When you hear the words “self-harm”, what comes to mind? For many, there’s a feeling of discomfort and a preference not to think about it. There might also be some misunderstanding about why some people choose to physically harm themselves.
March is Self-harm Awarness month, and like any awareness month, it invites us to learn more about a complex topic and hopefully feel more knowlegeable and less uncomfortable as we understand it better.
Self-harm usually refers to deliberately injuring your own body without the intention of ending your life. It can include behaviours such as cutting, burning, or hitting, and it exists on a broad spectrum.
For some people it happens once or twice during a period of intense distress, while for others it becomes a repeated way of coping. Self-harm and suicidal intention can overlap, but not always. Many who self-harm aren’t trying to die, but the behaviour still deserves to be taken seriously because it can accompany suicidal thinking and increase future risk in some cases.
A lot of misunderstanding comes from the stories we tell ourselves about why someone would self-harm in the first place. The “attention-seeking” explanation is common, but it misses the mark in terms of what the research shows.
Self-harm often functions primarily as emotion regulation. When distress, anxiety, anger, shame, or agitation feels overwhelming, self-harm can bring short-lived relief. For others, it’s linked to self-punishment, driven by harsh self-criticism or a sense of deserving to be in pain.
Some people describe using it to break through numbness or dissociation, while others experience it as a way of reducing suicidal urges. Many who self-harm recognise more than one of these functions, and it can vary at different points in their life.
Here are some of the reasons poeple might engage in the beaviour:
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To reduce overwhelming emotion especially when it feels uncontainable
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To interrupt numbness when they feel detached or unreal
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To punish themselves driven by shame, self-hatred, or a belief they’re “bad”
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To express pain they can’t put into words particularly when talking feels impossible
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To regain a sense of control when everything else feels chaotic
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To signal that they’re struggling often to a friend rather than an adult or professional
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To resist suicidal impulses by substituting a different behaviour in the moment
Self-harm is also more common than many people assume. Large studies suggest roughly one in six adolescents will self-harm at some point, with higher rates reported among girls and young people in parts of Asia.
That said, it occurs across cultures, backgrounds, and diagnoses, and sometimes with no diagnosis at all. Risk for self-harm tends to cluster around difficult or traumatic experiences and limited support, including bullying, adverse childhood experiences, mental health difficulties, problem behaviours such as substance use or internet addiction, and lower health literacy.
When someone discloses self-harm behaviour, fear can make people either close down or withdraw. What people who self-harm consistently describe as helpful is a steady, non-judgemental response, alongside someone who can tolerate the topic without flinching. It can be difficult to know how to support someone who self-harms, but being there for someone can make all the difference.
Here are some practical ways we can offer support:
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Stay calm and listen. If you look shocked or repulsed, it’s likely the person will stop sharing.
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Ask direct questions. “What can I do that’d be most helpful right now?”, “Can you tell me what was going on just before you hurt yourself?”, “Are there times when it feels harder to stay safe?”
Ask qustions with the intention to understand rather than judge. -
Focus on what was happening before it happened. This helps you to understand the function of the behaviour rather than having arguments about stopping.
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Avoid threats, ultimatums, or punishment. And definitely avoid asking the person to promise you they won’t harm themselves again in future. This will likely only serve to increase the person’s sense of guilt and shame.
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Encourage support and offer to help with access. That can mean walking with them to a school counsellor, or helping them to make an appointment with a mental health professional. Don’t force them to seek help – encourage and invite, but remember the choice is theirs to make.
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Look after yourself as well. Supporting someone who self-harms can be emotionally heavy, so make sure to take care of yourself and keep in mind that your wellbeing matters, too.
If you think someone is in immediate danger, or at risk of severe harm, treat it as urgent and involve appropriate help straight away, whether that’s emergency services, a trusted adult, or a clinical service. Otherwise, the most useful next step is often small and concrete: a calm conversation, a check-in the next day, and a practical plan for what they can do and who they can speak to when the urge spikes.
For more insights into self-harm, you can listen to Dr. Chua Sook Ning’s conversation with self-harm expert, Prof. Nancy Heath, on the Being Human podcast.