Subtle Signs of Self-Harm

February 27, 2020

Self-harm is most simply defined as when somebody intentionally damages or injures their body through various means. Yes, there are other types of destructive self-harm which can include a wide variety of emotional destructive behaviors however, the most common type of self-harm recognized by parents, teachers and the medical community is physical self-harm. Generally, self-harm is used as a means for coping with or expression of emotional stress that the person cannot cope with in any other way.

Sometimes those who engage in self-harm view it as a gateway of sorts to attempted suicide. For that matter, more than half of those who eventually die by suicide have a history of self-harm in some form. However, more commonly, the reason for self-harm lies in outcomes with less finality. Most individuals who engage in self-harm do so to punish themselves, express distress or relieve tension and anxiety that have become unbearable or sometimes it is a combination of all the above. However, make no mistake, self-harm is often a cry for help. Unfortunately, it can also be hard to notice. Below we will explore a little further some of the reasons behind self-harming behaviors, what to watch for and how to get help if you are concerned about your child or teen.

What May Cause Your Teen to Self-Harm?

Often when people think of the “type” of person who may engage in self-harm they think of young adults or individuals with already diagnosed mental health conditions. Unfortunately, self-harm is far more common in younger people than most people realize. Although people of all ages may engage in self-harming behaviors, it is estimated that between 10 and 25% of teens and young adults will engage in these behaviors at some time. As noted above, one of the most common reasons people engage in self-harm is as a coping mechanism for emotional issues that have become overwhelming. These issues can be caused for a variety of reasons including:

Social problems

Many children, teens and young adults today are engaged in a consistent struggle to cope with extreme levels of stress. This stress can be present at school, within their family units, and in their relationships with peers. It is not uncommon for teens to be over scheduled with school obligations, sports, family obligations, extracurricular activities and peer relationships. Additionally, our currently world is highly media driven and consequently quite toxic and negative. It is easy for teens to fall prey to the negativity and hostility that is ever present on social media outlets today. For teenage girls, there is also the added pressure of the “standards” associated with appearance which tend to be imposed both by relationships with peers and social media pressures. Girls who feel as though they have failed to live up to these standards may turn to self-harm as an outlet.


Experiencing or witnessing a traumatic event can also cause teens or children to turn to self-harm as an escape from their emotions. Traumatic experiences can include abuse (physical, sexual or emotional) or the death of a close family member or friend.

Psychological/mental health issues

Some people experience mental health issues that result in their hearing voices or having powerful thoughts that tell them to do things. In some cases, these thoughts or voices tell the person to self-harm. This can result from mental illnesses such as borderline personality disorder or other forms of dissociative disorders. Self-harming behaviors can also result from diagnoses related to depression and anxiety.

Types of Self-Harm

There are many ways people can intentionally harm themselves. These can include the following:

Cutting or burning their skin

Cutting and burning are two of the most common forms of self-harm. Cutting is exactly what it sounds like; using a sharp object such as a razorblade, knife or scissors to make marks, cut or scratches on one’s own body. Cutting, as with other self-harm activities, is an attempt to interrupt the feelings associated with strong emotions and pressures that the individual feels they can no longer tolerate. The sensation of pain associated with cutting or burning releases endorphins that offer a “rush” which allows for a temporary escape from their current anxiety feelings.

Punching or hitting themselves

Similarly, the discomfort associated with punching or hitting results in the endorphin release that results in distraction. While potentially not as dangerous as cutting or other self-harming behaviors these behaviors can still result in injury.

Other forms of self-harm can include taking pills or liquids that result in illness or sickness. It is not uncommon for people who engage in self-harm to try to hide their bruises out of shame or fear of having their behavior discovered by others. They will often wear long sleeve shirts or long pants in a effort to hide cuts and bruises.

Signs of Self-Harm

As previously noted, those who engage in self-harming behaviors will often try to hide their behavior. As a result, their injuries will often go unnoticed for quite some time putting them at a greater risk for long term injury or even loss of their life. Below are some signs you can look for if you are concerned that your child or teen is engaging is self-harming behavior.

  • Cuts, bruises or burns that appear without explanation. These will generally be most prevalent on the arms, wrists, thighs or chest however they can appear elsewhere as well.
  • If your child or teen keeps themselves fully covered despite warm or hot weather.
  • Watch for signs of depression such as moodiness, lack of motivation and reduced interest in their normal day to day activities.
  • Self-loathing or a desire for self-punishment.
  • Statements (or actions) about not wanting to “go on” or wanting to “end it all”.
  • Becoming abnormally withdrawn and not speaking to others
  • Outward signs of other forms of self-harm such as unexplained bruises, missing hair or missing fingernails.

