Self-Harm Behaviors

What self-harm is

Self-harm — or non-suicidal self-injury — is deliberately hurting yourself physically to relieve emotional pain that has become unbearable. It usually starts in adolescence and often carries on: plenty of people reach their twenties or thirties having lived with it for years without telling anyone. It does not happen for fun, but when distress outgrows the resources someone has to hold it.

In most cases it is not an attempt to end life and, at the same time, it is one of the signals most strongly associated with later suicide risk. So this is not about dramatising it or playing it down: it is about having it assessed by someone with clinical training. This page describes no methods or specific ways of hurting yourself, following the World Health Organization's guidance on safe communication.

Do you recognise any of these situations?

• You hurt yourself physically to cope with what you feel.
• When an emotion gets very intense, the urge to hurt yourself shows up on its own.
• You would like to stop and have no idea where to start.
• You hide it, and hiding it weighs on you too.
• You stopped a long time ago and it has come back.

How therapy can help

We start with a clinical assessment that looks at what is happening and at how much risk there is, because the plan comes out of that rather than the other way round. From there we work with what current clinical guidelines set out for self-harm — NICE NG225 (2022) is the reference we follow: a psychological intervention designed specifically for self-harm, not general therapy with self-harm in the background. What form it takes is decided by what the assessment finds. You set the pace; safety sets the frame.

An assessment that takes this seriously. The first task is not to make you stop hurting yourself, but to understand what function it serves for you and how much risk there is right now. No judgment, no lecture, and no treating you as a problem to be solved. That assessment is what decides which treatment makes sense and at what intensity.

A safety plan built with you. A safety plan is a recognised clinical tool: which signals warn you that things are getting hard, what you can do before you get there, who you tell, and which number you call if risk rises. It is built with you — and with whoever you decide should be part of it — in session, not downloaded from a web page, because it has to fit your life and be revised when that life changes.

Skills for holding intense emotions. Recognising what is rising before it overwhelms you, bringing the intensity down without hurting yourself, and being able to ask for what you need when asking is hard. Trained in session and practised outside it. These are not tricks for gritting your teeth: they are ways for the emotion to come down without your body paying for it.

Working on what sits underneath. Self-harm almost never travels alone. Underneath there is usually bullying, trauma, a relationship that hurts, a bereavement, academic or family pressure, difficulties with body image, or badly battered self-esteem. While that is still there, the urge comes back; when it is treated, it has far less work to do.

When you have lived with this for years. Starting at fifteen and still going at twenty-eight is more common than it looks, and it brings its own weight: scars to explain or hide, the sense that it is too late, and years of not having told anyone. None of that makes treatment work less well. We also work on the shame, your relationship with your body, and what to tell whom, and when.

Why getting help matters

Self-harm brings relief for a while, and that relief is real: that is why it repeats. What it does not do is resolve what sits underneath, and over time the cycle tends to settle in — more episodes, more guilt, more isolation, and injuries that sometimes go further than intended. On top of that, people who self-harm are at higher risk of suicidal behaviour later on, even when they do not want to die at the time. None of this means there is no way out: it means it is reason enough for a professional to look at it, and there is no reason to wait for it to get worse.

If you are thinking about ending your life right now, call 800 911 2000 (Línea de la Vida). In immediate danger, call 911. We Are Psycho does not provide emergency care.

Frequently asked questions

Does self-harming mean I want to die?

In most cases, no: self-harm usually seeks to stop feeling something unbearable rather than to stop living. But the two are not as far apart as they look, and having hurt yourself is one of the factors most strongly associated with later suicidal behaviour. So the honest answer is not "don't worry, it's not that serious" but "this deserves to be assessed by a professional". If you are thinking about ending your life right now, use the phone numbers at the top of this page before reading any further.

Is what I say in session confidential?

Yes, with one limit: a serious and imminent risk to you or to someone else. Nobody is told because you self-harm, and your family is not called for the sake of it; you can say all of it without triggering anything you have not discussed first. If you are under 18 it is different: your legal guardians are part of the process and have to be informed of the essentials, and whoever sees you will agree with you what is shared and how.

How am I supposed to stop if it is the only thing that helps?

That is the right question, and the goal is not to take away the only thing you have. It is to build alternatives that serve the same function first — bringing the intensity down, feeling something again, putting outside what does not fit inside — so that self-harm gradually stops being necessary. That is done with a professional, a safety plan and trained skills, not with a list of substitutes off the internet: some of the "tricks" that circulate are still harm under another name, and are not recommended.

I have been doing this for years. Is there any point starting now?

Yes. Having done it for a long time does not make it part of your character, or something that can no longer be treated: it is still a learned way of holding distress, and what is learned can change at any age. What does change over the years is how established the pattern is, so it may take longer and it is worth not doing alone. If you have read this far, that is exactly the hard part.

How is self-harm treated?

With a psychological intervention designed specifically for self-harm: that is what current clinical guidelines recommend, and NICE NG225 (2022) is the reference. What no guideline recommends is treating it with general advice alone, or waiting for it to pass on its own. What form it takes is decided after the assessment, with you, because no single method suits everyone. No web page, this one included, replaces an assessment.

What is this page based on?

On two references: NICE NG225 on the assessment and management of self-harm (2022), and the World Health Organization's guidance on suicide prevention and safe communication. The second is why we describe no methods or specific ways of hurting yourself.