Overview

What is self-harm?

Self-harm is when you intentionally injure yourself for a psychologically motivated reason. This includes a wide range of actions and injuries. The most common and best-known form of self-harm is “cutting.” But self-harm can refer to several other forms of harm, too.

There are two main categories of self-harm, and while their intents are different, both are still dangerous. The two categories are:

Nonsuicidal: This is when you deliberately injure yourself for a psychologically motivated reason, but your intention is NOT to cause death. The medical term for this is “nonsuicidal self-injuries,” or NSSIs.
Suicidal: This is self-harm where a person intends to die, regardless of whether or not they do.

Is self-harm a mental health emergency, and what are some ways to get help?

People who engage in self-harm have a much higher risk of having suicidal thoughts or attempting suicide in the future. Self-harm also poses a risk to your health. Because of this, self-harm needs treatment, including medical care for injuries and mental healthcare for psychological concerns.

You should get immediate help if you have thoughts about harming yourself or others, or if you suspect someone you know is in danger of harming themselves. Resources that can help you include:

National Suicide and Crisis Lifeline (United States): This line can help you if you have suicidal thoughts or impulses. You can also call this line even when you’re not in crisis. To call this line, dial 988. You can also get help via text message. To do so, text HELLO to 741741.
911 (or your local emergency services number): You should call 911 (or the local emergency services number) if you feel like you are (or someone you know is) in immediate danger of self-harm or suicide. Operators and dispatchers for 911 lines can often help people in immediate danger because of a severe mental crisis and send first responders to assist.

What are some forms of self-harm?

Self-harm can take many forms. Some are more common than others, but all come with risks. 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.

Most people who self-harm use more than one means to do so at some point in their lives. Some of the most common self-harm behaviors (with more about them below) are:

Cutting.
Burning.
Impact injuries (hitting).
Scratching/rubbing.
Poisoning.
Hair-pulling/skin-picking.

Cutting

This is the most common form of self-harm, accounting for about 70% of cases. Cutting is also the most common form of self-harm among women and people assigned female at birth.

Cutting involves using sharp-edged objects to create cuts (lacerations) on your skin. The most common objects used are knives, razor blades, box-cutter blades, surgical blades or other sharp-edged objects. Sticking and stabbing are similar to cutting and can involve pointed items like needles.

Cutting injuries often have certain features:

Injury patterns: Cuts or scars often run in parallel lines or perpendicular line patterns (like a hashtag, number sign or tic-tac-toe grid).
Clustering: A person who cuts to self-harm often makes multiple cuts in the same “session.” These are typically several distinct cuts arranged in a pattern. Experts call these patterns “clusters” or “groupings.”
Depth: Cutting injuries can be shallow, affecting only the outermost layers of skin, or deep, cutting through your skin and into the fat or muscle tissue underneath.

Burning

Burns are a common form of self-harm. They’re more common in men and people assigned male at birth. Thermal (heat) burns are the most common, but chemical burns (such as from household products like cleaning chemicals) are also possible.

Cigarettes or matches are among the most common objects used for self-injury burns. Cigarettes typically leave circle-shaped burns about 6 millimeters to 8 millimeters across, roughly the same width as a green pea.

Impact injuries (hitting)

Impact injuries involve hitting part of your body against something solid or causing something solid to hit you, such as hitting your head or fist against something solid. Impact injuries are the most common form of self-harm among people assigned male at birth.

These kinds of injuries cause bruises (contusions) and swelling. When they’re more severe, they can lead to serious injuries like bone fractures or compartment syndrome.

Scratching/rubbing

Scratching or rubbing injuries are a form of self-harm that can create minor, harmless-seeming injuries. These can involve fingernails or objects that can damage your skin.

Scratches happen when something damages the outermost layers of your skin. Depending on their depth, these injuries may or may not bleed.

Rubbing-related injuries may involve simple pressure only. Repeated pressure or rubbing can wear away your outer layers of skin. Over time, rubbing or scratching will wear through your skin and a wound will form.

Poisoning

People sometimes use self-poisoning as a way to self-harm. This can be things you swallow or ingest, inhalants or toxic substances you apply to your skin. This isn’t as common, but it’s still possible.