What Can Parents Do If Teens Self-Harm?

Self-harming behaviors can be hard to notice as the outward signs are not always visible. Often, it is a parent or close peer that notices the behavior first. As a parent, there are ways you can help but by addressing your own feelings and seeking help for your teen.

Address your personal emotions

First, it is important to accept your personal emotions as related to the situation. If you suspect or find that your child or teen is harming themselves, it is expected and natural to feel a wide range of emotions. These can range from anger or sadness to confusion and fear. You may also feel upset or hurt that your child did not feel they could come to you for help. These emotions are all ok. It is important to take the time you need as a parent to identify the emotions you are experiencing and find a way to address and express them. Until you are able to gain perspective on your emotions, you will not be able to adequately provide the support your child needs.

Educate yourself

Do your research and learn all you can about cutting (or the self-harming behavior in which your child or teen is engaging). Learn about why teens cut and what options are available to help your teen stop this behavior. As we already noted, the reasons teens engage in self-harming behaviors are quite varied and it will be important for you, as a parent, to understand why your teen is engaging in these behaviors and how you may be able to help them stop.


Talk to your child. This is a painful topic and it is not easy to talk about. It is also likely you will have no idea how to address the subject or what to say. Remember, what you say isn’t even remotely as important as how you say it. Avoid accusations or assumptions. Voice your fears and concerns and make sure they know you are willing to walk with them on their journey to healing. Realistically, this will be equally as hard for your teen to talk about with you. Your teen may feel embarrassment, shame or worry. They may fear your reaction or the consequences of your reaction. You can help to alleviate these worries by being patient, open and listening to what they have to say without lecturing, scolding or punishment. If your teen shuts down and resists your efforts to talk about cutting, don’t give up. Find another time to approach the subject and try again.

Be encouraging and positive

Above all, offer your teen encouragement and support. If you choose to seek professional help, stay involved in the process as much as you can. This will help your teen to know that you are there for them. It may also help to let your teen know you are there for them to talk to when they are having experiences that are difficult or painful. This may encourage them to talk to you first before engaging in self-harming behavior. Encourage them to talk to you about their day or the events of the day. Be sure to focus on the positive parts of their day and how those events impacted them.

Hoodie | Self-Harm | Hillcrest

Where to Go for Help?

There really isn’t one “core” treatment or “best treatment” for self-injuring behavior. Treatment plans are designed around the specific issues your child or teen is experiencing as well as the underlying mental health conditions that could be leading to the behavior. For instance, if the self-harming behavior is related to a mental health disorder such as depression, the treatment plans will address the mental health condition as well as the resulting self-harming behavior.

Some of the most common therapy options include:


Psychotherapy is also known as talk therapy. This form of therapy can help a person to better identify and address the underlying issues they are experiencing that trigger the self-harming behaviors. It can also help your child or teen to better regulate emotions and learn how to better manage the stressors they are experiencing that could also contribute to the behavior. Psychotherapy techniques include treatment models such as cognitive behavioral therapy (CBT), Dialectical behavior therapy and mindfulness-based therapies


There are no medications that are used to treat self-harming behavior, however, if the self-harming behavior is related to another mental health condition such as depression or anxiety, medications may be used to treat the underlying condition.

Residential treatment:

Ongoing self-harm may be best treated as part of a residential treatment program. The most severe consequence of self-harming behavior is loss of life. Unfortunately, for some people who engage in these behaviors they are unable to stop before harming themselves irreparably. Also, as noted above, roughly half of people who die by suicide have engaged in some form of self-harming behavior. For children and teens who are unable to address their self-harming behaviors in an outpatient setting or for whom symptoms of the disorder are too intense or too persistent for an outpatient setting to be entirely successful residential treatment may be the best option. Residential treatment programs can be individual designed to meet the specific needs of the individual through options such as weekly counseling sessions, group counseling and individual counseling. Additionally, a residential setting offers the opportunity for medical interventions that may be necessary depending on the severity of the self-harming behavior. For inpatient and residential settings, a team approach is the best method for treating a variety of teen mental health needs including the underlying mental health issues that can lead to self-harming behavior. A team approach will likely include a variety of medical professionals, including a medical doctor, mental health professional, and nutritionist, among others.

If you have tried other treatments and feel a residential program may be helpful, look to Hillcrest. Our providers understand how the struggles your child is experiencing can have a significant impact on their overall health, emotional wellbeing, and their ability to thrive. We would like to show you how our program at Hillcrest can help your family. Why not reach out for a callback or to set up a tour?