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How to Help a Friend Who is Self-Harming

Did you just uncover a troubling secret about someone you know? Discovering that a friend or loved one self-harms can be extremely upsetting and difficult to understand. You may wonder what you can do to help, or if you should keep this behavior a secret.

While self-injury may bring a momentary sense of peace or release, it’s usually followed with guilt, shame and a return to emotional pain. Although suicide may not be their intention, with self-harm comes the risk for more serious, even fatal, consequences.

“Whatever you do, don’t be silent,” said Yazhini Srivathsal, a psychiatrist at Banner Behavioral Health Hospital in Scottsdale, AZ. “It’s important to take self-harm seriously and not disregard the behavior.”

You can’t be their superhero and stop the pain, but you can be there for them in their time of need. The good news is that with treatment and support, many can overcome this behavior.

Dr. Srivathsal shares information about self-harming and ways you can help someone you know.

What is self-harm?

Nonsuicidal self-injury, often called self-harm, is a deliberate, self-inflicted way for someone to cope with emotional pain or distress and typically is not meant as a suicide attempt. The method and ways someone self-injures themselves can vary, which can sometimes make it difficult to recognize.

“Most people who self-injure use multiple methods but often self-inflict on the hands, wrists, stomach or thighs,” Dr. Srivathsal said. “Self-harm can range from mild, such as scratching or interfering with wound healing, to more severe, such as cutting, burning or hitting themselves.”

Reasons for self-harming

“There are no easy answers as to why someone turns to self-harm, though typically the reasons are intrapersonal, or self-focused, or less commonly it’s interpersonal, or directed at others,” Dr. Srivathsal said.

Intrapersonal or Sslf-focused
  • To alleviate overwhelming negative emotions
  • To relieve a sense of emotional numbness
  • To self-direct their anger and punish themselves
Interpersonal or focused on others
  • To produce a physical sign of emotional distress
  • To influence others (i.e., avoid interpersonal demands, gain attention or increase social support)

Self-harm and suicide

“While some link self-harm with suicide, this might not be the case,” Dr. Srivathsal said. “For many, self-harming is a method for coping with difficult feelings and circumstances—even as a way of avoiding suicide. However, some people may self-harm and then feel suicidal, as self-harm is an important risk factor for suicide. The more a person engages in self-harm the less inhibited they get towards future self-harm behaviors, and ultimately suicide. This is why self-harming should always be taken seriously.”

Recognize the warning signs

Self-harming can occur at any age and may even be difficult to pinpoint. It is most common among adolescents and young adults, and it is prevalent at equal rates in men and women. In any situation, however, you don’t have to be sure that you know what’s going on in order to reach out and help someone you are worried about. Here are some of the red flags to look out for:

  • Unexplained, frequent injuries, including cuts and burns, and excuses for their causes
  • Attempts to conceal the injuries (e.g., wearing long sleeves or pants on a hot day)
  • Difficulty handling emotions
  • Tumultuous relationships or avoidance of relationships
  • Self-isolation from others, such as school or social gatherings
  • A low sense of self or self-esteem
  • Scars on the skin in patterns or shapes
  • Impulsivity

Ways you can help

If you’ve noticed suspicious injuries on someone close to you or if they’ve recently admitted to you they are self-harming, you may wonder how to help? Dr. Srivathsal shared these recommendations:

  • Avoid judgement. Those who are self-harming may get worried that they are being judged or assumed to be suicidal. This can cause them to shut down even more.
  • Seek understanding. Genuinely be interested in understanding how this helps them, what purpose it serves and why they do it. It might be helpful to know about the type of injury, the frequency, coexisting mental health issues, their willingness to seek help and their risk for suicide.
  • Be supportive. Even if their actions don’t make sense to you, try to be supportive and tell them you will be there for them.
  • Don’t dismiss. Please don’t dismiss or ridicule their actions.
  • Don’t ask for promises. Asking someone to promise you they will stop hurting themselves might be even more distressing to them. This ask might also make them feel like they don’t have control over the action anymore. Unfortunately, if they hurt themselves, they will end up with an additional guilt of disappointing you.
  • Try to be accepting and normalize (you don’t have to tell them they’re right) how they feel as people cope differently, and gently encourage them to seek help. You can gently help them understand that this behavior is not working for them and offer to get help.

Treatment for self-harm

Self-harm isn’t something that can be fixed overnight. Treating a self-injury behavior takes time and hard work. But, with the right support, recovery is possible.

“Coming up with an effective treatment can be challenging as some people are ambivalent about receiving help while others use self-harm as a coping mechanism and may fear losing this method of coping,” Dr. Srivathsal said. “The goal of treatment is to learn how to better identify and tolerate their thoughts and emotions and learn and practice healthier coping strategies.”

Treatment options may include some of the following:

  • Evaluation by a mental health professional to find out what their reasons for hurting themselves are and what emotional difficulties they’re experiencing.
  • Psychotherapy or talk therapy to help address and manage underlying issues and learn healthy coping skills. Therapy may include individual, group or family sessions.
  • Medication can help treat an underlying mental illness, such as depression or anxiety, but there are no FDA-approved medications that specifically treat those who self-harm.
  • Inpatient or partial hospitalizations and intensive outpatient programs are available if they need a safe environment or more intense treatment.

Don’t wait. Seek help today.

If you or a loved one needs help coping, Banner Health offers education and support resources. Learning about self-harm behaviors, triggers and treatment as well as talking to others who've gone through what you're going through can help. Banner Behavioral Health has counselors, therapists and support groups for patients and parents, family members or friends of people who self-injure.

You can also call the SAFE Alternative information line at 1-800-366-8288 for referrals and support for cutting and self-harm. 

988 Suicide and Crisis Lifeline (formerly The National Suicide Prevention Lifeline): Call 988 if you or a loved one is contemplating suicide.

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