17% at Cornell and Princeton students purposely cut themselves.
March 1 is
Self-injury Awareness Month


The Skeletons in My Closet


Self Injury

Teens & self-injury

Understanding Self-Injury/Self-Harm
Teenage Cutting: A Trend on the Rise
Cutting & Other Self-Harm: What every Parent Needs to Know
Talk with your kids about cutting
Self-Injury: The Secret Language of Pain for Teenagers
Self-mutilation rampant at 2 Ivy League schools
Cutting and Self-Harm: Warning Signs and Treatment
Adolescents who self-harm more likely to commit violent crime

Self-Injury and Cutting

What is Self-Injury?
What is cutting?
Cutting/Self Harm
Wound Locations

Self-Injury & Suicide

Understanding Suicide and Self-Harm - USA Today
Self-harm and Suicide
Self-harm and Suicide (12 page PDF)
Relations between Nonsuicidal Self-Injury and Suicidal Behavior in Adolescence
The Difference Between Self-Harm and Attempted Suicide
Suicide and Self-Harm
How Are Self-Injury and Suicide Related?
Does Cutting Mean That Someone Is Suicidal?
Does someone who cuts herself want to die?
Relations between Nonsuicidal Self-Injury and Suicidal Behavior in Adolescence: A Systematic Review (15 page PDF)
Correlates of Cutting Behavior among Sexual Minority Youths and Young Adults (14 page PDF)

Why do people self-harm?
Why do people engage in NSSI?
What are common misconceptions about NSSI?
Signs and symptoms of self-injury
Who is at risk for non-suicidal self-injury?
How Are Self-Injury and Suicide Related?
Is non-suicidal self-injury contagious?
Can people stop self-injuring?
Where can I find more information?
This researcher who studies self-injury explains why people do it. And why he did it.
How do I knows if my friend is self-injuring?
How do I talk to my friend about self-injury?
Painful feelings
Why Go to Therapy?
Finding the Right Kind of Therapy
Cutting: A Cry for Help
Cutting myself seemed like an escape
Dear Abby
Celebrity Cutters
Resource: - Support and Advice for Self Harm
Related Issues: 
Celebrity Cutters, Cutting from a teen's perspective , EMO, Cornell Research Program on Self-Injury and Recovery
Merchandise - Single card - $1.00 includes shipping, Positive Parenting Pack (all 34 cards) - $13.00 plus shipping


Self Injury

Self-injury has traditionally been known as self-harm (SH), self-inflicted violence (SIV), self-injurious behavior (SIB), and self-mutilation, although this last term has connotations that some people find worrisome, inaccurate, or offensive. A broader definition can also include the phenomenon of those who inflict harm on their bodies by means of disordered eating, or compulsive tattooing or body piercing or impulsive non-lethal injuring. When discussing self-injury with someone who engages in it, it is suggested that one use the same terms and words which that person uses, e.g. "cutting". Self-injury is usually not associated with an attempt at suicide; the person who self-injures is not usually seeking to end his or her own life, but is instead hoping to cope with or relieve unbearable emotional pain or discomfort.

A common form of self-injury involves making shallow cuts to the skin of the arms or legs. This is casually referred to as "cutting"; a person who routinely does this may be colloquially called "a cutter". Localized multiple cuts, especially those similar in appearance, are sometimes characteristic of cutting, but are not reliable indicators of self-injury. Less frequently, this behavior may involve cutting other parts of the body, including the breasts and sexual organs. Other examples of self-injury include:

  • Punching, hitting and scratching
  • Choking, constricting of the airway
  • Self-biting of hands, limbs, tongue, lips, or arms
  • Picking at wounds, ulceration, sutures, or blemishes
  • Burning, including cigarette burns, and self-incendiarism (as well as eraser burns)
  • Stabbing self with wire, pins, nails, staples, or pens
  • Ingesting corrosive chemicals, batteries, or pins
  • Self-poisoning; for example by overdosing on medication and/or alcohol, without suicidal intent

A popular misconception of self-injury is that it is an attention seeking behavior. In truth, many people who self-injure are very self-conscious of their wounds and scars and go to great lengths to conceal their behavior from others. They may offer alternative explanations for their injuries or conceal their scars with clothing.

In the strictest terms, self-harm is a general term for self-damaging activities (which could include alcohol abuse and bulimia), whereas self-injury refers more specifically to the practice of cutting, bruising, poisoning, overdosing (without suicidal intent), burning or otherwise directly injuring the body. Many people, including healthcare workers, define self-harm based around the act of damaging one's own body. It may be more accurate to define self-harm based around the intent, and the emotional distress that the person wishes to deal with. An example of this form of definition is provided by the self-injury awareness charity, LifeSIGNS.

Neither the DSM-IV-TV nor the ICD-10 provide diagnostic criteria for self-injury. It is often seen as only a symptom of an underlying disorder, though many people who self-injure would like this to be addressed.


Accurate statistics on self-injury are hard to come by since most self-injurers conceal their injuries Recorded figures tend to be based on hospital admissions, though more recently researchers have attempted to document the topography and correlates of the behavior in the general population. Studies based only on hospital admissions may hide the larger group of self-injurers who do not need or seek hospital treatment for their injuries. Many of these statistics show that more women seem to self-injure than men, and that it is more common among young people.

One of the earliest studies into self-injury was carried out in 1986 by Conterio and Favazza, who estimated that 0.75% of the population exhibit self-injurious behavior. Half the sample had been hospitalized for the problem, and 97% of were female. It should be noted that more recent studies show the numbers of self-injurers to be more evenly split between female and male.

"Cornell University's Program on Self-Injury and Recovery says U.S. studies find self-injury ranges from 12% to 37% in adolescents and 12% to 20% in young adult populations, with cutting as the most common form." from a review of 13 Reasons Why'."

A study of self-injurious behavior in college students published by Cornell University researchers in 2006 found that the most common methods of self-injury reported by both male and female subjects were scratching or pinching with fingernails or other objects to the point that bleeding occurred or marks remained on the skin (51.6%), banging or punching objects to the point of bruising or bleeding (37.6%), cutting (33.7%), and punching or banging oneself to the point of bruising or bleeding (24.5%). Female subjects were 2.3 times more likely to scratch or pinch and 2.4 times more likely to cut. Male subjects were 2.8 times more likely than female subjects to punch an object with the intention of injuring themselves. Male subjects were 1.8 times more likely to injure their hands, whereas female subjects were 2.3 times more likely to injure their wrists and 2.4 times more likely to injure their thighs. Self-injury is popularly assumed to represent a female phenomenon, and although there is some disputed support to this claim, the authors of the study believe that the popular association of self-injury with cutting may account for this belief.

