What Is Self-Harm?

Self-harm is deliberate. It’s often an escape or form of self-punishment, but you can learn to change self-harm behaviors into more adaptive styles of coping.

How you adapt and respond to challenges in life depends on your coping and defense mechanisms.

Defense mechanisms are your involuntary responses to stress, like denial or rationalization, while coping mechanisms are conscious things you do to relieve negative thoughts and feelings. They include behaviors like exercising, creating art, meditating, or venting to a close friend.

Most people who engage in self-harm use it as a coping mechanism. But self-harm isn’t a long-term solution — it can be dangerous and make you feel worse in the long run.

Self-harm is also known as non-suicidal self-injury (NSSI). It’s when you hurt yourself directly and intentionally, but without the goal of ending your life.

According to a 2022 meta-analysis of more than 64,000 adolescents, the global lifetime prevalence of NSSI behaviors is 22%.

The last 20 years have seen the cost of medical care increase about 70% faster than the rate of general inflation as measured by the Consumer Price Index (CPI), the Research Division of the Federal Reserve Bank of St. Louis Healthcare inflation dropped to a historical low after 2010 but is again on the rise as of 2018, according to Bloomberg.

Research indicates onset usually occurs between the ages of 12 years and 14 years of age, and NSSI is common among youth living with eating disorders and borderline personality disorder.

While biological females, adolescents, and young adults seem more likely to engage in NSSI behaviors, it’s seen across all age groups and demographics.

The symptoms of self-harm can vary depending on the type of NSSI involved. It’s usually a secretive process, and as a caregiver, you might not see obvious signs.

Common signs of self-harm include:

unexplainable scars, marks, wounds, or bruises
frequent injuries
wearing high-coverage clothing even in hot weather
collecting odd objects like razors, lighters, or pins
high use of medical supplies
extreme defensiveness of privacy
withdrawal
mood changes
hanging out with friends who self-harm
participating in other potentially harmful behaviors
hair loss/thinning

Research shows the majority of people use self-harm as a maladaptive coping mechanism, something that provides temporary relief but comes with long-term negative consequences.

Maladaptive vs. adaptive

Maladaptive describes behaviors that aren’t helpful and have negative consequences. Adaptive behaviors promote well-being and positive outcomes.

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When you engage in NSSI, it replaces psychological distress with physical pain, pulling you out of your unhappy thoughts. The trauma to your body also generates a release of pain-killing endorphins, which can give you an all-around, feel-good boost.

Being able to escape your thoughts and feel better at the same time can lay the foundation for self-harm to become compulsive and ritualistic.

It can become that thing you go to whenever you need to de-stress.

For some people, NSSI is also about self-punishment. Negative thoughts and emotions around self-worth can make you feel like you deserve pain. In this way, NSSI also provides relief; once you’ve punished yourself, you can temporarily move on.

What are the risk factors for self-harm?

Some people may have a higher risk of NSSI compared to others, including people who:

are biological females
are between the ages of 16 years and 19 years
have a history of adverse childhood events or trauma
have low health literacy
live with mental health disorders
have high symptoms of anxiety and depression
live with physical disabilities
experience sleep problems
are prone to maladaptive behaviors (e.g., substance misuse, internet addiction, running away from home)

There are plenty of ways to hurt yourself. Self-injurious behaviors like drinking too much alcohol, restricting your eating, or sharing drug needles can negatively affect your health, but these are indirect ways of causing harm.

NSSI is direct action you take against yourself that causes immediate injury, and injury is the primary intent.

According to the same 2022 meta-analysis, the most common form of NSSI is hitting/banging, followed by pinching and hair-pulling.

Cutting/carving

Cutting self-harm is more common among biological females. It can involve using knives, razors, or any sharp object to break through the skin.

Cutting can sometimes evolve into carving, a more severe form of engraving deep patterns and marks into your body.

Research suggests that carving, in particular, can be a predictor of suicide ideation among people living with substance use disorders.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

Call the 988 Suicide and Crisis Lifeline at 988.
Text HOME to the Crisis Textline at 741741.
Not in the United States? Find a helpline in your country with Befrienders Worldwide.
Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

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Biting

Biting your hand, wrist, or another part of your body is a recognized form of NSSI.

Among those living with developmental disorders, biting can be an involuntary response or a way to express frustration in the absence of other communication. It’s not necessarily a self-harm behavior but more of a self-injurious one.

Burning

Burning self-harm may involve lighters, matches, candles, or cigarettes. Biological males are more likely to engage in burning self-harm, compared to biological females.

Pinching

Pinching is one of the most common forms of NSSI. Unlike other methods that require tools, pinching involves squeezing, twisting, or compressing small sections of the skin with your fingers.

Hair-pulling

Another common form of self-harm, hair-pulling can mean pulling out the hair on your head — or anywhere else on your body.

It’s not the same as trichotillomania, which is a separate mental health disorder. Trichotillomania involves compulsive hair-pulling, but not specifically to cause harm.

In fact, the Diagnostic and Statistical Manual of Mental Disorders, 5 th edition, text revision (DSM-5-TR), specifically notes self-harm should be ruled out when determining a trichotillomania diagnosis.

Scratching/rubbing

Using your nails or other tools to scratch or cause skin abrasions falls under the scratching category of NSSI.

Banging/hitting

The most common form of self-harm, banging/hitting involves a broad range of actions.

For some, it might mean smacking themselves with their hands or kicking a wall. For others, it can mean banging their head against a desk or slamming their body into hard objects.

Healing prevention

Sometimes self-harm comes in the form of preventing injuries from healing. You might repetitively pick scabs, for example, or keep injuring the same spot over and over again.

Emotional

Self-harm doesn’t have to be physical. Calling yourself names, berating yourself, and holding yourself to unreasonable standards can be forms of emotional self-harm.

Self-poisoning

Self-poisoning walks the boundary of NSSI definitions, with some experts debating that self-poisoning usually crosses over into suicidal intent. It’s the least common form of self-harm.

Self-poisoning can mean overdosing on medications, drinking household chemicals, or exposing yourself to toxic substances.

Those who self-harm don’t necessarily have a mental health disorder. However, they may still benefit from psychotherapy interventions.

According to the International Society for the Study of Self-Injury, there are several types of treatments that have shown the most promise for NSSI:

dialectical behavior therapy (DBT)
emotion regulation group therapy (ERGT)
treatment for self-injurious behaviors (T-SIB)

These frameworks help you develop new, beneficial problem-solving skills and ways to cope with stress. Therapy can help you shift your behavior patterns from maladaptive to adaptive.

Recovering from self-harm

You can recover from self-harm. The journey may not be easy, but you absolutely can recover.

When things feel overwhelming, you can try:

journaling
talking with a loved one
creating art
deep breathing
meditating
exercising
spending time in nature
bonding with your pet
performing a mind-body art like tai chi
reading

You don’t ever have to be alone with negative thoughts or urges to self-harm. Confidential help and support are available any time by calling the SAMHSA National Helpline at 1-800-662-4357 or by texting “HOME” to 741741.

Self-harm is direct, intentional, and always done with the purpose to cause injury. It doesn’t involve a desire to end your life, but it can mean you’re under an extreme amount of psychological distress.

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