Self-harm, or self-injury, is when a person hurts his or her own body on purpose. The injuries may be minor, but sometimes they can be severe. They may leave permanent scars or cause serious health problems. Some examples are

• Cutting yourself (such as using a razor blade, knife, or other sharp object to cut your skin)
• Punching yourself or punching things (like a wall)
• Burning yourself with cigarettes, matches, or candles
• Pulling out your hair
• Poking objects through body openings
• Breaking your bones or bruising yourself

Self-harm is not a mental disorder. It is a behavior - an unhealthy way to cope with strong feelings. However, some of the people who harm themselves do have a mental disorder.

People who harm themselves are usually not trying to kill themselves. But they are at higher risk of attempting suicide if they do not get help.

People deal with difficult feelings in all sorts of ways. They may talk with friends, go work out, or listen to music. But some people may feel an urge to hurt themselves when distressed. Harming or thinking about harming yourself doesn’t mean you have a mental disorder. But it is an unhealthy way to cope with strong feelings. Finding new ways to cope can help you get through difficult times.

Some unhealthy ways people may try to relieve emotional pain include cutting, burning, or hitting themselves. These behaviors can be difficult to detect. People usually keep them a secret. Wounds can often be treated at home and covered with clothing or jewelry.

“The largest percentage of people who engage in non-suicidal self-injuring behaviors are teenagers,” says Dr. Jennifer Muehlenkamp, an NIH-funded psychologist at the University of Wisconsin-Eau Claire. Around 2 out of 10 teens and college-aged students report trying this behavior at least once.

Those are the key ages because youths are changing environments, Muehlenkamp explains. “Transitioning into college or from junior high into high school creates a lot of potential change. You lose the familiarity of your social group, and your social support might shift. There’s a lot of new stress and pressures.”

People who are anxious, are depressed, or have an eating disorder are also more likely to turn to self-injuring behaviors. So are those in sexual minority groups who experience discrimination and bullying, such as those who identify as gay, lesbian, bisexual, or transsexual.

“Self-injury is a sign that someone is struggling,” says Muehlenkamp. “Many youths transition out of it. But those who engage in it more repetitively and chronically may benefit from a direct clinical intervention.”

If you’re a parent or caregiver who’s concerned, look for frequent unexplained injuries and clues like bandages in trash cans. Watch to see if the person wears appropriate clothing for the weather. Someone who is self-harming may wear long pants or sleeves to cover their injuries, even when it’s hot.

“The way most people find out is the person who is self-injuring will disclose it,” Muehlenkamp says. They often tell a friend or a sibling first.

If someone confides in you, “your first reaction is essential to whether or not they will seek help,” Muehlenkamp explains. “Be as nonreactive and nonjudgmental as possible.”

Not everyone who self-injures is suicidal. But the only way to know is to ask. If they express any suicidal thinking, get them connected with a mental health provider. You can also call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) for advice.

Parents can open conversations with their kids by asking them if they’ve heard of self-harming behaviors or if they know friends who do it. If a friend has confided in them, they can offer to go talk to a trusted adult with their friend to get them help.

There are no medications for treating self-injuring behaviors. But some medications can help treat mental disorders that the person may be dealing with, like depression or anxiety. Mental health counseling or therapy can also help you learn new ways to cope with emotion.

Ways to Cope

There’s no right or wrong way to deal with intense emotions. If you’re feeling distressed:

• Talk with friends.
• Watch a funny movie or read a comforting book.
• Listen to music.
• Get active. Go for a walk or get some exercise.
• Distract yourself with any activity or hobby you love.
• Avoid smoking, drinking, and other risky behaviors.
• Take care of your body. Eat and drink well. Get enough sleep.
• Realize it’s okay to cry it out.

What Is Self-Harm?

Self-harm refers to a person harming his/her own body on purpose. Other terms for self-harm are "self-abuse" or "cutting." Overall, a person who self-harms does not mean to kill himself or herself.

Self-harm tends to begin in teen or early adult years. Some people may engage in self-harm a few times and then stop. Others engage in it more often and have trouble stopping the behavior. Self-harm is related to trauma in that those who self-harm are likely to have been abused in childhood.

How Common Is Self-Harm?

The rates of self-harm vary widely, depending on how researchers pose their questions about it. It is estimated that in the general public, 2% to 6% engage in self-harm at some point in their lives. Among students, the rates are higher, ranging from 13% to 35%.

Rates of self-harm are also higher among those in treatment for mental health problems. Those in treatment who have a diagnosis of PTSD are more likely to engage in self-harm than those without PTSD.

What Are Self-Harmers Like?

Self-harmers, as compared to others, have more frequent and more negative feelings such as fear or worry, depression, and aggressive impulses. Links have also been found between self-harm and feeling numb or feeling as if you're outside your body. Often those who self-harm have low self-esteem, and they do not tend to express their feelings. The research is not clear on whether self-harm is more common in women or men.