The WHO/EURO Multicentre Study of Suicide estimated that the average European rate of self-injury for persons over 15 years is 0.14% for males and 0.193% for females. For each age group the female rate exceeded that of the males, with the highest rate among females in the 15-24 age group and the highest rate among males in the 12-34 age group. Recently, however, it has been found that the female to male ratio, previously thought to be around 2:1, is diminishing – in Ireland it has been close to parity for a number of years.

The Mental Health Foundation estimates the rate in the UK to be 0.77% , and that the majority of people who self-harm are aged between 11 and 25 years, with between 1 in 12 and 1 in 15 young people self-harming .

A 2003 study commissioned by Samaritans found that more than 1 in 10 15-16 year olds in the UK have deliberately harmed themselves, and that girls of this age were nearly four times more likely to have self-harmed than boys.

In a study of undergraduate students in the United States, 9.8% of the students surveyed indicated that they had purposefully cut or burned themselves on at least one occasion in the past. When the definition of self-injury was expanded to include head-banging, scratching oneself, and hitting oneself along with cutting and burning, 32% of the sample said they had done this. This suggests that this problem is not associated only with severely disturbed psychiatric patients but is not uncommon among young adults.

In a study of psychiatric morbidity carried out in the UK, respondents were asked the question: "Have you ever harmed yourself in any way, but not with the intention of killing yourself?" This survey found an overall lifetime prevalence of 2.4%, this being 2.0% of males and 2.7% of females.

About 10% of admissions to medical wards in the UK are as a result of self-harm, however the majority of these are for drug overdoses, with only 5 to 15% of this number being caused by cutting.

In New Zealand, more females are hospitalized for intentional self-harm than males. Females more commonly choose methods such as self-poisoning that generally are not fatal, but still serious enough to require hospitalization.

Risk factors

A number of social or psychological factors can be seen to have a positive statistical correlation with self-injury or its repetition.

People experiencing various forms of mental ill-health can be considered to be at higher risk of self-injuring. Key issues are depression, phobias, conduct disorders. Substance abuse is also considered a risk factor as are some personal characteristics such as poor problem resolution skills, impulsivity, hopelessness and aggression. Many self-injurers grew up in an environment that discourages expression of anger. Abuse during childhood is accepted as a primary social factor, also losing a parent or loved one, along with troubled parental or partner relationships. Factors such as war, poverty, and unemployment may also contribute.

However, some people who self-injure have no experience of these factors.


Attempts to understand self-injury fall broadly into either attempts to interpret motives, or application of psychological models.

Motives for self-injury are often personal, often do not fit into medicalised models of behavior and may seem incomprehensible to others, as demonstrated by this quote:

"My motivations for self-harming were diverse, but included examining the interior of my arms for hydraulic lines. This may sound strange."

Assessment of motives in a medical setting is usually based on precursors to the incident, circumstances and information from the patient however the limited studies comparing professional and personal assessments show that these differ with professionals suggesting more manipulative or punitive motives.

The UK ONS study reported only two motives: “to draw attention” and “because of anger”. Many people who self-injure state that it allows them to "go away" or dissociate, separating the mind from feelings that are causing anguish. This may be achieved by tricking the mind into believing the pain felt at the time is caused by self-injury instead of the issues they were facing before: the physical pain therefore acts as a distraction from emotional pain. The sexual organs may be deliberately hurt as a way to deal with unwanted feelings of sexuality, or as a means of punishing sexual organs that may be perceived as having responded in contravention to the persons well being.(e.g., responses to child sexual abuse).

To complement this theory, one can consider the need to 'stop' feeling emotional pain and mental agitation. "A person may be hypersensitive and overwhelmed; a great many thoughts may be revolving within their mind, and they may either become triggered or could make a decision to stop the overwhelming feelings."

Alternatively self-injury may be a means of feeling something, even if the sensation is unpleasant and painful. Those who self-injure sometimes describe feelings of emptiness or numbness (anhedonia), and physical pain may be a relief from these feelings. "A person may be detached from himself or herself, detached from life, numb and unfeeling. They may then recognize the need to function more, or have a desire to feel real again, and a decision is made to create sensation and ‘wake up’." A flow diagram of these two theories accompanies this section.

It is also important to note that some self-injurers report feeling very little to no pain while self-harming.

Those who engage in self-injury face the contradictory reality of harming themselves whilst at the same time obtaining relief from this act. It may even be hard for some to actually initiate cutting, but they often do because they know the relief that will follow. For some self-injurers this relief is primarily psychological whilst for others this feeling of relief comes from the beta endorphins released in the brain (the same chemicals responsible for the "runner's high"). These act to reduce tension and emotional distress and may lead to a feeling of calm.

As a coping mechanism, self-injury can become psychologically addictive because, to the self-injurer, it works; it enables him/her to deal with intense stress in the current moment. The patterns sometimes created by it, such as specific time intervals between acts of self-injury, can also create a behavioral pattern that can result in a wanting or craving to fulfill thoughts of self-injury.

Another possible source of self-injury can be self-loathing, often as a means of punishment for having strong feelings that they were expected to suppress when they were children, or because they feel bad and undeserving, having previously been physically or emotionally abused and feeling that they were deserving of the abuse.

Another often overlooked area that can result in self-injurious behavior is processing disorders. Autistic-spectrum disorders, especially when undiagnosed, or misdiagnosed, can result in severe depression, anxiety and fluctuating behavior. The rising depression rates in the UK teenage population could be accounted for by the fact that there is no testing being carried out on the NHS for such disorders. If a person is diagnosed with depression and anxiety, the help available is most often medication and (arguably pre-scientific) therapy (such as psychodynamic therapy). This could mean that a large proportion of people with various processing disorders are unable to be diagnosed as such. It is arguable that the stress resulting from living with no support for an undiagnosed disorder, or being given inappropriate therapy, could lead to self-injurious behavior.

Often, people with disorders such as autism are unable to feel certain stimulation, such as temperature, hunger and pain, in the same way as someone without a processing disorder usually would. In his book The Ultimate Stranger: The Autistic Child, Carl Delacato (1974) classified each sensory channel as being either hyper (too much stimulation gets in through the sensory channel for the brain to cope with) hypo (too little stimulation gets in through the sensory channel causing the brain to be deprived) and "white noise" (the faulty channel creates its own stimulus).

A person with autism often displays behaviors to balance their sensory dysfunction. If, for example, a person was hypo-tactile, they may attempt to stimulate themselves by using methods that could be categorized as self-injury.

Self-injury awareness

There are many movements among the general self-injury community to make self-injury itself and treatment better known to mental health professionals as well as the general public. SIAD (Self Injury Awareness Day) which is set for March 1 of every year, is one such movement. On this day some people choose to be more open about their own self-injury, and awareness organizations make special efforts to raise awareness about self-injury. Some people wear ribbons to show awareness; commonly orange ribbons are used for this. Sometimes a red and black ribbon is also used, generally signifying a person who self-injures. Sometimes orange is used to represent those who self-injure, white for those who don't injure but show support and white and orange together show someone who is trying to stop or has stopped self-injury. A single white bead on an orange bracelet may sometimes be used for those who want to stop and several mixed white and orange beads is for those who have stopped.


