How to Recognize Self-Harm in Teens and Provide Support

Self-harm is common among teenagers. Here’s how to recognize it — and how to help teens who self-harm.

Teenagers are more likely to self-harm than adults and young children. Self-harm can be a way to calm emotions, self-punish, or regain a sense of control. It can include self-injury, mental self-harm (like negative self-talk), and self-destructive behavior.

Self-harm should always be taken seriously. If you suspect a teenager in your life is self-harming, support them by giving them a compassionate, nonjudgmental space to talk. It’s also strongly advised that you find them a counselor or therapist.

With appropriate treatment, many people who self-harm break the cycle and begin feeling better.

Self-harm is an act of hurting yourself on purpose without intending suicide.

Cutting — lacerating your skin with a sharp instrument — is probably the most well-known form of self-harm, but it’s not the only kind of self-harm that teenagers may engage in.

It’s not just health insurance premiums, but also deductibles, that keep on rising. In 2018, the average deductible was $3,000 for a gold-tier family plan, $8,000 for a silver-tier family plan and $12,000 for a bronze-tier family plan, according to USC Annenberg’s Center for Health Journalism.

Self-harm can include different forms of self-injury, such as:

• burning your skin with lit matches and candles, cigarettes, or heated objects
• carving words, patterns, or symbols into your skin
• cutting or scratching
• head-banging, usually into a wall
• hitting, punching, or biting
• piercing your skin

Self-harm can also include ways of hurting yourself that aren’t self-injury. People of all ages may engage in emotional self-harm and self-destructive behavior.

This can include:

• binge eating
• digital self-harm (where someone uses anonymous platforms to bully themselves)
• engaging in toxic relationships
• negative or belittling self-talk (including insulting themselves)
• restricting food or sleep as self-punishment
• risky behavior, like sex without a condom or other barrier method, substance use, and reckless driving
• withholding enjoyable activities as self-punishment

Teenagers may self-harm when they feel difficult emotions. It may provide a temporary release or distraction from pain, and they may also use it to punish themselves.

Self-harm is a maladaptive (harmful) coping mechanism. Not only can it lead to physical complications (such as infected cuts), but it can also lead to a cycle of self-hurt and shame.

If you’re supporting a teenager who may be self-harming, it’s possible for them to learn better coping mechanisms so that they can regulate and manage their emotions in a healthy, effective way.

Because there are so many forms of self-harm, the signs and symptoms of self-harm can vary widely.

Mental forms of self-harm — like negative self-talk — may have no obvious sign. Teens may engage in some self-talk verbally or explicitly express self-derogatory thoughts.

Physical forms of self-harm may have more obvious signs. In some cases, you might see evidence of self-injury, although many teenagers who self-harm try to hide the area they self-harm.

Signs of self-injury can include:

• avoiding activities that expose their body, such as swimming
• frequently carrying sharp objects and other self-harm tools
• reporting frequent “accidents” to explain scars
• unexplained blood on clothing
• wearing long sleeves and long pants even in hot weather (to cover self-injury)
• wearing bandages or plasters frequently

Signs of all forms of self-harm can include:

• difficulties in relationships
• expressing feelings of sadness or hopelessness
• lack of interest
• low self-esteem
• intense mood changes
• social withdrawal
• talking about themselves in critical, belittling terms

It’s not always easy to tell whether a teenager is self-harming. If they seem significantly withdrawn, hopeless, or sad, it may be worth opening a conversation with them. They may benefit from speaking with a mental health professional.

Teenagers may self-harm to:

• calm themselves down when upset
• feel emotional release
• express or distract from painful emotions
• punish themselves
• regain a sense of control

Although people can self-harm at any age, it’s particularly common among teenagers. This may be because teenagers often haven’t yet developed healthy coping mechanisms and emotional regulation skills.

As such, they may turn to harmful coping mechanisms — like self-harm — in order to manage their emotions.

Self-harm isn’t always a sure sign that someone has a mental health disorder. But it can be present among teenagers who have conditions like:

• anxiety disorders
• bipolar disorder
• depression
• eating disorders
• personality disorders
• post-traumatic stress disorder (PTSD)

Self-harm can also be common among teenagers who are dealing with:

Children who cut need compassion and support. Don’t approach them from a place of anger or punishment. Instead, emphasize that you’re there to help them.

