Understanding Self-Harm and How to Help Someone Struggling

It’s heartbreaking to see signs that a child is hurting themselves: Bruises. Cuts. Burns. Bite marks. Scratches. Missing clumps of hair.

If you’re a parent, teacher, coach, sibling or friend who sees these injuries, you probably wonder what you can do to help.

First, stay calm. Most people who engage in self-harm are not attempting suicide but are trying to deal with problems like anxiety, depression or impulse control, says UNC Health child and adolescent psychiatrist Rebecca Taylor, MD.

“Ask nonjudgmental, open-ended questions,” she says, “something like, ‘That looks like it might have been painful. Can you tell me what happened?’”

Intentional self-harm—or nonsuicidal self-injury (NSSI)—is defined as hurting yourself on purpose. Most commonly, it’s a sign of emotional distress and self-harm is a coping mechanism.

“Self-harm perpetuates itself because it does something for the person,” Dr. Taylor says. “Our goal is to understand what the driving force is behind the behavior and find healthier ways to deal with it.”

Dr. Taylor works with patients in the child and adolescent psychiatric units at UNC Hospitals. Self-harm is not the reason most are admitted to the hospital, she says. “Usually, the self-harm is secondary to depression or anxiety.”

Adolescents Are Experiencing a Mental Health Crisis

Cases of self-harm seem to be increasing, Dr. Taylor says, although reliable statistics are hard to find because most people hide the behavior. They may cut, pinch or scratch themselves on their thighs or arms, then cover the injuries and scars with clothing. For some, multiple tattoos are a way to inflict pain.

Dr. Taylor says the isolation, social upheaval and school struggles of the pandemic have undoubtedly contributed to the severity of mental health illnesses among adolescents in particular.

While children as young as 9 years old may intentionally hurt themselves, the behavior usually starts during adolescence and may continue into adulthood. People of all genders, ethnic and cultural backgrounds, sexual orientation and socioeconomic situations engage in self-harm.

In popular culture such as TV, movies and teen novels, self-harm is usually a problem for a white, middle-class girl teenager. Dr. Taylor encourages doctors, parents and others to be aware that others also may be harming themselves.

“While it is possible there is some truth to this stereotype, it is also true that when we do not look for something, we will never see it,” she advised doctors in a recent UNC School of Medicine blog post. “Our current approach and research focus may have thus far failed to appreciate the extent of NSSI in other cultures, races and ethnicities.”

Why People Engage in Self-Harm

Although people who hurt themselves are more likely than others to attempt suicide, these self-harm behaviors are not suicide attempts, Dr. Taylor says.

“Patients say to me, ‘I don’t want to die; I just want to feel better,’” she says.

There is no single or simple reason why some people engage in self-harm, Dr. Taylor says.

“Everybody has their own reasons why,” Dr. Taylor says. “Some are so overwhelmed internally that they need to find relief. Sometimes they do it to prevent themselves from acting out in worse ways. And some are just so numb that they hurt themselves just to feel something.”

She doesn’t think people hurt themselves to get attention. “I think it’s more ‘seeking connection.’ But there are healthier ways to get all those needs met.”

How to Get Help for Self-Harm

If you or a child in your care is self-harming, see your primary care doctor or pediatrician. Your doctor can help you find a therapist or psychiatrist.

“Only go to the emergency department if someone is having suicidal thoughts,” Dr. Taylor says. “They need to find someone who can work with them over time.”

A mental health professional can help build coping skills to deal with the underlying issues that result in self-harm, Dr. Taylor says.

“The goal is to understand what the driving force is and find healthier ways to deal with it,” she says.

Therapy may help a person communicate better with others and explain what is distressing them or making them angry or sad. They may learn how to walk away when they can’t cope with a situation. They can learn practical skills such as listening to music, reaching out to a friend, playing a video game, watching a movie, or finding another distraction until they are calm and better able to deal with the problem.

While their loved one is getting better, parents and friends can reduce exposure to implements that can be used to self-harm, such as razor blades (including those inside pencil sharpeners and eyebrow pencils), knives, scissors, lighters and matches.

Try not to lecture or shame the person who is struggling, Dr. Taylor says.

“It’s important for everyone to know that things can get better,” she says.

If you or a loved one is hurting themselves, talk to your doctor, or find one near you.