Self-injury may be an indicator of depression and / or other psychological problems. Therapy and skills training can be very useful for those who self-injure. The therapy module used will vary depending on the person's diagnosis and their individual needs.

DBT, or Dialectical behavioral therapy can be very successful for those with a personality disorder, and could potentially be used for those with other mental illnesses who exhibit self-injurious behavior. Cognitive Behavioral Therapy is generally used to assist those with axis 1 diagnoses, such as depression, schizophrenia, and bipolar disorder. Diagnosis and treatment of the causes is thought by many to be the best approach to self-injury; but in some cases, particularly in clients with a personality disorder, this is not very effective, which is why more clinicians are starting to take a DBT approach in order to reduce the behavior itself. A person who is injuring themselves may be advised to use coping skills, such as journaling or taking a walk, when they have the urge to harm themselves. They may also be told to avoid having the objects they use to harm themselves within easy reach. People who rely on habitual self-injury are sometimes psychiatrically hospitalized, based on their stability, and their ability and especially their willingness to get help.
Source: and

Understanding Self-Injury/Self-Harm

Non-Suicidal Self-Injury (NSSI), commonly referred to as self-injury or self-harm, may be confusing and difficult to understand. Many people have a hard time talking about self- injury because it seems unnatural to them. It is important to understand what motivates teens to harm themselves because not all people do it for the same reason. The best way to help someone to stop self- injuring is to help him or her address the underlying issues.

When someone self-injures, they do not intend to die. Young people who self-injure may do so as a method to cope with stress– hurting themselves is often seen as a way to control their upsetting feelings. Others do so to dissociate from their problems (e.g. to distract themselves from emotional pain). Research suggests that self-injury can activate different chemicals in the brain which relieve emotional turmoil for a short period of time.

Other motivations for why teens may self-injure include:

  • To reduce anxiety/tension
  • To reduce sadness and loneliness
  • To alleviate angry feelings
  • To punish oneself due to self-hatred
  • To get help from or show distress to others
  • To escape feelings of numbness (e.g. to feel something)

What are the symptoms of self-injury?

There are many ways in which a young person can engage in self-injury behaviours, but the most common is cutting the skin with razor blades or pieces of glass. Injuries can range from moderate to severe.

Other forms of self-injury include:

  • Burning and hitting oneself
  • Scratching or picking scabs (to prevent wounds from healing)
  • Overdosing on medications
  • Pulling out one’s hair, eyelashes, or eyebrows with the intention of hurting oneself
  • Inserting objects into one’s body

Who is at risk for self-injury behaviors?

Self-injury has become more common than most people suspect. People who self-injure often begin in early adolescence, although they can be any age, ethnicity, or socioeconomic status.

Young people who have symptoms of Depression, Anxiety, or low self-esteem are more likely to self-injure. There isn’t one absolute predictor of self- injury, but the following predictors increase someone’s risk for self- injury.

  • Abuse/neglect (past/present)
  • Bullying
  • Past episodes of self-harm
  • Losses (e.g. deaths, break-ups)
  • Inability or difficulty coping
  • High self-criticism
  • Addictive behaviours/ substance-use
  • Peers/ family members who self-harm
  • Mental illness

Information about the prevalence of young people who self-injure varies. This is because not everyone who self-injures seeks help or treatment and because some jurisdictions combine data on self-injury with data on suicide, which makes it difficult to obtain an accurate picture of either concern. A Canadian study conducted in 2002 found that 13.9% of high school students reported having self-injured. Females are more likely to self-injure than males.

How do you know if someone you love self-injures?

It's often difficult to know if someone you love self-injures because many people are very secretive about the behaviour. The person may go to great lengths to hide any evidence and cover up any physical injuries. Keep an eye out for:

  • Cuts/scars on arms, legs, and/or stomach
  • Wearing long sleeves/covering legs in situations where it doesn’t make sense (e.g., on a hot summer day)
  • Finding razors and other sharp objects
  • Unexplained or poor excuses for injuries

Emotional warning signs are important to consider as well. Some indicators may include difficulty handling emotions or problems with relationships. It is critical to recognize the signs and get help early so that the person’s behaviour does not escalate or lead to other serious injuries.

How can you tell the difference between suicide and non-suicidal self-injury?

It is common for those unfamiliar with self- injury to assume that self- injury is a suicide attempt that didn’t work – but that is incorrect. Self- injury is not an attempt to die. Young people often say that they self-injure so that they don’t attempt suicide. This can be confusing to onlookers because self- injury and suicide often involve the same behaviours, but the key difference is the motivation behind the behaviour. Individuals who self-injure engage in these behaviours so that they can feel better, not so that they can end their life.

Although self- injury is different than suicide, many teens who self-injure may be depressed and may indicate that life is not worth living. They may have thoughts of death but no actual intention to die.

People who self-injure have a hard time dealing with their feelings. Self- injury is used to reduce, manage or escape from intense emotions. If someone you know self-injures, listen to what he or she is saying, talk about his or her emotions, and encourage the person to get help. If the young person is at immediate risk of hurting him- or herself in a life-threatening way, he or she should be taken to the hospital.

What are the criteria for diagnosis of non-suicidal self-injury?

It is important to note that NSSI, or self-harm, is not a diagnosable mental disorder. More research is required to help mental health professionals better understand self- injury in young people.

The following criteria are suggested as an area for further research in the 5th edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V):

1. In the last year, the individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body of a sort likely to induce bleeding, bruising, or pain (e.g., cutting, burning, stabbing, hitting, excessive rubbing), with the expectation that the injury will lead to only minor or moderate physical harm (i.e., there is no suicidal intent).

Note: The absence of suicidal intent has either been stated by the individual or can be inferred by the individual’s repeated engagement in a behavior that the individual knows, or has learned, is not likely to result in death.

2. The individual engages in the self-injurious behavior with one or more of the following expectations:

  • To obtain relief from a negative feeling or cognitive state.
  • To resolve an interpersonal difficulty.
  • To induce a positive feeling state.

3. Note: The desired relief or response is experienced during or shortly after the self-injury, and the individual may display patterns of behavior suggesting a dependence on repeatedly engaging in it.The intentional self-injury is associated with at least one of the following:

Interpersonal difficulties or negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self-injurious act.

Prior to engaging in the act, a period of preoccupation with the intended behavior that is difficult to control.

Thinking about self-injury that occurs frequently, even when it is not acted upon.

4. The behavior is not socially sanctioned (e.g., body piercing, tattooing, part of a religious or cultural ritual) and is not restricted to picking a scab or nail biting.

