We all have ways of dealing with overwhelming negative feelings like stress, pressure, and even numbness. If someone deliberately hurts their own body as a way of dealing with their own negative emotions, they are engaging in non-suicidal self-injury, which is sometimes called “self-harm,” “deliberate self-harm,” or simply “self-injury.” Self-injury is most common in teenagers and young adults. Indeed, nearly one in five teenagers report that they have ever self-injured.
The difference between the kind of self-injury that is used to feel better (or to feel at all) and the forms of self-injury with suicidal intent can be hard to tell. Most self-injury, especially in teens and young adults, is non-suicidal, which means that they do not want to die–they just want to feel better. But non suicidal self-injury is not a safe or healthy way to cope with emotions, and can have long-lasting physical and emotional effects.
If you or someone you know is exhibiting signs of self-injury, text “START” to 741-741 or call 1-800-273-TALK (8255)
Common Forms of Self-Injury
There are a lot of ways people can hurt their bodies, and most people who use self-injury to feel better hurt themselves using different methods. The most common forms of self-injury include:
- Severe scratching
- Punching or hitting or other objects, like a wall with the conscious intention of hurting their body
- Carving words or symbols into their skin
Tattooing and piercing are not considered non-suicidal self-injury, although some people may use these practices as a way to self-injure.
Sometimes people who self-injure inadvertently hurt themselves more seriously than they intend to and may need medical attention. When this happens, the person who injures may resist seeing a medical doctor, even if they may need stitches or other care. Offering to accompany a friend in this situation to the emergency room or calling a family doctor for advice on treating an open wound can be helpful. If you are worried that the unintentionally serious wound may be lethal, call 9-1-1.
Understanding Patterns of Self-Injury
Self-injury isn’t always obvious–in fact, a lot of people who self-injure try to hide their behavior from others. That’s why in addition to knowing what methods people use to hurt themselves, it’s also important to understand why they self-injure–and how and why they try to hide what they’re doing to themselves.
Self-Injury as a Coping Mechanism
People who self-injure use behaviors like cutting, scratching, or burning as a way to cope with overwhelming feelings–or lack of feeling at all, a condition called “dissociation.” There are a lot of different reasons people give for doing it, but some of the most common are to:
- Manage or distract from negative or unwanted feelings
- Express feelings that feel overwhelming and hard to share otherwise
- Feel something if they feel numb emotionally
- Feel a sense of control
- Show people in their lives that they are hurting
- Punish themselves for things they believe they’ve done wrong
Self-Injury is often cyclical
Many people who use self-injury as a primary way of coping go in and out of periods where they self-injure. So they may use cutting or other forms of self-injury over a period of time–for example, when they are going through a stressful situation–then stop for a while. Sometimes they can stop for weeks, months, or even years.
However, unless they find and use other more healthy ways of coping, they are likely to turn to self-injury again to manage stress or negative feelings. This can make loved ones who are aware of the self-injury feel like they are walking on eggshells, since they never know when their friend or family member may start injuring themselves again. This is a challenging pattern to stop without help. If you or someone you know is self-injuring, it’s important to reach out for support.
Hiding Self-Injury Behavior
Although it’s relatively common, many people self-injure in private, making it difficult for others to detect. Watch out for signs that someone may be hiding evidence of self-injury, including:
- Clustered or patterned wounds, scars or other marks on the body. Hands and arms are the most common areas for injury, but people can harm themselves on any part of their body.
- Covering up common areas for injuries. For example, constantly wearing wristbands or dressing in long sleeves during the summer.
- Avoiding activities or events with exposed skin. For example, avoiding swimming or changing for gym class.
Not all of the effects of self-injury are physical–it can also impact people’s behavior and emotional well-being. Changes in mood or behavior can be signs of several other mental health challenges, but if you notice this in combination with the above signs of self-injury, it’s important to check in with the person.
- Changes in behavior or activities. For example, disconnecting from friends or family, or avoiding activities they used to enjoy.
- Changes in mood or affect. For example, being more withdrawn, depressed or anxious than usual, having more unstable or unpredictable moods, or expressing feelings of worthlessness.
About a third of people who self-injure say that no one in their lives knows or suspects that they self-injure. When someone does know or suspect, it is most likely to be a friend or family member. If you think your friend might be harming themselves, it’s important to reach out for help.
In addition to these behaviors, the stigma around self-injury may leave many people feeling ashamed or embarrassed, which can keep them from reaching out for support. If you or someone you know are struggling with your feelings around self-injury, text “START” to 741-741 or call 1-800-273-TALK (8255) for a free, confidential conversation.
Long-Term Effects of Self-Injury
If left untreated, self-injury can cause long-term emotional effects and physical consequences, including:
- Permanent scars
- Uncontrolled bleeding
- Severe, possibly fatal, injury
- Infections from untreated wounds or from sharing self-injury implements, like razor blades, with others
- Worsening feelings of guilt, shame, or hopelessness
- Damage to relationships with friends or loved ones
- If self-injury is being used as a coping mechanism for an underlying mental health issue like depression, the underlying issue may become more serious
Does Self-Injury Lead to Suicide?
While non-suicidal self-injury can be a risk factor for suicidal thoughts or actions, most often it is something that people do to manage stress.
But, while non-suicial self-injury is genereally used to feel better and does not, in and of itself, lead to suicidal thoughts and behaviors, it’s a sign that someone is struggling and can signal that they are at risk for suicide. And, if someone becomes suicidal, research shows that having experience hurting their body can make it easier for them to end their life. Because of this, it’s important to keep an eye out for commons signs of suicidal thoughts or behaviors, including:
- Talking about wanting to “end it all” (either in person, over text, or posting on social media)
- Expressing guilt or hopelessness by saying things like “I’m a terrible person,” “What’s the point, things will never get better,” or “No one would miss me.”
- Escalating self-injury by asking about or getting hold of dangerous things like weapons or pills
- Giving away personal possessions
- Misusing drugs and alcohol
How to Help Someone Who’s Self-Injuring
Because self-injury can lead to unintended serious injuries–perhaps even lethal injuries–and may leave lifelong scars, it’s important to trust your instincts if you suspect that someone you know is self-injuring.
If you’re worried that a friend is hurting themselves, try asking them about what you’ve noticed and letting them know that you want to support them in seeking help. Remember, it’s common for people who self-injure to keep it secret, so they may not want to admit it or talk about it. If they don’t want to, you can keep the door open for future conversations by reminding them that you care about them and you’re a safe person to talk to.
If you’re unsure if a friend is struggling with self-injury or don’t know what to do next, consider expressing your concerns to a mutual friend or trusted family member. They may have insights into what your friend is experiencing and how to help.
Helping friends can sometimes impact our own mental health, so it’s just as important to trust your instincts about your own feelings, too–remember, it’s okay to ask for your own support while you’re helping a friend.