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Your Questions About Self-Harm, Answered

According to a recent study, nearly 1 in 4 teenage girls have engaged in self-harm. This means that self-harm is much more common than we may have thought, identifying self-harm as a serious public health problem. But there are still a lot of misconceptions about what self-harm is and how to help someone who’s engaging in it.

Here’s what you need to know.

What is self-harm?

Self-harm (sometimes referred to as self-injury or self-mutilation) is defined as the direct and intentional injuring of one’s own body tissue. The most common form of self-harm is cutting. However, self-harm can include burning, head banging, throwing yourself against a wall, scratching yourself, biting yourself and intentionally bruising yourself. In some cases, disordered eating and substance abuse can be viewed as self-harm.

Who self-harms?

Adolescents typically begin to self-harm when they’re 13-16 years old. Research shows that girls self-harm more often than boys do. However, it may be that boys self-harm in less obvious ways, such as by abusing substances instead of cutting. Or, it could be that girls are simply more likely to report self-harm and other mental health concerns.

What we do know, is that experiencing trauma (such as abuse or assault), being a victim of bullying, not having a supportive person in your life, or experiencing consistent invalidation can all put someone at an increased risk for self-harm. LGBTQ adolescents, especially transgender youth, are also at an increased risk for self-harm, due to the intense invalidation they experience.

Why do people self-harm?

People self-harm for a variety of reasons. They may want to “feel something,” to “distract from emotional pain by inflicting physical pain,” to punish themselves, or to communicate distress. The common theme is that teens self-harm when they’re “emotionally dysregulated.” This means they feel overwhelmed by an emotion (e.g. sadness or anger) and their emotion has complete control. They feel like they can’t use effective coping skills (e.g. talking to a friend, journaling, or going for a run) to help them calm down. As a result, their emotion intensifies to the point where it feels like nothing can help, and the only way to deal with it is to hurt themselves.

Does self-harm work?

No. Self-harm is an ineffective way of dealing with pain, as it does not solve a person’s problems. Instead, it can get in the way of a person’s ability to achieve their long-term goals.

Are people who self-harm suicidal?

The short answer? Maybe. In most cases, people who self-harm are NOT trying to commit suicide. However, some young people who physically hurt themselves may be hoping that the injury is severe enough to kill them.

But while self-harm does not mean that a teen is suicidal, there is a strong relationship between self-harm and suicide. Seventy percent of teens who engage in self-harm have reportedly also attempted suicide, with more than half of those individuals attempting suicide on multiple occasions. Remember, teens don’t attempt suicide because they self-harm. Rather, the emotional distress and pain that can lead to self-harm can also lead to suicide.

How is self-harm treated?

Young people are resilient, and with support and counseling they can learn skills to manage their emotions in healthier ways. As part of my job at the Mount Sinai Adolescent Health Center, I co-run a Dialectical Behavior Therapy (DBT) program to teach young people skills to manage their emotions, like mindfulness, communication, tolerating distress, and skills for navigating teenager and family challenges. DBT helps young people create a toolbox of coping skills to use when they feel overwhelmed, so they don’t have to resort to self-injurious behaviors. When teens learn and use coping skills, they build confidence, which helps them feel better overall and decreases the urge to self-harm. Consistent therapy and learning coping skills is key to treating and reducing self-harm behaviors and emotional distress.

What can I do to help?

If you’re worried about someone in your life, talk to them. Be non-judgmental. Ask them how they’re feeling or what they’re going through. Avoid saying things like, “I can’t believe you would do this,” or “Things can’t be that bad.” Instead, validate their emotions. Remember, validation does not equal agreement. It simply entails reflecting back to a person their emotional experience. For example, saying to a friend, “I’m hearing you say that you’re in a lot of pain.”

If you’re concerned that they might be thinking about suicide, ask.

If talking is hard for you, use your actions! You can help a friend or family member by doing fun or relaxing activities with them. Going to the movies or eating ice cream together can make them feel happier and connected to others and distract them from their urge to self-harm.

It may feel like it’s a lot to handle, but you don’t have to do it alone. Connect the young person with a professional who is trained to support young people through these types of challenges.

If you or a young person you know has purposefully injured themselves or thought about suicide, get support. You are not alone.

Dr. Lindsay Gerber is an Assistant Professor and Licensed Psychologist in the departments of pediatrics and psychiatry at the Mount Sinai Adolescent Health Center. She earned her doctorate in Clinical and School Psychology from the Ferkauf Graduate School of Psychology in New York and completed post-doctoral training at Mount Sinai St. Luke’s Hospital Center, with a focus on high risk adolescents and Dialectical Behavior Therapy (DBT). Dr. Gerber’s areas of interest include severe psychopathology in adolescents and young adults, co-occurring disorders (mental health and chemical dependency), trauma, and diversity issues.

The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.

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