5. The behavior or its consequences cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning.

6. The behavior does not occur exclusively during psychotic episodes, delirium, substance intoxication, or substance withdrawal. In individuals with a neurodevelopmental disorder, the behavior is not part of a pattern of repetitive stereotypies. The behavior is not better explained by another mental disorder or medical condition (e.g., psychotic disorder, autism spectrum disorder, intellectual disability, Lesch-Nyhan syndrome, stereotypic movement disorder with self-injury, trichotillomania [hair-pulling disorder], excoriation [skin-picking] disorder).

What can you do if someone in your life self-injures?

It is important to encourage someone who self-injures to seek help. Although he or she may want to avoid discussing the issue, understanding the feelings and emotions that make him or her want to self-injure is an essential component of treatment. In addition to better understanding what causes someone to self-injure, treatment also focuses on learning more adaptive ways of coping, so that the individual can find healthier and safer ways to solve his or her problems.

Although it’s important to encourage the young person to seek help, he or she must be ready and committed to change. Trying to force someone to change his or her behaviour before he or she is ready will only make the person increasingly resistant to treatment and cause frustration for you. Express your concern to the young person, but don’t be overly dramatic or cause a scene. The young person needs you to be part of his or her support system now and when he or she is in treatment. Self- injury can become addictive and a habit, so it is important to be patient during recovery. Don’t expect the person to change his or her behaviour right away. Remember that the person needs to have healthier coping strategies in place before completely relinquishing his or her self-injurious behaviour.

Being a positive influence while the young person is seeking professional help is important. Encourage him or her to avoid things that can be used to hurt him- or herself. Remind the person to do things that make him or her happy. Help him or her connect with other people. Even just spending time with him or her and listening to what he or she has to say can make a difference. Remember not to blame yourself and know that you should not handle someone’s problems with self- injury alone.

What treatment options exist for young people who self-injure?

A variety of treatment options exist for youth who self-injure. Determining which course of action is appropriate for each individual should be done with the guidance of a trained health professional.

Treatment options for youth who self-injure may include one (or a combination) of the following:

Psychological Treatments: Psychotherapy or “talk therapy” works by helping your brain better control your thoughts and emotions. There are two different types of psychotherapy that have been found to be effective for treating self-injury in teenagers:
Dialectical Behaviour Therapy (DBT), a type of therapy based on a philosophy of balancing, acceptance and change.

Cognitive Behavior Therapy (CBT), a type of therapy which helps people understand, problem solve, and change the relationship between their thoughts, emotions, and behaviours

Medication: Medication may be used for young people who have symptoms of Depression and/or Anxiety along with their self-injury behaviours. Rather than treating the self-injury directly, medication helps with the underlying issues that are contributing to why someone chooses to self-injure. For more information on how to properly use medications, check out MedEd.

School supports: Sometimes certain adaptations can be made by the school to assist a student in coping with and managing his or her self-injury.

Regular Routine: Maintaining a healthy, regular daily routine is very important for someone who is struggling with mental health issues. For help maintaining the kind of healthy lifestyle that should accompany professional treatment, check out Taking Charge of Your Health.

Contagion and self-injury

For someone who uses healthy coping strategies to deal with emotion, knowing that someone else self-injures is unlikely to make them start. If, however, someone has difficulty coping with intense emotions, he or she may be more likely to self-injure after finding out that someone he or she knows self-injures. It’s important to be aware that for some young people, but not all, media portrayal and peer awareness of self-injury may act as a trigger for their own self- injury. Be attentive to what the young person watches and hears, and talk to him or her about how he or she is feeling.

Related disorders

  • Depression
  • Borderline Personality Disorder
  • Anxiety Disorders
  • Post-Traumatic Stress Disorder
  • Substance Use Disorders

It’s important to note that many young people who self-injure do not have a mental illness; although it is more common for someone who self-injures to have a mental illness than someone who does not self-injure. Most often, young people who self-injure are looking for a way to deal with their emotions, and they will continue to self-injure until they learn more effective coping strategies.

Why do people self-harm?

Self-harm, also known as self-injury, self-mutilation, or more method-specific terms like "cutting" or "burning," is the act of purposely causing physical harm to oneself. It usually happens without the intent to die -- that is, not as a suicide attempt.

People who hurt themselves most often start as teens or young adults. Because people who self-injure frequently hide their injuries from others, it can be difficult to identify.

There are many different types of self-harm, which cause varying degrees of damage. All forms should be taken seriously.

Why Do People Self-Harm?

People self-harm for a variety of reasons. Understanding the reason someone is hurting themselves is often an important step to supporting them. Examples of reasons include:

  • Coping with stress. For some people, self-harm becomes a way of dealing with negative emotions and transitions.
  • Distraction. Self-harm is used by some people as a way of taking their minds off overwhelming emotions.
  • To feel something physical. People who feel numb, often from trauma, may self-harm to experience the physical sensation it causes.
  • Sense of control. Individuals who feel their lives are out of their control might hurt themselves because self-injury is something they feel they can control.
  • Self-punishment. People experiencing extreme shame or guilt may turn to self-harm to give themselves the pain they feel they deserve.
  • Expressing emotions. Some people find their emotions so painful that they struggle to put them into words. Other people feel that they shouldn't express their emotions because they have been socialized not to do so. These individuals may use self-injury to show others how they're feeling rather than telling them.

Risks of Self-Injury

Self-harm has physical, emotional, and social effects.

Physical Effects

  • Permanent scars
  • Uncontrolled bleeding
  • Infection

Emotional Effects

  • Guilt or shame
  • Diminished sense of self, including feeling helpless or worthless
  • Addiction to the behavior

Social Effects

  • Avoiding friends and loved ones
  • Becoming ostracized from loved ones who may not understand
  • Interpersonal difficulty from lying to others about injuries

The risk of accidental death by self-injury is very real, and varies based on the method.

Treatment and Recovery: How Do You Stop Self-Harming?

It's normal to want to quit self-harming, but feel unable to. Even knowing the risks, many struggle to break themselves away from the cycle. But it is possible. Here are some of the key steps:

  • Name your reason for hurting yourself, and your reason for quitting. Ask yourself: "What do I feel before, during, and after self-injury? Which of those emotions do I actively seek out, and which are harmful?"
  • Identify other ways of achieving the same result. For example, if you self-harm for the physical sensation, seek other ways of releasing endorphins, like exercise. If you self-harm to express your emotions, practice expressing them in words by writing them down.
  • Tackle the underlying emotions. Explore the feelings that lead you to want to hurt yourself. If it's guilt, where is that guilt coming from?
  • Tell someone you trust. Let a friend, family member, or trusted adult know what you're going through and that you need their support.
  • Text Crisis Text Line. We're here to listen, never to judge. Text Crisis Text Line at 741741 in the US or 686868 in Canada.

