Self-harm, also known as self-injury, is when a person intentionally injures themselves without suicidal intent. Cutting the skin with a sharp object is the most common form of self-harm, although other forms of self-harm exist (e.g., burning self, hitting self with fist or another object, piercing the skin, scratching, pulling out hair). Cuts made may be small or large, shallow or deep. Sometimes they are made on parts of the body that are easily visible, and other times they are kept hidden.
Self-harm is most common in adolescence and young adulthood, usually first appearing between the ages of 12 and 24, but occurs in people of any age. Self-injury seems to be more common among college students than other populations: In one study of United States undergraduates, 9.8% indicated that they had purposefully cut or burned themselves on at least one occasion in the past. When the definition of self-harm was expanded to include head-banging, scratching oneself, and hitting oneself along with cutting and burning, 32% of the sample said they had self-injured. People of any gender may self-harm; it used to be thought that it was more common in females, but recent research challenges this idea.
People who have been physically or sexually abused may be more likely to self-harm. It's also common for people with body image and self-esteem issues to self-injure. Finally, people with certain mental health issues (e.g., Borderline Personality Disorder, PTSD, depression, eating disorders) may self-harm.
People self-injure for a few different reasons. The most common ones are as follows:
- To "feel something" because of feeling numb physically or emotionally (often due to trauma or other mental health issues)
- To self-punish due to guilt or shame
- To distract themselves from difficult memories, thoughts, and feelings
- To feel more in control (i.e., by choosing when and how to feel pain when other things in their life feel out of control)
- To communicate: Some people self-harm to show others they are in pain, get attention or a reaction from others, or to punish others
Common triggers include low self-esteem and having friends and family members who self-harm, as well as certain mental health issues (e.g., Borderline Personality Disorder, PTSD, depression, eating disorders). Higher rates of self-injury are seen in people who use more cigarettes, drugs, and alcohol.
Like using alcohol or another drug, overeating, restricting eating, or other potentially harmful behaviors to cope, self-injury can cause problems. While it may serve a desired purpose in the short term, it is unlikely to be useful in the long term. Self-injury can become a compulsion and take time and attention away from other things and begin to feel out of control. It can also prevent a person from learning other, healthier, coping tools that don't have negative consequences. Finally, self-injury can result in infections, scars, unintentionally life-threatening injuries, guilt or shame, isolation from others, and avoidance of activities (e.g., because a person is spending more time and energy on self-injury or doesn't want their injuries to be visible during particular activities).
It is possible to stop self-harming. People who used to self-harm but were able to quit have some advice:
- Be honest with yourself: Admit that you have a problem.
- Get empowered: You have the power and the right to seek help and support. You can learn more about self-harm and healthy coping tools. You can make the choice to get help.
- Notice triggers: Become more self-aware of the events, people, memories, and situations that make you want to self-injure. Avoid triggers when you can, and learn new ways to cope when you can't avoid the triggers.
- Build a support system: Recognize the people in your life who can help you make different choices and who give support: These may be relatives, friends, partners, RAs, mentors, or religious/spiritual leaders. Take the risk to open up to them.
- Work on reducing the use of alcohol and other drugs, as they can make it harder to avoid self-harm and cause problems of their own.
- Get professional help: If you have been self-harming a while, your self-harm has increased, you are at risk of serious injury, and/or your behavior feels out of control, consider talking to a therapist or doctor.
Therapy is one way to overcome self-injury. Some of the ways it can help include providing a safe place to express thoughts and feelings, learning new coping tools, becoming more self-aware of patterns and triggers, having support to make changes, having help setting goals for changing your self-harm patterns, and building self-esteem.
Getting enough sleep, eating well, and regular exercise set the foundation for good physical and mental health, which is important in reducing and eliminating self-harm. There are many self-help tools that can help you build self-awareness, learn new coping skills, and reduce unwanted behaviors. For example, self-help books and websites are a good start. Journaling, meditation, yoga, engaging in hobbies and creative practices, and spending time with supportive people may also help. Starting a gratitude practice (a regular practice of recognizing and focusing on the good things in your life and in yourself) and volunteering have also been shown to boost mood, which can help you cope and reduce the need for unhealthy coping patterns.
If you know or suspect that someone you know is self-injuring, there are a few things you can do. First, ask them about it. They may feel relieved to have someone to talk to. If they want to talk to you, be sure to listen empathically and resist the urge to jump in with advice, judgment, or pressure. You may have suggestions or opinions, but it's best to be a good listener first. Let them know that you care about them and want to help. Ask how you can best help them--is it just by listening? Is it by giving advice? Is it through looking for resources for your friend, making calls to potential therapists, or accompanying your friend to CAPS or another source of help?
Be sure to pay attention to your own emotional needs when helping a friend who is self-harming; sometimes, it can feel like too much, and you may need to get support of your own. It's also important to set some boundaries: Be very careful about agreeing to keep your friend's self-harm a secret, as you may feel the need to break their privacy to seek help for them if their safety or life is at risk. Encourage your friend to get help from others besides just you--being someone's sole source of support can be too much to handle. In an emergency (e.g., your friend has cut themselves very deeply and is bleeding heavily), get help by calling 911.