disability whose self-injury is new or suddenly worse (check for pain or illness)
Book a routine appointment
- Any ongoing self-harm: talk to a doctor, school counselor or mental health professional
- Wanting to stop but finding it hard
- Concern about a friend or family member who may be self-harming
Why people self-harm
Self-harm is usually a way to cope with emotions that feel overwhelming. People describe it as a way to:
- release intense anger, sadness or tension
- feel something when they feel numb or detached
- punish themselves because of guilt or self-hatred
- feel in control
- distract from distressing thoughts or memories
- show others how much they are hurting
The relief is short-lived and often followed by shame, which can lead to a cycle of repeated self-harm.
Risk factors
- depression, anxiety and emotional dysregulation
- childhood abuse, trauma or neglect
- bullying, including online
- family conflict or loss
- feeling different or isolated, including LGBTQ+ young people facing rejection
- eating disorders
- alcohol or drug use
- friends who self-harm, or exposure online
- personality difficulties involving unstable emotions and relationships
Warning signs
- unexplained cuts, bruises, burns or scratches, often on wrists, arms, thighs or chest
- wearing long sleeves or trousers in hot weather
- avoiding activities where skin would be visible, such as swimming
- keeping sharp objects or first aid supplies hidden
- spending long periods alone, especially in the bathroom or bedroom
- withdrawal, low mood, irritability, statements of hopelessness or worthlessness
Self-injury in autism and intellectual disability
In children and adults with autism or intellectual disability, self-injury such as head-banging, hand-biting or skin-picking has different causes:
- pain or illness they cannot express: ear infections, toothache, constipation, reflux, headaches
- frustration or difficulty communicating needs
- sensory overload or seeking sensation
- changes in routine
- some genetic syndromes
A medical check for hidden pain is an important first step, followed by behavioral assessment (functional behavior analysis), communication support and environmental changes. Medicines may help in some cases.
Self-harm and suicide
Most people who self-harm do not want to die, but self-harm is one of the strongest predictors of future suicide. Every episode deserves to be taken seriously. If you or someone you know talks about wanting to die, has a plan, or feels hopeless, contact 988 or emergency services. See suicidal thoughts.
Caring for wounds
- clean minor wounds with water and cover with a clean dressing
- apply firm pressure to bleeding for 10 minutes
- cool burns under running water for 20 minutes
- seek medical care for deep or gaping wounds, signs of infection, burns larger than the palm, or if tetanus vaccination is not up to date
Getting medical care for wounds is important and nothing to be ashamed of.
Treatment and support
Talking therapies
- Dialectical behavior therapy (DBT): teaches emotion regulation, distress tolerance and relationship skills; well supported for adolescents who self-harm.
- Cognitive behavioral therapy (CBT): addresses thoughts and behaviors linked to self-harm.
- Mentalization-based therapy and family-focused therapy for young people.
- Trauma-focused therapy when trauma is a driver.
Treating underlying conditions
Depression, anxiety, PTSD and eating disorders are treated with therapy and, where appropriate, medicine.
Safety planning
A written plan lists personal warning signs, coping strategies, people to contact, ways to make the environment safer and crisis numbers.
Coping strategies people find helpful
- talking to someone trusted
- holding ice, snapping a rubber band lightly, or taking a cold shower to create intense sensation without injury
- intense exercise
- writing, drawing or music
- delaying the urge for 15 minutes at a time
How to help someone who self-harms
- stay calm and listen without judging or showing shock
- avoid ultimatums or forcing them to promise to stop
- ask directly whether they are thinking about suicide; asking does not put the idea in their head
- help them get professional support and medical care for wounds
- look after yourself too, and seek support
Frequently asked questions
Why do people self-harm?
Most people self-harm to cope with emotions that feel overwhelming, such as sadness, anger, anxiety or numbness. It can bring brief relief or a sense of control. The relief does not last, and underlying problems remain, so professional support helps.
Is self-harm a suicide attempt?
Usually not. Most self-harm is a way of coping with pain rather than trying to die. However, people who self-harm have a higher risk of suicide, so it should always be taken seriously. If suicidal thoughts are present, call or text 988.
What are the signs that someone is self-harming?
Signs include unexplained cuts, burns or bruises, wearing long sleeves in warm weather, hiding sharp objects, spending a lot of time alone and changes in mood or behavior. Young people may also withdraw from friends and activities.
How can I stop self-harming?
Reach out to someone you trust and a health professional. Therapies such as DBT and CBT teach other ways to manage intense emotions. Safety plans, distraction techniques and treating depression or anxiety help. Recovery takes time, and setbacks are part of it.
How should I respond if my child is self-harming?
Stay calm and listen without anger or blame. Let them know you care and want to help. Check that wounds are treated, ask gently about suicidal thoughts, and arrange an appointment with their doctor or a mental health professional.
Sources
This guide was written from current patient and clinical guidance, including:
- National Institute of Mental Health: Self-harm
- 988 Suicide and Crisis Lifeline
- NICE: Self-harm, assessment, management and preventing recurrence (NG225)
- American Academy of Child and Adolescent Psychiatry: Self-injury in adolescents
- Mayo Clinic: Self-injury/cutting