17 Quotes You Need if You're Struggling with Self Harm

According to Mental Health America, 17-35% of college students engage in self-harm. Part of the reason we don’t know the exact numbers for sure is because of the intense stigma around the topic. Many people interpret self-harm as an way of “acting out” or “looking for attention." However, it’s important that we don’t stereotype-- pain does not discriminate and people of all ages and backgrounds can be at risk for self-harm.

We’ve compiled a list of quotes that we hope will help you overcome pain and learn to love yourself. If you’re struggling with self-harm, text SOS to 741741 to talk with a trained Crisis Counselor.

On Overcoming Pain

  • "A gem cannot be polished without friction, nor a man perfected without trials." Chinese proverb
  • "It's not whether you get knocked down. It's whether you get up again." Vince Lombardi
  • "The only person who can pull me down is myself, and I'm not going to let myself pull me down anymore." C. JoyBell C.
  • “Anyone can give up, it’s the easiest thing in the world to do. But to hold it together when everyone else would understand if you fell apart, that’s true strength.” Unknown
  • “You are not your past. You are the warrior that rose above it to become the example of someone who didn't just survive, but thrived in creating the most beautiful last chapter of their life.” Shannon L. Alder
  • "Strength does not come from winning. Your struggles develop your strengths. When you go through hardships and decide not to surrender, that is strength." Arnold Schwarzenegger

On Forgiving Yourself

  • “Stop beating yourself up. You are a work in progress, which means you get there a little at a time, not all at once.” Unknown
  • “You have been criticizing yourself for years, and it hasn’t worked. Try approving of yourself and see what happens.” Louise L. Hay
  • "Embrace and love all of yourself - past, present, and future. Forgive yourself quickly and as often as necessary. Encourage yourself. Tell yourself good things about yourself." Melody Beattie
  • "Forgive yourself for your faults and your mistakes and move on." Les Brown
  • "The real difficulty is to overcome how you think about yourself." Maya Angelou

On Loving Yourself

  • “You, yourself, as much as anybody in the entire universe, deserve your love and affection.” Unknown
  • “Love yourself—accept yourself—forgive yourself—and be good to yourself, because without you the rest of us are without a source of many wonderful things.” Leo F. Buscaglia
  • "To accept ourselves as we are means to value our imperfections as much as our perfections." Sandra Bierig
  • “If only you could sense how important you are to the lives of those you meet; how important you can be to people you may never even dream of. There is something of yourself that you leave at every meeting with another person.” Fred Rogers
  • “You’re always with yourself, so you might as well enjoy the company.” Diane Von Furstenberg

“Loving yourself…does not mean being self-absorbed or narcissistic, or disregarding others. Rather it means welcoming yourself as the most honored guest in your own heart, a guest worthy of respect, a lovable companion.” Margo Anand
Source: Crisis Text Line

Self-Injury: The Secret Language of Pain for Teenagers

"You have so much pain inside yourself, you try and hurt yourself on the outside because you need help," --Princess Diana, 1996

Self-injury has not been a topic discussed over family dinner.

Although self-injury has been plaguing lives for quite some time, with increasing incidences being cited in middle school and high school, it was not until 1996, when Princess Diana admitted to bouts with self-injury, that article, books, and television documentaries began to appear. Now, conversations about self-injury are appearing at the dinner table, despite its remaining distastefulness.

Today, researchers are describing the phenomenon of self-injury among teenagers as "the deliberate, direct, non-suicidal destruction or alteration of one's body tissue" (Favazza, 1996), and quantifying it under three major categories: a) Major Self-Injury (the most rare form which usually results in permanent disfiguration), b) Stereotypic Self-Injury (which consists of head banging and biting), and c) Superficial Self-Injury (the most common which involves cutting, burning, and hair pulling) (Anonymous, 1999).

Why would students purposely hurt themselves? Our personal research indicates that most students self-injure themselves because they are unable to handle intense feelings, and so they turn to self-injury as a way to express their feelings and emotions. We tell audiences, "Pain that is self-inflicted is pain over which a person has control. Just enough pain will cause a person to divert their attention away from the outside pain over which they have no control to the known pain they self-inflict." We like what psychologist Scott Lines so eloquently said, "The skin becomes a battlefield as a demonstration of internal chaos. The place where the self meets the world is a canvas or tabula rosa on which is displayed exactly how bad one feels inside."

Research indicates that cutting is the most common method of adolescent elf-injury, and is usually done with razor blades, knives, or matches.

In the following excerpt, note the priority system involved in cutting, and how this priority system centers on victim convenience (i.e., the ability to hide the injury the easiest). In the 1999 docudrama movie titled, Secret Cutting it was revealed that the most common parts of the body injured include (in ranked order) "the forearms and wrists, upper arms, thighs, abdomen, and occasionally, breasts and calves. The reason for the variation in the ranked locations is that those most concealed by clothing are the most preferred areas."

Crucially important to the victim is concealment of the injury. By keeping self-injuries away from peering eyes, the adolescent can increase the ability to do it more often without interruption. The fact that self-injury has been so little documented until recently is due in part to the "almost expert awareness" on the part of the victim to be able to avoid detection.

It is common to associate a great number of ancillary activities with self-mutilation, but differentiate between what is, and what is not harmful self-injury needs to be made.

Adolescent activities such as skin piercing, tattoos, and group rituals fall into the category of simple adolescent trends. Although these activities fit the description of self-injury, the motivation to engage in these actions differs greater from intention physical self-injury. For instance, teens want a tattoo, and they do it for the tattoo or from peer pressure, and not the pain that is involved in the procedure. When a self-injurer cuts his or her skin it is to feel the pain, and not for the decorative results (Levenkron, 1998).

We tell high school students that self-injury is a self-inflicted act most often used as a coping mechanism for relieving an unwanted emotion, or as Jimmy Buffet (1999) said in a song, "It's a permanent reminder of a temporary feeling." Basically, it is a way to alter a mood state by focusing pain in a controllable area of the body. Think of a child who is riding his or her bike right after a heated argument with a sibling. That child would still be feeling angry or upset about the argument. But if that child falls off the bike and skins a knee, the primary concern instantly becomes focused on the knee, not on the anger. Falling off the bike made the child focus on the feeling of physical pain, or the skinned knee. The emotional anger that the child was feeling on the inside has now seemed to vanish.

Teens seek physical pain to distract themselves from emotional pain. In popular culture we see ...

Self-Injury and Cutting

Causes, Warning Signs and Treatments

What Is Self-Injury?

Self-injury involves self-inflicted bodily harm that is severe enough to either cause tissue damage or to leave marks that last several hours. Cutting is the most common form of SI, but burning, head banging and scratching are also common. Other forms include biting, skin-picking, hair-pulling, hitting the body with objects or hitting objects with the body.

Other Names

Self-injury, self-harm, self-mutilation, cutting, burning, SI.

