Self-Harm: More than Just Cutting

“People say things / meant to rip you in half / but you hold the power to not / turn their words into a knife / and cut yourself.” ― Rupi Kaur

Trigger Warning: This post contains explicit descriptions of self-harming behavior and may be triggering to some. 

Educating my clients has become an important part of my role as a therapist, much more than I would have ever realized. One of the topics I found myself teaching is self-harm: what it is, the signs to look for, and to understand that self–harm is simply a loud plea for help. Help is available, and hope is possible for anyone who is coping with life’s difficulties by self-harm.

Most individuals who self-harm keep their habit a secret, which means that the statistics for self-injury are likely quite skewed. In the United States, each year approximately 2 million cases of self-harm are reported. Ninety percent of people who engage in this behavior begin during their teen years (which is one more reason to befriend our teens). Each year, one in five women and one in seven men engage in some form of self-injury. This is an issue that needs to be talked about, by you and me, as it is happening more than we would like to know!

What is Self-harm?

Self-harm is the intentional harming of one’s own body–any form of hurting oneself on purpose. This type of behavior is normally not an attempt at suicide, but rather an unhealthy coping mechanism in the face of emotional pain, frustration, mental illness, loneliness, and/or anger. Self-injury may bring a temporary sense of peace and well-being immediately after the act, which is almost always followed by intense guilt and shame. Not only that, the painful emotions that initially triggered the self-injury inevitably return, thus creating a pattern of self-harming in order to feel peace. Self-injury is generally considered to be an impulsive act, so becoming upset or experiencing any strong emotion may trigger the behavior. While many people only self-harm temporarily, others may find that the behavior serves a unique purpose and becomes a long-term habit. 

Causes & Risk Factors

The propensity to self-harm may be influenced by genetics or environmental causes or both. Some individuals are predisposed to mental illnesses because of their familial DNA, which can trigger the urge to self-harm. For some people, depression and/or anxiety lead to a vast range of emotions, which turns to self-harm in order to feel relief.  It has also been found that people who experienced abuse are at a greater risk for self-harming behaviors. Self-injury is used as a way to cope with overwhelming emotions and trauma. Although not everyone who self-harms has the following risk factors, these are common markers: gender (female), age (teens to early 20s), social (having friends who also self-injure), identity (unstable personal identity or sexuality), mental health disorders, and addiction (drug and alcohol). 

Forms of Self-harm

The arms, legs, and front of the torso are the most common places on the body for an individual to self-harm because these areas can be easily reached as well as hidden under clothing. Although we often talk about self-harm including cutting, scratching or otherwise harming oneself, self-harm can also include burning oneself; carving words or symbols into the skin; breaking bones; scratching, hitting, punching or biting oneself; pulling out hair, picking at and deliberately interfering with healing wounds, and piercing the skin with sharp objects. Additionally, other forms of self-harm that are even less talked about (but are done to achieve the same emotional outcome) include behaviors such as purposely not taking necessary medications, withholding basic needs such as food, water or even medical attention in order to feel something.

Signs & Symptoms

Not only are the individuals who do this good at hiding the physical marks, they are often equally as efficient in hiding the emotional indications– meaning they seem happy on the outside so self-harm is the farthest thing from your mind. Plus self-harm is often done in private. The signs and symptoms will vary but can include behavioral symptoms (wearing pants and long-sleeved shirts year-round, explaining away injuries as accidents or clumsiness, volatile relationships, over/undereating, excessive exercise, etc), physical symptoms (visible scars, scratches, bruises, and cuts; broken bones, patches of missing hair), cognitive symptoms (questions about personal identity, feelings of helplessness, hopelessness, worthlessness) and psychosocial symptoms (emotional instability, mood swings, depression, increased anxiety, guilt, shame, and disgust).


While self-harming is almost never intended to be life-ending, it can lead to serious, even fatal consequences. Long-term effects of self-injury include isolation, shame, disgust, guilt, low self-esteem, permanent internal and external body damage, infections, suicide and even accidental death.  

What You Can Do to Help

If you suspect someone close to you is self-harming, I urge you to get help. There are trained, licensed individuals who are qualified to assist in this process, and we want to help. A few practical suggestions include making your living space safe by removing everyday items that could be used to self-harm (razor blades, pencil sharpeners and scissors, etc); disposing of unnecessary medications; securely storing necessary medications; and letting your loved one know that you are aware of what they are doing and that you are there to support them through it. 

You may not understand why your loved one would self-harm, but responding to them with love and patience can make you a safe person for them to seek support from. You may consider arranging a signal for them to give you before they do any self-harm–like a squeeze of your hand or asking to do a specific form of distraction with you. This is a way you can support them both emotionally and physically. Then, help them learn about and practice healthy coping strategies like listening to music, writing a poem, expressing feelings through art, counting, saying the alphabet backwards, spending time with a pet, biting on a lemon or a chili, holding ice tightly until it melts, watching a funny film, going for a walk with a relative/friend or pet, or talking to someone funny.

While self-harming behaviors are an unhealthy way of coping with intense emotions, with the proper types of therapy and self-care, those who self-injure are able to recover from this behavior and have a future free from self-injury. It just takes one person noticing the mental and/or emotional pain they may be going through, supporting them through it, and getting them the help they need in order to stop self-harming. Self-harm is not a death sentence; it is a cry for help. Now you know what it is and what to look for…Go and be the help they need.

Melissa Cluff is a Licensed Marriage and Family Therapist based in North Texas, providing face-to-face and telehealth therapy options to clients in Texas.


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Melissa Cluff, MS, LMFT, CSAT

Melissa Cluff is a Licensed Marriage and Family Therapist based in North Texas, providing face-to-face and telehealth therapy options to clients in Texas.