Cutting and Self-Harm: Warning Signs and Treatment

Medically Reviewed by Melinda Ratini, MS, DO on May 22, 2024
6 min read

Cutting is the most common form of self-injury — more than 80% of people who self-harm choose this method — but it’s not the only one. You or someone you love may also bang or hit your head, scratch yourself, pick scabs or interfere with wound healing, infect yourself, embed objects in your skin, bruise yourself, break your own bones, or pull out your hair.

Why would anyone do that to themselves? Because their emotions feel too big to process.

“Self-injury is not the problem, it is a symptom of something else,” says Michelle M. Seliner, owner and clinical director of S.A.F.E. (Self Abuse Finally Ends) Alternatives in St. Louis, MO. “This could be anxiety, depression, trauma, grief/loss, disordered eating, and poor impulse control.”

Self-harm can be scary, but it’s treatable. Here’s what to look for and how to get help.  

The emotions that can spur self-harm in tweens or teens may look familiar at first.

“Look for symptoms of depression like staying in the bedroom a lot, crying spells, pulling away from friends and family, and more reactive patterns of behavior,” says Hillary VandeLinde, a therapist with Symmetry Counseling in Nashville, TN. “Self-harm is always paired with low self-worth, core beliefs of I’m bad; I deserve bad things; I deserve to be punished for being bad. This leads to hopelessness.”

Other emotional signs of self-harm include:

  • Overwhelmed by feelings
  • Inability to function or decline in functioning at school or home
  • Inability to maintain stable relationships

There are physical signs, too, like unexplained injuries, cuts and burns, or wearing long-sleeve shirts and long pants even when it’s hot outside.

“A lot of teenagers self-harm in places you won’t be able to see, like their thighs, waistline, creases of their legs, and upper arms so T-shirts cover it,” VandeLinde says. “You can do all the right things as a parent and still miss it.”

There are as many paths to self-harm as people who do it. It often starts with an impulsive scratch triggered by strong feelings.

“Physiologically when we’re exposed to pain or shocking stimuli, it’s a really quick way to reset our nervous system and it either stops negative emotions or leads to more positive ones,” VandeLinde says. “The pain hurts, but there’s a brief sense of euphoria you get with that stimuli. It’s called pain offset relief. Over time, people react more favorably to the pain because it’s paired with this brief euphoria — with the pain I feel better. Self-harm [can be] effective at thought stopping, but it’s not the most effective coping skill.”

It’s not always happening the way you might think. VandeLinde says some of her clients use a dermablading tool or remove the blade from a pencil sharpener – something small and easy to hide, not your kitchen knives or scissors.

Self-harm can escalate if the original issue — anxiety, depression, trauma, etc. — gets worse, or “because the individual finds they need to increase the intensity and frequency [of self-harm] to get the same effect,” Seliner says.

Though adults and children can engage in self-harm, the reported numbers of cases are much lower than in teens and young adults.

“My clients who self-harm range from 13 to 23,” VandeLinde says. “It’s younger than we think it is, but for sure it’s middle school, high school, and college students.”

And it’s not just young, white females.

“Studies are inconclusive on the ratio of males to females, but there are clearly many more males injuring [themselves] than previously believed,” Seliner says. “However, more females than males seek treatment.”

Studies show that young people who experience race-based harassment or bullying are more likely to injure themselves. In fact, one small study in Mississippi found that African American boys were the group most likely to self-harm.

Self-harm, also called nonsuicidal self-injury (NSSI), is not the same thing as a suicide attempt.

“Suicide is a way to end your life. Self-injury is a coping strategy,” Seliner says. “However, individuals who self-injure are nine times more likely to attempt suicide, and many of our clients describe chronic suicidal thoughts at the time of injury.”

If your child self-harms, it doesn’t mean they’re going to commit suicide. But they should be assessed for what mental health professionals call suicidality, or the risk of suicide.

Self-harm is a sign of emotional distress, not a stage kids go through or drop on their own as they get older.

“Of course there are cases where an individual outgrows the behavior without clinical intervention. However, those are few and far between,” Seliner says. “Because … this is a symptom of something else – depression, anxiety, trauma, disordered eating, etc. – coupled with the increased rate of suicide attempts, this behavior is just too risky, with significant emotional physical and social consequences, to ignore.”

The best way to treat self-harm is the one tailored to the form of self-harm you use and the mental health issues behind it.

Treatment may be a combination of:

  • Medication to manage depression, anxiety, obsessive-compulsive behaviors, and racing thoughts
  • Cognitive-behavioral therapy to help you understand and manage destructive thoughts and behaviors
  • Contracts, journals, and behavior logs to regain self-control
  • Interpersonal therapy to gain insight and skills to develop and maintain relationships

These methods may be overseen with a mental health professional on an outpatient basis or with residential or inpatient hospitalization.

“When the behaviors interfere with daily living, such as school, employment, and relationships, and are health- or life-threatening, a higher level of care with specialized services and an experienced staff is recommended,” Seliner says. “Services for eating disorders, alcohol or substance abuse, trauma abuse, and family therapy should be readily available and integrated into treatment, depending on individual needs.”

The most important part of treatment is your motivation to work hard on yourself and learn new ways to manage your emotions.

VandeLinde’s clients have had success with dialectical behavior therapy, a type of cognitive behavior therapy that teaches skills to help you manage stress and emotions.

“Clients learn how to sit and navigate through tough emotions with new coping skills like mindfulness and radical acceptance,” she says. “They learn how to ride emotions like a wave, knowing it’s going to crash and trusting that process.”

Call it out calmly and respectfully. If you notice cuts or anything that could be self-harm, bring it up in a calm, nonchalant way, and don’t make your child show you any cuts or marks.

VandeLinde suggests these phrases:

  • I noticed you had some cuts on your arm. I’m worried about you. How are you doing?
  • You’ve seemed like you’re not yourself. Do you ever have thoughts of not wanting to be alive?

“Have a compassionate lens. The most important thing is to avoid shaming and remember no one asks for these emotions,” she says. “If they’re nonsuicidal, we need to focus on self-esteem and mental health. If there’s suicidal intent, they need a more intense treatment plan.”

Find a qualified professional. If you notice any signs of self-harm or just have a gut feeling about it, seek out a qualified mental health professional who has experience with self-harm. There’s not a certification for self-harm, so it’s important to find someone who’s successfully worked clients through this issue in the past.

“I typically see teens after they’ve seen two or three other therapists who don’t know what to do or use antiquated methods,” VandeLinde says. “We don’t snap your wrist to create pain. We don’t take a red marker and draw a line on your wrist.”

To screen a therapist, ask these questions:

  • How do you treat self-harm?
  • Have you treated self-harm before?
  • Do you feel comfortable treating self-harm?

Know your resources. Dial or text 988 for the 988 Suicide and Crisis Lifeline. It's available nationwide, 24-7.

To connect with a crisis counselor via a national Crisis Text Line, text HOME to 741741 for 24/7 support.

Under their “resources” tab, The S.A.F.E. Alternative website has informational self-injury videos and a 32-minute video for parents called “How to Understand and Help My Child Who is Self-Injuring.”