Why Do People Do It?

Although suicidal feelings may accompany SI, it does not necessarily indicate a suicide attempt. Most often it is simply a mechanism for coping with emotional distress. People who select this emotional outlet may use it to express feelings, to deal with feelings of unreality or numbness, to stop flashbacks, to punish themselves, or to relieve tension.

Who Self-Injures?

Although SI is recognized as a common problem among the teenage population, it is not limited to adolescents. People of all sexes, nationalities, socioeconomic groups and ages can be self-injurers.

Warning Signs

People who self-injure become very adept at hiding scars or explaining them away. Look for signs such as a preference for wearing concealing clothing at all times (e.g. long sleeves in hot weather), an avoidance of situations where more revealing clothing might be expected (e.g. unexplained refusal to go to a party), or unusually frequent complaints of accidental injury (e.g. a cat owner who frequently has scratches on their arms).


Medications such as antidepressants, mood stabilizers and anxiolytics may alleviate the underlying feelings that the patient is attempting to cope with via SI. The patient must also be taught coping mechanisms to replace the SI. Once the patient is stable, therapeutic work should be done to help the patient cope with the underlying problems that are causing their distress.

Some experts say that hospitalization or forced stopping of the SI is not a helpful treatment. It may make the doctor and involved friends and family feel more comfortable, but does nothing to help the underlying problems. Further, the patient is generally neither psychotic nor actively suicidal and will benefit more from working with a doctor who is compassionate to the reasons that they are hurting themselves. Patient desire to cooperate and get well is a major factor in recovery.

Signs and symptoms of self-injury

Patients who self-injure can be as young as 12-years-old and can continue well into adulthood. More and more, kids are learning about the means and methods of how to induce self-injury to help control their emotional pain. Cutting, for instance, is the most common because it can be easily covered up.

It’s more common amongst girls to have these types of addictions but has been seen as boys as well. Children who self-injure will often battle with an eating disorder as well. They might also have a history of sexual, physical and/or emotional abuse or it may be a sign of or low self-esteem. It begins as a defense of what is going on in their personal lives and within their family. They may feel they have failed in one area of their lives and are looking for a way of taking back control.

Self-injury as a Sign for other Issues

Self-mutilation is a severe impulse control disorder that can often be associated with other psychiatric disorders. These include:

  • Borderline personality disorder
  • Depression
  • Substance abuse (alcoholism or drug abuse)
  • Eating disorders (anorexia or bulimia)
  • Psychosis
  • Antisocial personality disorders
  • Post-traumatic stress disorder

On the other hand, there are “regular kids” going through the adolescent struggle for self-identity and use self-injury is a form of experimentation, similar to alcohol or drugs that are also common around this age range.

Physical Signs and Symptoms of Self-injury

Because self-harm addiction is often kept secret, it may be difficult to spot signs and symptoms. Physical self-injury symptoms may include:

  • Scars, such as from burns or cuts
  • Staring at or playing with scars
  • Fresh cuts, scratches or other wounds
  • Small, linear cuts. Sometimes words are also cut in the body
  • Bruises
  • Broken bones
  • Head banging
  • Eye pressing
  • Finger or arm biting
  • Pulling out one’s hair
  • Picking at one’s skin
  • Claiming to have frequent accidents or mishaps
  • Unexplained cuts and scratches, particularly when they appear regularly. ‘The cat did it’ is a commonly used excuse

Situational Signs and Symptoms of Self-injury

Aside from physical examples that are indicative of self-injury, there are circumstantial evidences that loved ones can be suspicious of. These warning signs that an individual might be engaging in self-injury include:

  • Wearing pants and long sleeves in warm weather
  • The appearance of lighters, razors or sharp objects that one would not expect among a person’s belongings
  • Low self-esteem
  • Mood changes like depression or anxiety, out-of-control behavior
  • Promiscuity
  • Difficulty handling feelings
  • Relationship problems
  • Poor functioning at work, school or home
  • Creating artwork that features a lot of black or red
  • May sit with a pillow covering their legs or quickly change sitting position when someone enters the room
  • Person may be withdrawn or wishes to be alone
  • The person may often hold ice to their skin
  • The person may draw on their arms with red marker, food coloring or paint (a sign that they are wanting help)
  • The person may wear a lot of bracelets or a rubber band on the wrist that they can snap whenever they need to (another sign of wanting to stop self-injury)

How to Begin Treatment

In order for healing to take place, the user must cease the form of self-injury and allow the feelings they are avoiding to surface. It is only then that they can begin a form of counseling and therapy to start processing those feelings. Self-mutilation treatment is most beneficial with one-to-one counseling, group therapy and a daily program of recovery is implemented.

Self-injury Help

If you or someone you know is struggling with self-injury addiction, we can help. Please call our toll free number at (877) 259-5635. We are available 24 hours a day, seven days a week to answer your questions on self-injury treatment and addiction.

Does someone who cuts herself want to die?

Need-to-know information on cutting and self-harm

Perhaps you know someone who cuts herself and wonder if she really wants to die? The answer is that it depends.

The very act of cutting is not necessarily a suicidal gesture, however, those who engage in self-harmful gestures such as cutting may be struggling with suicidal thoughts. Additionally, self-injurious acts can be life threatening as they may accidentally go too far and result in unintentional suicide.

Why do people cut themselves?

People who cut themselves or injure themselves in other ways report a sense of relief after the act. Cutting, for them, is a way of mitigating deep emotional pain or distracting themselves from something they want to keep their mind off. It can help people express feelings that they are unable to articulate with words, and can help people feel alive when otherwise they report feeling numb. Cutting is a way of coping.

Interestingly, a 2003 study headed by Naomi Eisenberger indicates that the brain encodes physical pain and social emotional pain in the same regions, namely the dorsal anterior cingulate cortex and the anterior insula. The fact that the brain handles emotional social pain and physical pain in the same area may make some sense of why someone might turn to physical pain to help cope with emotional pain.

Is it true that people who cut themselves only do it for attention?

While there are some people who might cut or act in certain ways that call out for attention, the vast majority of people who cut are doing so because it is the best way they know how to cope with deeply painful feelings.

Many people cut or engage in self-harmful behaviors actually do so in secret. People who cut often wrestle with a great deal of shame and therefore hide this behavior. People generally do not cut themselves for attention.

If people keep cutting a secret, how can I tell if someone is cutting?

If you suspect that a friend is cutting, the best way to find out is to ask them from a non-judgmental and caring place.

People can be scared of bringing up difficult issues such as cutting or suicide with people they are concerned about, but talking about it is one of the ways to help a suicidal friend or someone who cuts. Signs to look out for may include unexplained injuries or wounds, isolation, irritability, and other secretive behaviors. Someone who seems to be especially accident prone or wears long sleeves when the weather is warm may also be hiding the fact that they are injuring themselves while alone.

