Self-harm

If you have hurt yourself and the injury is serious, if you have taken something, or if you are thinking about ending your life, get help immediately:

• Call 911 in the US, or your local emergency number.
• In the US, call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day.
• In the UK and Ireland, call Samaritans free on 116 123.

If you are worried about someone else who is in immediate danger, stay with them if it is safe to do so and call for emergency help.

You do not need to be in a life-threatening situation to reach out. Crisis lines also support people who are struggling with urges to self harm, feel overwhelmed or simply need to talk to someone right now.

Self harm is any act of intentionally injuring yourself. Cutting is one of the most widely known forms, but self-injury can also include burning, scratching, hitting, interfering with wound healing, or other ways of causing pain or damage.

Mental health professionals use the term non-suicidal self-injury (NSSI) when the person does not intend to die. For many people, self harm is a way to survive painful feelings rather than to end their life. Even so, self harm is linked to a higher risk of suicidal thoughts over time, so it should always be taken seriously and met with care.

Self harm can affect anyone, regardless of age, gender or background. It often begins in adolescence, which is why self harm in teens is a particular concern for parents and schools, but adults self-injure too. It is often kept secret because of shame or fear of others' reactions.

People self harm for many different reasons, and these can change over time. Common reasons people describe include:

• Getting temporary relief from intense emotions such as anger, sadness, shame or panic.
• Feeling something when they feel numb or disconnected.
• Punishing themselves because of self-hatred or guilt.
• Expressing pain that is hard to put into words.
• Feeling a sense of control.

The relief is real but short-lived, and it is often followed by guilt or shame, which can feed the cycle.

Risk factors include depression, anxiety, trauma or abuse, bullying, eating disorders, difficulties regulating emotions, borderline personality disorder, substance use, isolation and difficulties related to identity or relationships. Self harm is not a diagnosis by itself; it is a signal that someone needs support with what lies underneath.

People who self harm often hide it, so signs can be subtle:

• Unexplained cuts, burns, bruises or scars, often on arms, thighs or stomach.
• Wearing long sleeves or covering up even in hot weather.
• Keeping sharp objects or first-aid supplies hidden.
• Spending long periods alone, especially in the bathroom or bedroom.
• Withdrawal from friends and activities, low mood or irritability.
• Talking about feeling worthless, hopeless or like a burden.

If you are worried about a young person or adult, stay calm and approach them privately. Say what you have noticed without judgment, listen more than you speak and avoid ultimatums or anger, which can increase shame and secrecy. Let them know that help exists and offer to support them in finding it. If there is any risk to life, contact emergency services.

Professional support focuses on understanding what self harm does for the person and building safer ways to cope with distress.

Evidence-based approaches include:

• Dialectical behavior therapy (DBT): teaches skills for tolerating distress, regulating emotions and managing relationships. It has strong evidence for reducing self-injury, including in adolescents.
• Cognitive behavioral therapy (CBT): helps identify triggers and change thoughts and behaviors linked to self harm.
• Mentalization-based therapy and family-based approaches, particularly for young people.

A psychiatrist may also assess and treat underlying conditions such as depression, anxiety or trauma, which can include medication when indicated.

A clinical psychologist, psychiatrist or psychologist will usually start by asking about your safety, what you are going through and how self harm fits in. Together you will create a safety plan: a written list of warning signs, coping strategies and people to contact when urges are strong.

Stopping often takes time, and setbacks do not mean failure. Strategies that some people find helpful while they work with a professional include:

• Delaying the urge: wait a few minutes and do something else; urges often peak and pass.
• Holding ice, taking a cold shower or splashing water on your face to change your body state.
• Intense physical activity, such as a brisk walk.
• Reaching out to a trusted person or a crisis line.
• Writing down or drawing what you feel.
• Removing or putting distance between yourself and the means you use.

If you do hurt yourself, take care of the wound and seek medical attention if it is deep, bleeding heavily or shows signs of infection. Be as kind to yourself as you would be to a friend. You deserve support, not punishment.