Written By: Emily Vanderhoff, LMSW

Edited By: Dana Reszutek, LMSW, and Taylor Transtrum

Have you ever been in an environment that made you feel uncomfortable or caused you feelings of immediate fear, anger or a sense of danger? What thoughts go through your mind when in that environment? To some, we can easily remove ourselves from that environment and know we are safe. This is not always the case when our survival responses to healthy coping skills are not utilized. In many cases, non-suicidal self-injury (NSSI) can be our response. In fact, in a 2015 study published in the American Journal of Public Health, it was found that self-injury was common among American adolescents—with 1 in 10 high-school aged boys and 1-4 high-school aged girls in a given year. Read on to learn more about what self-harm is, how to help-others who self-harm, and how to get help for ourselves with self-harm.

What is self-harm/self-injury?

In psychology, non-suicidal self-injury (NSSI) is seen as a behavioral response to upsetting feelings when a person feels no other coping skills are useful. Self-injury/self-harm is used at times to dissociate or distract from the true emotional pain present.  NSSI involves a person hurting themselves on purpose. One reason people participate in self-harm is if they feel as if they are either emotionally numb, or are experiencing extreme emotions outside of their control, and want to be able to feel a sense of control over what they are going through.

Common forms of self-harm include:

• Cutting self with a sharp object
• Burning yourself
• Pulling out hair (this can include eyebrows and eyelashes)
• Picking at wounds to prevent healing
• Breaking bones
• Inserting objects into one’s body
• Hitting self with objects
• Carving words or symbols into the skin

Self-harm is a potential risk factor or warning signs for suicidal thoughts, or suicide attempts. However, research shows there’s a direct difference between self-injury and suicidal ideations. The main difference involves someone’s true intent to die. Those who participate in self-harm or self-injury do so as a behavioral response to distress, not with the intent of ending their lives are doing so as a behavioral response.  While self-harm is prevalent among all age groups, self-harm often starts in adolescence.

How can you help someone who is self-harming?

As a caretaker or friend it can be helpful to understand warning signs or triggers of self-harm. Those who self-harm may attempt to hide their injuries with bandages, covering potential scars or bruises. Wearing long-sleeve shirts, regardless of the weather, is another common indication of self-harm. Other warning signs can involve an increase in a student skipping classes, decrease in social interactions and participation in once enjoyable activities. 

A possible warning sign of self-harm could be a friend or loved one who might have once loved to swim but no longer is comfortable wearing a bathing suit around others. Not all of these changes or warning signs correlate with self-harm. It is important to be supportive to those we worry for and provide a safe place for emotional expression, rather than accusing them of self-harm.

The National Alliance on Mental Illness provides helpful information on how someone could respond to knowing of self-harm. It is important to comfort the individual and understand the subject can be difficult to express. If you do not fully understand, allow that person to know you are there to listen. 

If you are someone or know someone who is self-harming/self-injuring, speak to an adult or medical professional. A close friend can be helpful in listening as well. 

Once the behavior is known, it is important to let the individual know they can be cared for.

Common forms of treatment include:

• Psychotherapy – focuses on past experiences and emotions
• Cognitive Behavioral Therapy – focuses on recognizing negative thought patterns and increasing coping skills
• Dialectical Behavioral Therapy – can help a person learn positive coping method

In some cases medications can be provided for assistance and in severe cases, hospitalization may be encouraged. 

 Sadly, there can be long-term effects of self-injury if the behavior is left untreated. This can include permanent scars or severe injury; worsening feelings of guilt, shame, or hopelessness; and damage to social relationships. 

Being a listener first and a helper second is key to allowing someone in need know you care.  If you or someone you know is self-harming, please reach out to an adult or medical professional for help. 

How do I get help if I self-harm?

Let a loved one and trusted individual know if you are participating in self-harm, and ask for help. The following resources are also available to those who have experienced self-harm.

Self-Harm Crisis Hotlines:

• Self-Harm Crisis Text Line
  • Text “HOME” to 741741 to connect with a volunteer crisis counselor
  • Available 24/7
• S.A.F.E. Alternatives
  • Call or text 1-800-366-8288 for support/resources on how to stop self-harming
  • Visit the “resources” page on www.selfinjury.com for articles, videos, impulse control logs, research and more
• Boys Town National Hotline
  • Call 1-800-448-3000 to speak with a trained crisis counselor
  • Available 24/7

Emergency Resources

• If you are experiencing a self-harm or suicidal crisis, or another mental health crisis, call 988 for help (available 24/7). 

If you or someone you know is experiencing a severe and immediate case of danger, call 911 for immediate assistance or go to a nearby emergency room.

In addition to the resources above, therapy can help address the root causes of self-harm, such as anxiety and depression, and provide us with healthy coping skills to respond to factors that lead to self-harm. To learn more about Valera Health’s virtual therapy services, request a free consultation with a designated Health Connector here or visit www.valerahealth.com to learn more. Treatment services are available for those ages 6+.

Works Referenced:

(n.d). Self-harm. NAMI: National alliance on mental illness. Retrieved from: https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Self-harm.

(n.d). Understanding self-injury/self-harm. Mental Health Literacy. Retrieved from: https://mentalhealthliteracy.org/understanding-self-injury-self-harm/

(n.d.). Understanding self-injury. The Jed Foundation. Retrieved from: https://jedfoundation.org/resource/understanding-self-injury/

Hendel, H. J. (2018). Why do some people harm themselves? National Alliance on Mental Health. Retrieved from: https://www.nami.org/Blogs/NAMI-Blog/March-2018/Why-Some-People-Harm-Themselves

Monto, M.A., McRee, N., & Deryck, F.S.  Nonsuicidal self-injury among a representative sample of US adolescents, 2015. Am J Public Health. 2018 August: 108(8) 1042-1048. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050840/