Self-Harm Awareness Month: Understanding Self-Injury And How To Help

March is Self-Harm Awareness Month (also known as Self-Injury Awareness Month), and despite a recent cultural shift toward more open discussions about mental health, self-harm remains a significant and often misunderstood topic. It may be helpful to learn more about the behaviors surrounding self-harm and suicidal self-injury, how to recognize signs, and how to prevent them within your peer group and community. This month can also be a time to get involved and support those who are struggling with self-harm and related mental health challenges. 

What is Self-Harm Awareness Month?

Self-Harm Awareness Month is an unofficial awareness month that takes place annually during March when mental health organizations and individual activists come together to educate the public about self-harm. This outreach often includes spreading awareness about the prevalence, signs and symptoms, and prevention strategies of self-harm, as well as resources for those affected by it.

Understanding self-harm

Nonsuicidal self-harm or nonsuicidal self-injury is a behavior where individuals intentionally inflict harm on themselves as a coping mechanism for dealing with emotional pain, stress, or trauma. Someone who self-harms usually does not mean to kill themselves, but according to the Substance Abuse and Mental Health Services Administration, they are at a higher risk of attempting suicide or dying by suicide if they do not get help.

Common forms of self-harm

Self-harm typically involves injuring oneself by actions like cutting, burning, hitting, picking at wounds, pulling out hair, or inflicting bruises or bite marks on the body. However, self-harm can also refer to other behaviors that might endanger one’s health and safety, such as consuming alcohol and substances, engaging in dangerous activities, or neglecting one’s physical or emotional needs.

Who is most at risk for self-harm?

While it can affect individuals of any age, teens are at an exceptionally high risk for self-harm. One meta-analysis involving 597,548 adolescents identified a lifetime prevalence of 16.9%, with girls at a higher risk. There is no single reason why a young person might engage in self-harm. It may be a way to cope with the emotionally painful aspects of life, like feeling overstimulated or misunderstood. Some teens may self-harm because they feel overwhelmed by responsibilities, or they may be attempting to gain control over their bodies when they feel that other things in their life are out of their control.

Risk factors for self-harm

There are a number of risk factors for self-harm. For example:

• Research has found that members of the LGBTQ+ communityare at risk for self-harm. One study involving 3713 LGBT adolescents, aged 11–19 years, found that 65.3% reported engaging in self-harm. 
• Self-injury is also known to co-occur with mental health conditions. One 2023 study found that the most common psychiatric diagnoses associated with self-harm episodes were alcohol use disorders, borderline personality disorder, and major depressive disorder.
• Self-harm is prevalent in those with autism spectrum disorder. According to one systematic review, individuals with autism are more than three times more likely to engage in such behaviors. However, interventions for self-harm in autistic individuals may differ from those in the general population.

Why do people self-harm?

For those who have not experienced it, self-harm can seem perplexing. To understand this behavior, it might help to understand the biochemical mechanisms that underpin self-injury—namely, the body’s release of endorphins in response to pain.

Emotional regulation and control

Endorphins are natural painkillers produced by the brain, which can create a sense of emotional release or numbing. Because physical and emotional pain activate the same parts of the brain, those endorphins may bring emotional relief immediately following a self-harming behavior. For this reason, self-harm typically occurs in response to severe stress or psychological pain and may be an attempt to control these intense emotions. 

Those who self-harm often do so impulsively and compulsively, making it difficult to stop even when it causes negative feelings like shame, embarrassment, anxiety, or physical pain. Research from 2021 suggests that those who self-harm may have a higher pain tolerance, which may explain why the physical discomfort it causes may not be enough to deter the behavior.

Recognizing the signs of self-harm and responding with care

For teens and those who care for them, as well as adults, it can be crucial to be aware of the signs of self-harm. Key signs to notice may include the following. 

• Physical injuries. Frequent cuts, bruises, burns, or scars can be a sign that a person is engaging in self-harm, particularly if the injuries are not easily explained or located in a place that is easily hidden. 
• Different clothing and appearance. Those who self-harm often attempt to conceal their injuries. For example, they may wear long sleeves or trousers even during warmer months or use accessories like bandanas or wristbands to cover their injuries. 
• Unusual excuses for injuries. Implausible excuses for physical injuries or a dismissive attitude towards noticeable wounds might be a sign. For example, someone might say their frequent cuts are due to their cat scratching them or falling. 
• Behavioral changes. Self-harm and the extreme emotional distress that causes it may be accompanied by behavioral changes, such as social withdrawal, decreased engagement with school or work, substance use, or risk-taking behavior. Those who self-harm may carry sharp objects, lighters, and other implements that can be used to inflict injury.
• Emotional distress. Self-harm is often a response to significant psychological strain, such as that caused by trauma, mental illness, or environmental stress. Social withdrawal, changes in eating or sleeping patterns, or expressions of pain or anguish may co-occur with self-harm and are themselves signs that a person may benefit from a mental health intervention.

How to talk to someone who self-harms

It can be difficult to know what to say to someone who is engaged in self-harm. Here are some ways you can start the conversation. 

• I’ve noticed that you have some marks on your arms/legs, and I’m worried about you. Are you hurting yourself?
• I can tell that you’re in a lot of pain. Can you tell me what is going on?
• I want to help you, but I can’t do that alone. Have you thought about seeing a professional? I will help you find support if you don’t want to deal with it on your own.
• I can see that you don’t want to talk about this right now, but I want you to know that I am here if you want to talk.

How family members and friends can help

Self-Harm Awareness Month can be a time to get involved and offer support to people who are experiencing self-harm, but it can also be important to understand how to help loved ones on a daily basis.

Supporting without controlling

Family members may want to protect someone they love, but it can also be important to respect the person’s boundaries. Rather than placing pressure on them, offering patience and a steady, nonjudgmental presence can be more beneficial. Listen more than you talk, and ask how you can help rather than assuming you know what they need.

Encouraging treatment and healing

Encouraging someone who is engaging in self-harm to seek professional treatment can be challenging. Normalize seeking treatment and getting professional help, and frame it as a tool for healing, not a sign of weakness. If they choose to get help, celebrate small steps toward recovery with them and help them maintain hope without pressuring them to meet specific milestones or hold them to a timeline.

Finding hope and healing

For people dealing with self-harm and the complex emotions that may contribute to this behavior, it can be hard to imagine things getting better. But with the right support, recovery can be possible.

Recovery may be an individual experience. Some people find hope in hearing about the lived experience of others, while others may find that individual therapy is a key part of their recovery journey. Regardless of the type of treatment you are undergoing, it can be helpful to keep in mind that healing rarely happens overnight. However, with the right support and professional help, you can keep moving forward.

Find support for self-harm

Recovery from self-harm can be intensive, often including psychiatric interventions from doctors, ongoing counseling and peer support, and lifestyle adjustments. However, early interventions that promote physical and emotional well-being can be crucial for preventing mental health from deteriorating in response to stress or trauma.

Reaching out for support from a mental health professional for mental health conditions or symptoms can be challenging in person. In these cases, online therapy platforms like BetterHelp for adults or TeenCounseling for teens aged 13 to 19 may be beneficial. 

While online therapy may not be appropriate as the sole source of support for those with severe self-harm or suicidal ideation, it can be a valuable source of emotional support and guidance, allowing clients to choose between phone calls, video chats, or in-app messaging sessions with a therapist from home.

Studies also support the effectiveness of internet interventions. Online therapy can be as effective as in-person therapy and may be preferable for teens with busy schedules, transportation limitations, or social anxiety. Young people may find it easier to open up to a neutral third person like a therapist, particularly if they can attend from the comfort of home.