Self-Harm (Nonsuicidal Self-Injury Disorder)

What is self-harm?

Self-harm is when you injure yourself on purpose. Also known as nonsuicidal self-injury disorder, people who self-harm do things to hurt themselves but don’t want to cause death. They may injure themselves:

• To help them cope. Some people self-harm because it feels good to them, to prove they can tolerate pain or to relieve negative feelings.
• To direct emotion inward. Some people self-harm to punish or take out their anger on themselves.
• To communicate with others that they’re in distress or need support.

How do people with this disorder harm themselves?

Self-harm can take many forms. Some are more common than others, but all come with risks. Some of the most common self-harm behaviors include:

• Cutting with sharp objects to break through or injure skin.
• Burning with something hot like cigarettes, matches or heated sharp objects, or with chemicals like household cleaning products.
• Hitting with solid objects — like punching a wall — which can lead to impact injuries.
• Scratching/rubbing that leads to skin damage.

What are the symptoms of nonsuicidal self-injury?

If you self-harm, you may try to hide it from those around you. You might wear long sleeves or pants to cover up, even if it’s hot outside. Or you might tell stories to explain your injuries as an accident. Even so, other people might notice the following symptoms of self-injury:

• Scabs or scars in a particular shape or cluster.
• Multiple burns in the same size or shape.
• Frequent accidents that lead to new scratches, bite marks, bruising or swelling.
• Issues with impulse control, like they just can’t stop scratching an area of skin.

Where on the body do people self-harm?

The most likely body areas for a person to injure are:

• Arms (especially their forearms).
• Wrists.
• Front of their thighs.
• Abdomen.

Self-injury is less common elsewhere on their body but is still possible.

What causes someone to self-harm?

It’s hard to say exactly what causes a person to self-harm. But certain mental health conditions are linked to self-injury, including:

• Anxiety.
• Autism.
• Bipolar disorder.
• Borderline personality disorder.
• Depression.
• Disruptive, impulse-control and conduct disorders, like conduct disorder and intermittent explosive disorder.
• Dissociative disorders, especially dissociative identity disorder and dissociative amnesia.
• Eating disorders, especially anorexia nervosa.
• Obsessive-compulsive disorder.
• Post-traumatic stress disorder (PTSD).
• Sleep disorders.
• Substance use conditions and disorders, including alcohol intoxication, alcohol use disorder and cannabis use disorder.

What are the risk factors for nonsuicidal self-injury disorder?

Risks for nonsuicidal self-injury include:

• Abuse or trauma. Self-harm is more common among people with a history of trauma or abuse (including childhood abuse or other adverse events).
• Age. Self-harm behaviors are most likely to start between ages 12 and 14. But it can start earlier. People who self-harm often continue to do so for years. Self-harm is common in young adults, especially people in college.
• Sexual orientation. People who belong to sexual minorities (meaning they aren’t heterosexual) have higher rates of self-harm. Experts believe the self-harm rates are higher because sexual minority individuals are more likely to face adverse life events.
• Social isolation. People who feel socially isolated or rejected, especially children and teenagers who experience bullying or social isolation for other reasons, have higher rates of self-harm.

How is it diagnosed?

Nonsuicidal self-injury disorder can be difficult to diagnose. People who self-harm tend to hide their injuries and avoid talking about them.

Healthcare providers don’t use a specific test to diagnose self-harm. Instead, they inspect your injuries, looking for patterns and scars from previous self-harm. They ask questions about your medical and social history. They also talk with you about what’s going on in your life. They look for things that might add stress, like financial problems, a recent death in the family, trouble at school, bullying or a break-up.

How is self-harm treated?

If you see a healthcare provider about self-harm, they’ll first treat your injuries if needed. Longer term, they may recommend therapy and/or medications to help manage underlying mental health conditions and life stressors.

What are the possible risks of not treating self-harm?

Getting treatment for self-harm is important because it has several potential short- and long-term risks.

Short-term risks

Sometimes, self-harm leads to issues you didn’t intend, including:

• Medical complications. Self-harm behaviors can lead to infections, nerve damage and permanent and/or severe scarring. Sometimes, it can lead to severe injuries or death.
• Social problems. Self-harm can — intentionally or unintentionally — affect your relationships with family, friends or other loved ones. It can also affect how you feel in social settings like work or school.

Long-term risks

Self-harm can also lead to long-term issues, including:

• Worsening mental health. Self-harm can lead to feelings of shame, guilt or regret. You might worry about people noticing your injuries and go to great lengths to cover or hide injuries or scars.
• More severe injuries. Self-harm behaviors can often escalate. You might start to self-harm more frequently or your self-harm may become more severe.
• Suicide risk. Nonsuicidal self-injury disorder doesn’t involve suicidal intent. But the risk of attempting or dying by suicide is much higher for people who self-harm.

Can self-harm be prevented?

Preventing first-time self-harm isn’t always possible, but seeking help from a mental healthcare provider can reduce the chances that someone will continue to self-harm.

When should I see a doctor about self-injury?

If you realize that you (or notice that someone you care about) are self-harming, reach out to a healthcare provider. Your injuries may require medical care. It may also help to know that you’re not alone. Your healthcare provider is there to listen and support you. They’ll recommend a treatment that’s right for you.

When should I go to ER?

You should go to the ER or call 911 (or your local emergency services number) if you feel like you’re in immediate danger of harming yourself or others. In the United States, you can also dial 988 to speak with someone at the Suicide & Crisis Lifeline.

You should also seek emergency care if your injury is severe, including if it causes:

• Difficulty breathing.
• Bleeding that won’t stop.
• A physical deformity.
• Loss of motion in your arm or leg.

How does pain affect people who self-harm?

Part of why self-harm can be a coping mechanism is because of how your body processes and reacts to pain.

When your body encounters something that can damage it, nerve endings in the affected areas send emergency signals to your brain. One of the things your brain does in response to those signals is to release beta-endorphins. These chemicals trigger a domino effect that makes you feel better for a short time. But the effect doesn’t last very long. So, people who self-harm may use it more often to try to feel better.