How can I help my friend who is cutting?

If you know someone who may be cutting or engaging in some other kind of self-injurious behavior, it might feel awkward to bring it up in conversation. If you do try to talk about it, your friend may deny that she or he cuts or refuse to speak about it. Even so, it is worth making the effort to talk about it

It is important that you refrain from judging your friend or belittling what she or he is doing. Telling her or him to stop probably will not help either.

It is important to understand why your friend is cutting, which likely has to do with coping with difficult emotions. You can offer your support and encourage your friend to talk about his or her problems.

The best thing is for your friend to get appropriate mental health treatment. You can encourage your friend to get help, and if it makes sense for you, you can offer assistance on how to find a psychotherapist. It is important that the psychotherapist has experience working with people who engage in self-harming behaviors.

Your friend who cuts hopefully does not wish to die but is coping in a way that is ineffective in the long run. Discussing this problem in the open is often the first step toward healing.


Eisenberger, N, Lieberman, M, Williams, K. (2003). Does rejection hurt? An fMRI study of social exclusion. Science, vol. 302, pp. 218-226.

How Are Self-Injury and Suicide Related?

The intent is different, though one can lead to the other

This is an excerpt from Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones, by Janis Whitlock, PhD, and Elizabeth Lloyd-Richardson, PhD.

It’s not unusual for young people who are struggling with painful feelings to engage in self-injury — things such as cutting, burning or scratching themselves until they bleed. Knowing that a child is intent on harming herself is very upsetting to parents, and many worry that self-injury is a sign that their child is suicidal.

Self-injury and suicidal behaviors — imagining, planning or attempting suicide — are related, but the relationship between the two is confusing. Because they can look similar, it can be very difficult to tell the difference between them. But there are important differences in the intention as well as the danger: Self-injury is virtually always used to feel better rather than to end one’s life. Indeed, some people who self-injure are clear that it helps them to avoid suicide. In fact, the technical term for self-injury is non-suicidal self-injury, or NSSI.


Self-injury and suicide differ in multiple ways, including:

The intent: The intent of self-injury is almost always to feel better, whereas for suicide it is to end feeling (and, hence, life) altogether.

The method used: Methods for self-injury typically cause damage to the surface of the body only. Suicide-related behaviors are much more lethal. Notably, it is very uncommon for individuals who practice self-injury and who are also suicidal to identify the same methods for each purpose.

Level of damage and lethality: Self-injury is often carried out using methods designed to damage the body but not to injure the body badly enough to require treatment or to end life. Suicide attempts are typically more lethal than standard NSSI methods.

Frequency: Self-injury is often used regularly or off-and-on to manage stress and other emotions. Suicide-related behaviors are much more rare.

Level of psychological pain: The level of psychological distress experienced in self-injury is often significantly lower than that which gives rise to suicidal thoughts and behaviors. Moreover, self-injury tends to reduce arousal for many of those who use it and, for many individuals who have considered suicide, is used as a way to avoid attempting suicide.

Presence of cognitive constriction: Cognitive constriction is black-and-white thinking — seeing things as all or nothing, good or bad, one way or the other. It allows for very little ambiguity. Individuals who are suicidal often experience high cognitive constriction. The intensity of cognitive constriction is less severe in individuals who use self-injury as a coping mechanism.

Aftermath: Although unintentional death does occur with self-injury, it is not common. The aftermath of a typical self-injury incident is short-term improvement in sense of well-being and functioning. The aftermath of a suicide-related gesture or attempt is precisely the opposite.

Common risk factors

Despite differences and intention, suicidal thoughts and behaviors and self-injury do share common risk factors. Some of these include:

  • High emotional sensitivity
  • A history of trauma, abuse, or chronic stress
  • Extreme emotion or lack of emotion
  • A tendency to suppress emotions coupled with few effective mechanisms for dealing with emotional stress
  • Feelings of isolation (this can be invisible in people who seem to have many friends/connections)
  • A history of alcohol or substance abuse.

Because of these common risk factors, it is important for you to know that youth who self-injure are also at increased risk for suicidality. Our work shows that about 65 percent of youth who self-injure will also be suicidal at some point (though many will not go beyond having suicidal thoughts). For many, self-injury is used alone or in combination with other behaviors as a way to keep emotional distress or disconnectedness at a manageable level.

Although suicidal thoughts and behaviors can occur before self-injury is used, in most cases, suicidal thoughts and behaviors coincide with or come after self-injury starts. It is also important to note that only 36 percent of adults who self-injure in the United States reported having ever felt suicidal while engaging in self-injury, meaning that the majority of individuals who injure have never felt suicidal while engaging in self-injury.

Reducing inhibition to suicidal behavior

Although self-injury does not cause suicide, the other important thing to know about the relationship between self-injury and suicide is that the very act of engaging in self-injury reduces inhibition to suicidal behavior if someone becomes suicidal. In other words, having “practiced” injuring the body repeatedly makes it easier to actually injure the body with suicidal intent.

Other factors that can place someone at greater risk of moving from self-injury to suicide include:

  • Greater family conflict and poor relationship with parents
  • More than 20 lifetime NSSI incidents
  • Psychological distress in the past 30 days
  • A history of emotional or sexual trauma
  • Greater feelings of hopelessness
  • Identifying self-hatred, wanting to feel something, practicing or avoiding suicide as reasons for self-injury
  • High impulsivity and engagement in risky behaviors
  • Substance use
  • A diagnosis of major depressive disorder (MDD) or PTSD

These risk factors may be present individually or in clusters. The more of these your child has, the higher his or her risk is of at least having suicidal thoughts (this is called “suicidal ideation”).

What is especially important for you to know is that one of the most powerful protective factors against moving from self-injury to suicide is a feeling of connectedness to parents. Indeed, the consistency with which parents show up in our studies as important sources of support for their children is one of the reasons we wrote this book!

Janis Whitlock, PhD, is the founder and director of the Cornell Research Program on Self-Injury and Recovery. Elizabeth E. Lloyd-Richardson, PhD, is an associate professor of psychology at the University of Massachusetts, Dartmouth. This piece is an excerpt from Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones, from Oxford University Press.

The Skeletons in My Closet

This researcher who studies self-injury explains why people do it. And why he did it.

What do you think of when you hear the words "self-injury?"

You probably think of a middle-class, teenage girl cutting herself to get attention. That's the cliché, and it's all kinds of wrong.

Meet Dr. Stephen Lewis.

"As a male, as an academic, I may not be the first person you think about when you hear the words "self-injury."

He's been researching self-injury — we're most familiar with it as cutting or burning — for over 10 years.

A quick definition: Self-injury is intentional damage to body tissue (that doesn't include body modifications like piercings, tattoos, and scarification) without suicidal intent. And far more people are doing it than you'd think.

What he and other experts found might surprise you: Self-injury happens equally across gender, ethnicity, and socioeconomic lines.