Those who self-harm appear to have higher rates of PTSD and other mental health problems. Self-harm is most often related to going through trauma in childhood rather than as an adult. Those who self-harm have high rates of:

• Childhood sexual abuse
• Childhood physical abuse
• Emotional neglect
• Bonds with caregivers that are not stable or secure
• Long separations from caregivers

Those who self-harm very often have a history of childhood sexual abuse. For example, in one group of self-harmers, 93% said they had been sexually abused in childhood. Some research has looked at whether certain aspects of childhood sexual abuse increase the risk that survivors will engage in self-harm as adults. The findings show that more severe, more frequent, or longer-lasting sexual abuse is linked to an increased risk of engaging in self-harm in one's adult years.

Why Do People Engage in Self-Harm?

While many ideas have been offered, the answer to this question may vary from person to person. The reasons that are most often given are "To distract yourself from painful feelings" and "To punish yourself." Research on the reasons for self-harm suggests that people engage in self harm to:

• Decrease symptoms of feeling numb or as if you are outside your body or yourself
• Reduce stress and tension
• Block upsetting memories and flashbacks
• Show a need for help
• Ensure that you will be safe and protected
• Express and release distress
• Reduce anger
• Punish self
• Hurt self instead of others

How Is Self-Harm Treated?

Self-harm is a problem that many people are embarrassed or ashamed to discuss. Often, they try to hide their self-harm behaviors. They may hold back from getting mental health or even medical treatment.

Self-harm is often seen with other mental health problems like PTSD or substance abuse. For this reason, it does not tend to be treated separately from the other mental health problems. Some research suggests, though, that adding in a round of therapy focused just on the self-harming behavior may result in less self-harming.

There have not yet been strong studies on using medicine to treat self-harm behaviors. For this reason, experts have not reached agreement on whether medicines should be used to treat self-harm behaviors.

There are people of all ages who harm themselves, but it usually starts in the teen or early adult years. Self-harm is more common in people who

• Were abused or went through a trauma as children
• Have mental disorders, such as
  • Depression
  • Eating disorders
  • Post-traumatic stress disorder
  • Certain personality disorders
• Misuse drugs or alcohol
• Have friends who self-harm
• Have low self-esteem

There are different reasons why people harm themselves. Often, they have trouble coping and dealing with their feelings. They harm themselves to try to

• Make themselves feel something, when they feel empty or numb inside
• Block upsetting memories
• Show that they need help
• Release strong feelings that overwhelm them, such as anger, loneliness, or hopelessness
• Punish themselves
• Feel a sense of control

Signs that someone may be hurting themselves include

• Having frequent cuts, bruises, or scars
• Wearing long sleeves or pants even in hot weather
• Making excuses about injuries
• Having sharp objects around for no clear reason

There are no medicines to treat self-harming behaviors. But there are medicines to treat any mental disorders that the person may have, such as anxiety and depression. Treating the mental disorder may weaken the urge to self-harm.

Mental health counseling or therapy can also help by teaching the person

• Problem-solving skills
• New ways to cope with strong emotions
• Better relationship skills
• Ways to strengthen self-esteem

If the problem is severe, the person may need more intensive treatment in a psychiatric hospital or a mental health day program.

It is important to recognize signs that you or someone you know may be in crisis.

What's Important to Know?

People can experience an emotional or mental health crisis in response to a wide range of situations. A crisis may be triggered by troubles such as problems in personal relationships or loss of a job. A crisis can lead people to consider hurting or even killing themselves (suicide). In general, Veterans are at a higher risk of suicide than civilians.

These warning signs may indicate that someone is in crisis and/or possibly suicidal:

• Hopelessness, feeling like there's no way out
• Anxiety, agitation, sleeplessness, or mood swings
• Feeling like there is no reason to live
• Rage or anger
• Engaging in risky activities without thinking about possible harm
• Increasing or excessive tobacco, alcohol, or drug abuse
• Withdrawing from family and friends
• Expressing feelings of being trapped with no way out
• Expressing overwhelming guilt or shame

These signs require immediate attention:

• Thinking about killing yourself
• Looking for ways to kill yourself
• Talking about death, dying, or suicide
• Self-destructive behavior such as drug abuse, reckless behaviors, weapon use, etc.

If you or someone else is in a serious crisis and feeling suicidal:

• Seek immediate help from your health care team or the nearest hospital emergency room
• Call 911
• During times of crisis or hopelessness, consider removing firearms from the home or using a gun lock or gun safe to make them less accessible

If someone you know is self-harming, it is important not to be judgmental. Let that person know that you want to help. If the person is a child or teenager, ask him or her to talk to a trusted adult. If he or she won't do that, talk to a trusted adult yourself. If the person who is self-harming is an adult, suggest mental health counseling.