Hair-pulling/skin-picking

Sometimes, self-harm can involve actions that are symptoms of specific mental health conditions. Two examples of this are hair-pulling (trichotillomania) and skin-picking (dermatillomania). These conditions are in the same class as obsessive-compulsive disorder (OCD).

The key feature of these is the behaviors are compulsive or hard to resist. Hurting yourself isn’t the goal with those conditions, so experts classify them differently from nonsuicidal self-injury behaviors. However, these two conditions do cause harm and can happen for similar reasons.

How common is self-harm?

Self-harm is widespread. About 15% to 20% of teenagers and young adults will self-harm at some point. About 6% of adults report that they have a history of it, but experts aren’t sure exactly why that total is so much lower than the rates in teenagers and young adults

Possible Causes

What are the conditions where self-harm is a possible symptom?

Self-harm can happen in connection with several conditions. These conditions don’t necessarily cause self-harm, but they’re more likely to be present in people who self-harm and may contribute to it. They include, but aren’t limited to:

Anxiety disorders.
Autism spectrum disorder (ASD).
Bipolar disorder.
Borderline personality disorder.
Depressive disorders.
Disruptive, impulse-control and conduct disorders, such as conduct disorder and intermittent explosive disorder.
Dissociative disorders, especially dissociative identity disorder and dissociative amnesia.
Eating disorders, especially anorexia nervosa.
Gender dysphoria.
Obsessive-compulsive disorder.
Sleep disorders (including disruptive sleep disorders).
Substance use conditions and disorders, including alcohol intoxication, alcohol use disorder and cannabis use disorder.
Trauma- and stressor-related disorders, especially post-traumatic stress disorder (PTSD).

NOTE: The above list only includes conditions where self-harm is intentional. It doesn’t include conditions where a person may unintentionally harm themselves because of the symptoms or effects of another condition.

Why do people self-harm?

There are three main reasons why people self-harm:

As a coping mechanism.
As a form of self-punishment or a self-directed outlet for negative feelings.
To influence others.

While these cover a wide range of motivations, everyone is different and that makes their reasons unique to them. Because the motivations can be as unique as the person who describes them, the examples under the headings below are just some of the many possible motivations.

Self-harm as a coping mechanism

People who self-harm often do so because it temporarily relieves negative feelings or breaks through feelings of physical or emotional numbness.

Some of the most common coping mechanism motivations for self-harm include:

To calm yourself.
To feel something (breaking through emotional numbness, dissociation or feeling disconnected from yourself or the world around you).
To stop thoughts of suicide.
To create an injury that’s directly treatable, unlike emotional symptoms or distress.
To prove to yourself that you can tolerate the pain.
To cause positive feelings (see below under “How pain affects people who self-harm” for an explanation of how this works).

How pain affects people who self-harm

Part of why self-harm acts as 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 (some experts write this as “ß-endorphins,” using the Greek letter “beta”).

Beta-endorphins have two main effects:

Pain relief: Beta-endorphins are similar to opioid painkillers like morphine, but are much stronger. Beta-endorphins restrict how pain signals reach your brain.
Dopamine increase: Beta-endorphins indirectly increase dopamine levels in your brain. Dopamine boosts your mood and sense of well-being (among many other effects). That’s why it’s sometimes known as your brain’s “feel-good” chemical.

Combining those two effects means self-harm triggers a domino effect that makes you feel better for a short time. However, because the effect doesn’t last long, the improvement isn’t sustainable, so people who self-harm may use it more often to try to feel better.

Research also shows self-harm has similarities with substance use disorders. That means people who self-harm start to rely on its effects, which can lead to a cycle of self-harm that worsens over time.

As a self-directed outlet for negative feelings

Some people use self-harm to direct negative emotions inward. Those who do this often express that they self-harm to punish or take out anger on themselves. This may be why self-harm often happens with conditions that involve self-destructive behaviors, such as borderline personality disorder (BPD).

To influence others

Some who self-harm do so in an attempt — either consciously or unconsciously — to influence others. This only happens in a small number of cases, and the motives behind this can vary widely.