To support a teenager who self-harms, try the following:

• Do some research: This article is a good start. You may also do further research to learn more about overcoming self-harm and avoiding relapse.
• Regulate your own emotions: If you’re upset, it’s best to calm yourself down before approaching them. Many teens self-harm because they have difficulty coping with their own feelings — trying to cope with yours may be overwhelming. Try to be an example of good emotional self-regulation for them.
• Approach them privately: They may feel embarrassed if you discuss it in front of others. They may be more forthcoming if you chat with them one on one.
• Don’t punish them: This is counterproductive and can cause further harm. It may make them feel alienated from you.
• Emphasize that you’re not angry: Remind them that you love them and want to help them.
• Give them space to talk: People who self-harm don’t always understand why they do it. Ask how they’ve been feeling and what issues are triggering those feelings.
• Help them learn healthy coping mechanisms: There are alternatives to self-harm like running their hands under cold water or screaming into a pillow. They might also learn healthy ways to regulate or release emotions like calling a mental health hotline, exercising, or listening to music.
• Make an appointment to see a doctor if needed: If your child is engaging in self-injury, they may need to be examined by a healthcare professional to check for infections or serious wounds.
• Make an appointment with a therapist: Get them into therapy as soon as possible. A doctor can refer you to a mental health professional who works with adolescents. You can also use a therapy directory like Austra Health’s FindCare tool.
• Support your child in going to therapy: This can include helping them get there on time. Give them space to discuss their sessions, but don’t pressure them into sharing unless they want to.
• Consider joining a support group for parents: A therapist may direct you to local support groups, but you can also look for online forums and groups or join a National Alliance on Mental Illness (NAMI) Family Support Group.

It’s also wise to ask them how you can support them. Even if they don’t know what help they need, it can emphasize that you’re there to listen to them when times get tough.

Therapy is a good first step in helping someone who self-harms. You can look for a therapist who specifically has experience working with adolescents, addressing self-harm, or both.

Talk therapy, also known as psychotherapy, can give them space to process their emotions. It can also help them learn emotional regulation techniques as well as social and problem-solving skills.

These skills can serve them later in life, too. Consider online therapy if in-person therapy isn’t an option.

In many cases, group and family therapy can be helpful for teenagers who self-harm. It’s possible to start with one-on-one therapy and later do group or family therapy if necessary.

If your teenager has had suicidal thoughts or if they’ve severely injured themselves, short-term hospitalization may be helpful. An inpatient treatment program can help them stay safe while learning skills that help them reduce or stop self-harming behaviors.

Is self-harm a sign of suicidality?

Self-harm isn’t always a sign of suicidality, but it should still always be taken seriously. People who have engaged in self-harm are more likely to attempt suicide, according to a 2020 study on 9,173 teenagers.

A 2019 study with 380 participants found that most teenagers who self-harm won’t attempt suicide. But around 12% of the participants who engaged in nonsuicidal self-harm as teenagers had attempted suicide by the follow-up at 21 years of age. This means that their risk is higher than the rest of the population.

If someone is self-harming, make it a priority to get them into therapy. We have a guide on finding mental health resources that includes information on finding lower-cost or free counseling options.

How common is self-harm among teenagers?

To calculate the prevalence of self-harm among teenagers and children, one large meta-analysis study looked at studies between 1989 and 2018 that spanned 686,672 children and adolescents.

It found that, on average, 22.1% of children and adolescents engaged in nonsuicidal self-injury within their lifetimes, while 19.5% engaged in it within a 12-month period.

Similarly, 13.7% of participants engaged in deliberate self-harm (with and without suicidal intent) within their lifetimes, while 14.2% engaged in self-harm within a 12-month period.

Is self-harm always a sign of an underlying mental health condition?

Some people who self-harm have mental health conditions, but others don’t.

Regardless of whether you fit the criteria for a mental health diagnosis or not, you can speak with a therapist. This can help you overcome self-harm and build skills that will serve you in the future.

It can be a shock to learn that your teenage loved one is self-harming. But it’s possible for them to heal and develop healthy, effective coping skills.

Compassion, support, and therapy can go a long way in helping them feel better and stop the cycle of self-harm.

For more resources, you can try the following:

• Austra Health and Psych Central’s Youth In Focus series: Read about the mental health challenges facing teenagers and find tips, resources, and support.
• NAMI: Call their toll-free helpline available Monday through Friday from 10 a.m. to 6 p.m. Eastern Time (ET) at 800-950-NAMI. You can also text “NAMI” to 741741.
• S.A.F.E. Alternatives (Self-Abuse Finally Ends): Here you’ll find educational resources and a therapist referral service by state.
• Self-injury Outreach and Support: Read personal stories and learn how to cope with urges to self-harm.
• Teen Line: Find support and resources for your teen. Teenagers can also call them at 800-852-8336, 6 p.m. to 10 p.m. Pacific Standard Time (PST), for support.

Sian Ferguson is a freelance health and cannabis writer based in Cape Town, South Africa. She’s passionate about empowering readers to take care of their mental and physical health through science-based, empathetically delivered information.

Last medically reviewed on March 27, 2023