Kids and Self-Injury: What Parents Need to Know

Self-injury is the act of physically hurting oneself without the intent to die. It is a sign of emotional distress and indicates a person needs to learn and/or use healthier ways to tolerate that pain.

The most common forms of self-injury are cutting, burning, scratching, or embedding objects under the skin and banging or punching objects or oneself.

Is Self-injury a Diagnosis?

No. People who engage in self-injury are often diagnosed with mood disorders, eating disorders, personality disorders, and/or anxiety disorders. Many who self-injure do not have a diagnosable disorder at all. In the United States, between 12-37 percent of adolescents and young adults report engaging in self-injury at least once in their lives. The average age people begin to self-injure is fifteen years old, and females and males have similar risk for self-injury.

Why Do People Self-injure?

Young people generally report that they self-injure to cope with upsetting feelings, to feel in control of their body and/or mind, to relieve stress or pressure, and/or to express their pain. Being excluded from or discriminated against by peers and/or knowing someone who self-injures can increase a young person’s risk of self-injuring.

There is evidence that self-injury releases endorphins in the brain, helping people who self-injure to feel better in the short term. However, self-injury is not a healthy long-term coping skill, and it is a risk factor for later suicidal behavior. There is also a common belief that self-injury is attention-seeking, but most people who self-injure hide their cuts, scars, or burns. There is often shame involved in self-injury and extra attention is unwanted.

Is Self-injury the Same as Suicidal Behavior?

Self-injury is NOT an attempt to kill oneself. Some people who self-injure even say they do it to STOP themselves from acting on suicidal thoughts. Even though self-injury and suicidal behavior are very different, many individuals who self-injure may have suicidal feelings, too.

How Do Youth Learn about Self-injury?

Many youth use social media to learn about self-injury and connect with others who may encourage it as way of managing distress. Although major social media sites have policies restricting posts referring to or showing self-injury, images of self-harm do continue to pop up on platforms like Instagram, X, and TikTok. There are even websites that teach how to self-injure with step-by-step instructions. While it isn’t yet proven that social media directly increases self-harm, connections have been found between the amount of time spent on social media and greater exposure to and engagement in self-harm behavior.

How Is It Treated?

Due to the complex factors that may contribute to self-injury and the risks associated with these behaviors, treatment from a licensed therapist with experience in this area is recommended. Cognitive Behavioral Therapy and Dialectical Behavioral Therapy are the most-used therapies to address self-injury.

Additional consultation with a physician or psychiatrist may be warranted to help treat an underlying psychiatric condition. Most people do not grow out of self-injury without finding healthier ways to cope. Self-injury should not be viewed as a “phase” or “fad” and should always be taken seriously.

What Happens If It’s Left Untreated?

Although self-injury is different from suicidal behavior, it does increase risk for suicide. Self-injury allows someone to get used to dealing with distressing emotions or situations by damaging their body. Over time, hurting oneself can lead to increased feelings of shame and worthlessness, which are also risk factors for suicide.

Is Recovery Possible?

Yes! Recovery can occur when individuals learn effective alternatives to manage their emotions. Of course, a youth also needs to be motivated to stop self-injury for recovery to begin. Motivation can be low when people feel they only have one tool to manage their pain.

A skilled therapist will help look at the role self-injury plays in their lives, challenge the idea that only self-injury can reduce distress, build self-confidence to choose healthier coping skills, establish emotional support networks, prepare for possible relapses, and celebrate successes.

What Signs of Self-injury Should I Look for in My Child?

Because many who self-injure hide their scars and don’t want others to know about this behavior, noticing signs of self-injury can be hard. The following warning signs can alert parents that self-injuring may be occurring:

• Unexplained cuts, burns, or bruises, typically on the arms, hands, stomach, or thighs
• Wearing bandages frequently
• Finding razors, knives, or other items that could be used to self-injure
• Wearing long-sleeves or pants in warm weather
• Unwillingness to participate in activities that require less clothing (e.g., swimming)
• Wearing wrist bands, multiple bracelets, or wide-band leather bracelets to conceal injuries
• Expressions of self-loathing, shame, or worthlessness
• Withdrawing from family and friends

It is important to look for all these warning signs if you suspect your child is engaging in self-injury. Although many youth who self-injure isolate themselves, some continue to hang out with friends and family and appear happy.

How Should I Talk with My Child about Self-injury?

• Address the issue as soon as possible. Self-injury rarely resolves on its own.
• Be aware of your own emotions. Parents who learn their child is self-injuring may feel a wide range of valid feelings, from anger to sadness to guilt. If your emotions are running high, it is not the right time to talk.
• When you’re calm, start by telling your child what you have noticed and why you are concerned.
• Validate your child’s feelings, which is different from validating their behavior. You don’t have to agree with self-injury as a coping tool to be emotionally supportive.
• Listen non-judgmentally and without interrupting. Offer your thoughts when they are finished talking.
• Speak in a calm and comforting tone.
• Offer reassurance that you will get through this together.
• Think about how you wanted adults to react when you were a teenager.
• Don’t pressure your child to talk. If you’re feeling anxious, your child probably is, too. Self-injury is a stressful topic, and if your child is self-injuring, it can indicate they have difficulty expressing their emotions. Let your child know you are available and it’s okay to try talking again later.
• Get your child professional help from a licensed therapist with experience treating self-injury.

If you notice these warning signs of suicide in your child, go to your local emergency room immediately, call the Suicide and Crisis Lifeline at 988 (services are also available in Spanish), or reach out to the Crisis Text Line by texting “HOME” to 741-741.

To hear more about self-injurious behavior and treatments, listen to our PediaCast.