This kind of self-harm is most likely to happen for the following reasons:

To feel independent or show that you don’t need help from others.
To create distance or boundaries between you and others.
To show others that you’re experiencing severe pain.
To signal others that you need help or support.
To fit in with others who also self-harm or don’t disapprove of it.
To cause distress (as a means of revenge) to others.

Who is most likely to self-harm?

Self-harm is most likely to happen in people with certain characteristics or life circumstances. The circumstances include (but aren’t limited to):

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. However, self-harm 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 or other types of post-high school education.
Gender identity: People who aren’t cisgender have higher rates of self-harm. Experts link that to a higher risk of adverse life events, including abuse, bullying and more.
Sexual orientation: People who belong to sexual minorities (meaning they aren’t heterosexual) also have higher rates of self-harm. Similar to what happens to people who aren’t cisgender, experts believe the self-harm rates are higher because sexual minority individuals are more likely to face adverse life events.
Social reasons: 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.

What are some signs of self-harm to watch for other than visible injuries or scars?

Certain specific behaviors can indicate that someone is currently self-harming or did so recently. Other, more general, behaviors can indicate that a person is experiencing difficulties related to their mental health and well-being. Signs to watch for include:

Covering up: Deliberate efforts to cover certain areas of their body, especially their arms, wrists, thighs and abdomen, may indicate current or recent self-harm. Long garments that cover those areas, such as long sleeves or long pants, or certain kinds of accessories (wristbands, watches, bracelets, etc.) may also be attempts to cover body areas where a person self-harms. This is especially noticeable during warmer weather or in situations where dressing like that would seem unusual or out of place.
Avoiding situations where self-harm would be visible: While there are many reasons why people might not feel comfortable changing clothes in front of others or wearing shorter or lighter clothing items (especially for religious, cultural or personal preference reasons), noticeable avoidance of these situations may be a sign of self-harm.
Behavior changes: People who self-harm may show it in other ways. These can include changes in habits like avoiding social situations, withdrawing from loved ones and losing interest in things they recently enjoyed. Noticeable mood changes are possible warning signs, especially reduced emotions or emotions that can change quickly.

It’s important to keep in mind that there’s a difference between being observant and being intrusive. Someone who self-harms may feel like they’re being spied on or otherwise having their privacy invaded, and that can cause them to isolate more. If you notice behaviors that you think are causes of concern, it’s best to talk openly with your loved one rather than hover or pry.

Care and Treatment

How is self-harm treated?

Treatment for self-harm can involve multiple forms of medical care. Treatment for the injuries depends on the injury type(s), location(s), severity and more (see below under the “Treatment” section for more about the possible treatments that might be necessary).

Mental healthcare is also an important part of helping people who self-harm. This usually happens through treating mental health conditions that are causing or contributing to self-harm. Treatments can include medications and various forms of mental health therapy. The ultimate goal of mental healthcare is to help people find safe, effective ways to manage their feelings, so they don’t have to rely on self-harm to feel better.

Because so many mental health conditions can contribute to self-harm, there are also many medications and therapy approaches that can help. Your healthcare provider is the best person to explain and recommend treatment options.

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

Treating and preventing self-harm is important because it has so many short-term and long-term risks.

Short-term risks

The short-term risks of self-harm relate to unintended effects of the harm itself. Some of these include:

Medical complications: Self-harm behaviors can lead to infections, nerve damage, and permanent and/or severe scarring. Some self-harm behaviors can result in injuries that are much more severe than intended, resulting in severe injuries or even death.
Social problems: Self-harm can — intentionally or unintentionally — affect relationships with family, friends or other loved ones. It can also affect interactions in school and workplace settings.

Long-term risks

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

Mental health effects: Self-harm can lead to feelings of shame, guilt or regret. People often worry about visibility of their injuries and go to great lengths to cover or hide injuries or scars.
More severe injuries: Self-harm behaviors can often escalate, meaning that a person may self-harm more frequently, or the self-harm may become more severe.
Suicide risk: While some self-harm doesn’t involve suicidal intent, the risk of attempting or dying by suicide is much higher for people who self-harm.

Is self-harm preventable?

Preventing first-time self-harm isn’t always possible, but mental healthcare can reduce the risk of future self-harm behaviors.

