Self-harm is the deliberate act of hurting your own body without the intent to end your life. It includes behaviors like cutting, burning, hitting, scratching, or pulling out hair. About one in five adolescents reports engaging in self-harm, and it occurs across all ages, genders, and backgrounds. While it can be frightening to witness or experience, self-harm is typically a way of coping with overwhelming emotions rather than an attempt at suicide.
How Self-Harm Differs From Suicidal Behavior
One of the most important distinctions in mental health is the difference between self-harm and a suicide attempt. Clinicians use the term “non-suicidal self-injury” (NSSI) to describe self-harm done without the intention of dying. The purpose is usually to manage emotional pain, not to escape life. Confusing the two can lead to overestimating suicide risk in some people and underestimating it in others, which affects the kind of help someone receives.
That said, self-harm and suicide are not completely unrelated. People who self-harm do face a higher risk of suicidal thoughts over time, particularly when depression is also present. One study found that suicide intent was significantly higher among people who also had a diagnosis of major depressive disorder. So while self-harm itself is not a suicide attempt, it is a signal that someone is struggling and may benefit from support.
What Self-Harm Looks Like
Self-harm takes many forms. The most commonly recognized is cutting with a razor, knife, or other sharp object, but it also includes burning with cigarettes or matches, punching walls or oneself, pulling out hair, carving words or symbols into the skin, and deliberately breaking bones or bruising the body. Some people insert objects under the skin. The injuries range from minor scratches to wounds that require medical attention and can leave permanent scars.
People who self-harm often go to great lengths to hide it. They may wear long sleeves or pants even in warm weather, avoid situations where skin is exposed (like swimming), or offer repeated explanations for visible injuries. Social withdrawal, spending more time alone, and keeping sharp objects in unusual places can also be signs.
Why People Self-Harm
From the outside, self-harm can seem impossible to understand. But research consistently identifies clear emotional functions behind it. The two most widely studied reasons are managing intense distress and influencing interpersonal situations, like communicating pain that feels impossible to express in words.
For many people, self-harm works as an emotional release valve. When feelings like anger, sadness, or numbness become unbearable, the physical sensation of pain creates a shift. It can interrupt a spiral of emotional overload or, for people who feel emotionally numb or disconnected from reality, provide a grounding sensation that makes them feel “real” again.
Self-punishment is another common driver. People who carry intense shame or self-blame may use self-harm as a way to direct those feelings outward onto the body. Others describe a sense of mastery or control: in a life that feels chaotic, self-harm becomes the one thing they can regulate on their own terms. First-person accounts also describe self-harm as comforting or even, in some cases, enjoyable in the moment. These descriptions can be difficult to hear, but they help explain why the behavior is so hard to stop. It is meeting a real need, even if it does so in a harmful way.
Who Is Most at Risk
Self-harm peaks during adolescence. Data from a large study of over 12,000 adolescents found that about 20% reported self-harm behaviors, a figure that has remained relatively stable in recent years. While it is most common in teenagers, adults also self-harm, and it can begin at any age.
Self-harm rarely exists in isolation. It is strongly associated with several mental health conditions. Among people who frequently self-harm, the most common co-occurring diagnoses are alcohol use disorders (affecting about 51% in one study), borderline personality disorder (44%), and major depressive disorder (38%). Eating disorders, ADHD, schizophrenia, and adjustment disorders also appear at elevated rates. Many people carry more than one of these diagnoses at a time. For instance, people with borderline personality disorder frequently also have depression.
Risk factors beyond diagnosis include a history of trauma or abuse, difficulty identifying or expressing emotions, social isolation, and exposure to self-harm in peers or online communities.
How Self-Harm Is Treated
The most effective treatment for self-harm is a form of therapy called Dialectical Behavior Therapy, or DBT. Originally developed for adults, an adapted version for adolescents (DBT-A) involves both the young person and their caregivers in individual and group therapy, along with phone coaching for moments of crisis. The focus is on building skills to manage intense emotions, tolerate distress, and improve relationships. In a trial of 173 adolescents, DBT-A significantly reduced both self-harm and suicide attempts compared to supportive therapy alone. It is currently the only treatment classified as “well-established” for self-harm in young people, based on multiple independent clinical trials.
Cognitive Behavioral Therapy (CBT) is another option, though the evidence for its effectiveness with self-harm specifically is more mixed. CBT helps people identify the stressors and thought patterns that precede self-harm and develop healthier coping strategies. Research suggests that CBT works best when it includes a family component, particularly for younger people. In one trial, a family-based CBT approach reduced suicide attempts at three months but did not significantly reduce non-suicidal self-injury on its own.
Treatment often also addresses the underlying conditions that accompany self-harm, such as depression or borderline personality disorder, since resolving these can reduce the emotional pressure that drives the behavior.
Coping Strategies That Reduce the Urge
Therapists often teach sensory substitution techniques as a bridge for moments when the urge to self-harm is strong. These are not replacements for therapy, but they can interrupt the cycle in the moment. The goal is to create an intense physical sensation that is not harmful. Cornell University’s Research Program on Self-Injury and Recovery recommends several, organized by the emotion driving the urge:
- When feeling angry or overwhelmed: Squeeze ice cubes in your hand, bite into a hot pepper or piece of ginger root, or throw ice against a hard surface like a brick wall.
- When feeling numb or disconnected: Hold a finger against something frozen (like ice cream in the container), take a cold bath, or stomp your feet hard on the ground.
- When craving the visual element of cutting: Draw on the skin with ice cubes made from water tinted with red food coloring.
These techniques work because they provide a sharp sensory jolt without causing tissue damage. Over time, with therapy, many people find that the urge itself becomes less frequent and less intense.
If You or Someone You Know Is Struggling
In the United States, the 988 Suicide and Crisis Lifeline is available 24 hours a day, 7 days a week. You can call or text 988, or chat online at 988lifeline.org. Services are available in English and Spanish, with interpreter support for over 240 languages. Veterans and service members can press 1 after calling 988 to reach the Veterans Crisis Line.