When to Call the Doctor

When should self-harm be treated by a doctor or healthcare provider?

Self-harm always needs at least some form of care. Medical care for injuries may be necessary, and experts recommend mental healthcare for all people who self-harm.

Medical care for self-harm injuries

Depending on their severity, self-harm injuries may need medical care. Minor self-harm injuries, such as cuts, scratches or bruises, may be treatable at home with simple first aid supplies like antiseptic, bandages or cold packs.

However, more severe injuries may need treatment at an urgent care center, or they may be medical emergencies. See our “Emergency Department (ER), Urgent Care or Express Care: Which Do You Need?” page to learn more about how to decide which level of care is best.

When should I go to ER?

You should go to the ER or call 911 (or your local emergency services number) if you have thoughts about harming yourself, including thoughts of suicide, or about harming others. If you have thoughts like this, you can call any of the following:

Suicide and Crisis Lifeline (United States). To call this line, dial 988.
Local crisis lines. Mental health organizations and centers in your area may offer resources and help through crisis lines.
911 (or your local emergency services number): You should call 911 (or the local emergency services number) if you feel like you’re in immediate danger of harming yourself. Operators and dispatchers for 911 lines can often help people in immediate danger because of a severe mental crisis and send first responders to assist.

Frequently Asked Questions

What are some actions or practices that have similarities but aren’t the same as self-harm?

Self-harming behaviors are different from practices that have a cosmetic, social or cultural purpose (such as piercing, tattooing or ritual scarring). They also don’t include medical treatments, such as draining an infection or debriding a burn to remove dead tissue.

What can I do if I suspect my child or a loved one is self-harming?

It can be frightening or upsetting if you suspect or know that your child or a loved one is self-harming. However, there are things you can do that may help them now or in the future. These include:

Don’t push. People who self-harm often feel guilty or ashamed. Invite them to talk about it, but don’t push or pressure them. If they avoid the topic, deny that they self-harm or don’t want to talk about it, make sure they know that you care about them no matter what and that you’re there if they need you.
Listen. People who self-harm often feel isolated and afraid, and that they can’t or shouldn’t rely on others. Telling them that you care and want to be there for them can help them feel they can open up. If they do, try to make them feel safe doing so.
Don’t judge or assume. People who self-harm often fear how others will react. Be cautious not to judge, accuse or make assumptions about someone’s reasons for self-harming. Doing any of these could make your loved one feel more isolated and make it harder for them to ask for help in the future.
Ask what they need. People who self-harm may struggle to ask for help. They may be willing to open up to you, but aren’t ready to seek care. Ask them if they need you to listen or if they want you to offer suggestions or help them get care. Treatment to help stop or prevent self-harm is more effective when the person receiving treatment wants care and doesn’t feel forced, obligated or pressured.
Speak plainly. Talking about mental health openly and without judgment helps break down the stigmas surrounding these topics. If a loved one opens up to you and you’re concerned they’re having suicidal thoughts or are self-harming, ask them if that’s what’s happening. While some people believe asking this plainly can make suicidal thoughts or behaviors more likely to happen, research shows it actually makes those thoughts or actions less likely.
Care for yourself, too. Before you can care for others, you need to care for yourself. Tending to your mental health needs ensures you can help loved ones who ask for assistance. Trying to help others when you’re stretched too thin can create other issues and difficulties.

A note from Cleveland Clinic

For many people, self-harming behaviors may be difficult to understand. For those who self-harm, doing so may feel like it’s the only way to feel better or to have some control in their lives. While people might not mean to endanger themselves, self-harm still has risks. Because it isn’t a sustainable way to feel better, it also negatively affects your physical and mental health and well-being.

If you feel the need to self-harm or are doing so, it’s OK to ask for help. Self-harm is a symptom of recognized, treatable mental health conditions. If you seek care, it’s also a good idea to seek providers with training or experience in treating self-harm and related conditions. They can help you understand more about why you feel you need to self-harm and guide you on ways to feel better without doing it.

Asking for help or seeking care for self-harm is no different from seeking medical care for a physical condition. It may not feel like it now, but it’s possible for you to feel better both physically and mentally, and there are things you can do to help make that feeling a reality for yourself.

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Self-Harm