It's not just an issue in the U.S. either. Self-injury has emerged as a major global mental health concern.

Here's something else that might surprise you: Lewis isn't just an academic expert. He's a life expert. He lived it.

He used to self-injure, and he shared his experience with the world in his talk for TEDxGuelphU.

It took some soul-searching before Lewis decided to tell his story publicly. In the end, he told me, "I wanted to convey a sense of hope to those who presently struggle. I wanted them to know they are not alone and that recovery is possible."

"There is light at the end of the tunnel. As dark as it may seem, if you keep walking — you can find it," he says.

Like Lewis (and myself), 1 in 5 adolescents has engaged in self-injurious behavior at least once, and a quarter of them have done it repeatedly. It can start as young as age 12.

As Lewis put it, "Self-injury provided needed relief from that emotional turmoil I was feeling inside. It conveyed the words I could not."

It's an attempt to relieve overwhelming feelings of sadness, distress, or self-loathing. Most often, people do it to externalize inner pain, to make it tangible, or to stop feeling numb.

The relief that self-injury provides is only temporary, though, and it can develop an addictive quality: The longer it's used, the harder it is to stop (or to find another way to quell the pain).

There's also a tolerance factor: The more you self-injure, the shorter the period of relief. It makes for a cycle that's incredibly difficult to break.

So, how can we help stop the cycle of self-injury?

Whether you're someone who has self-injured or not, one of the most important things we can do is educate ourselves: The false cliches and stereotypes we carry around about self-injury affect those who do it, too.

When we characterize people who hurt themselves as crazy, manipulative, or attention-seeking, they're more inclined to feel ashamed and isolated. They live in fear of judgment, and that fear creates silence.

This silence means that many people feel hopeless and alone. While self-injury isn't, by definition, a suicidal behavior, it does elevate risk for suicide.

Without help, that silence and that hopelessness can be deadly.

Self-injury is a habit that's hard to break. One of the first steps toward ending the cycle is for us to allow the conversation to happen.

Four little words are all we need: "How can I help?"

That's what turned things around for Lewis:

"For me, this involved a willingness to not just ask for help, but to accept it —something I was not accustomed to. This help, for me, came from professionals. It came from friends, and it came from my family."

His story ends well. My story — as a fellow self-injurer — ends well, too. All of these stories can end well.

"Recovery is a process," said Lewis. "And not a linear one. I had good days and bad days, and on some bad days, I self injured again. But those bad days became fewer and farther between."

Nobody should suffer alone. We all have baggage, but we each bear the weight of our burdens differently.

We can help each other bear that weight if we're brave enough to listen and brave enough to start conversations that matter.

This is how we find better ways to heal. This is how we create hope for those who need it the most.

Want more information on self-injury? Take a look at the Self-Injury Outreach and Support website.

Why Teens Cut Themselves

Help Your Teen Stop Cutting and Learn Healthier Coping Mechanisms.

What Cutting Is

Cutting is a type of self-harm in which teens deliberately cut or scratch themselves with knives, razor blades, or other sharp objects, but not with any intention of trying to commit suicide.

Other self-harm behaviors can include head-banging, branding or burning their skin, overdosing on medications, and strangulation.

These behaviors are more common than you might think and affect up to 16 percent of teenagers and young adults.

Why Teens Cut Themselves

Parents and pediatricians often have a hard time understanding why teens would cut or do other things to harm themselves. Not surprisingly, cutting is a complex behavioral problem and is often associated with a variety of psychiatric disorders, including depression, anxiety, and eating disorders. Teens who cut themselves are more likely to have friends who cut themselves, low self-esteem, a history of abuse, and/or thoughts of committing suicide.

While it is sometimes seen as an attention-seeking behavior, cutting is a way for kids to release tension, relieve feelings of sadness or anger, or distract themselves from their problems. Of course, any relief is only temporary.

While some teens who cut may have a friend who cuts or may have read about it or seen it on TV, most kids who start cutting say that they were not influenced by anyone or anything else and came up with the idea themselves.

Signs of Cutting

Cutting is most common in teens and young adults—especially among teen girls—and often starts around age 14 or 15, during the early high school years.

Teens who cut themselves are usually described as being impulsive. Some are also described as being overachievers.

In terms of warning signs and red flags, your teen may be cutting if she:

  • always wears long-sleeved shirts or long pants (even when the weather is warm) to cover new cutting marks or older scars on her arms, wrists, or thighs (those are common areas of the body where cutting occurs)
  • routinely has suspicious cuts, scratches, or burns on her belly, legs, wrists, or arms
  • is developing symptoms of depression, anxiety, or an eating disorder
  • has trouble controlling her emotions (like if your teen doesn't know how to handle herself when she feels sad or angry)

If you think that your child is cutting, ask her about it gently. If the answer is yes, it's important not to get mad or overreact. You don't want to make her feel bad for doing it. Keep in mind that cutting is often a symptom of a larger problem, and you, as a parent, can help your child figure out the underlying cause by seeking professional help (more on that below).

Treatments for Cutting

It is critical to seek treatment for your teen right away if she is cutting, both to help treat any underlying psychiatric problems, like depression or anxiety, and to prevent cutting from becoming a bad habit.

The longer a teen cuts herself, the harder it becomes to break the habit.

And cutting can lead to more problems later in life. In fact, the S.A.F.E. Alternatives (Self Abuse Finally Ends) treatment program describes cutting as 'ultimately a dangerous and futile coping strategy which interferes with intimacy, productivity and happiness.'

These are some forms of treatment that may help your teen quit cutting and learn healthier coping strategies.

  • Psychotherapist: Teens who cut should be evaluated and treated by counselors or psychologists who have experience in treating teens with this particular condition. These types of professionals are skilled at talk therapy and can provide a safe, non-judgmental space in which your teen can speak openly about the problems that she's facing. Remember, it can sometimes be hard for a teen to completely open up to a parent, so talking to someone who is basically a stranger might be easier for your child.
  • Psychiatrist: An evaluation by a child psychiatrist (a medical doctor who can prescribe drugs) might also be a good idea for further treatment ideas, which might include antidepressant when necessary.
  • Treatment Center: You might look for a treatment center in your area that specializes in cutting. The name of the treatment center might include the phrases "self-harm," "self-injury," or "self-mutilation."
  • Support Group: Your teen might also find help by joining a self-harm support group. Meeting others who cut might help her feel less alone and might help her learn how others have successfully stopped cutting themselves.

Treatment for cutting will likely focus on helping the teen develop healthier coping mechanisms when faced with feelings of anger, stress, or sadness. It will also help boost a teen's self-esteem, help manage any underlying psychiatric problems, and help make sure that the teen isn't having thoughts of suicide.


American Academy of Child and Adolescent Psychiatry. Facts for Families. Self-Injury In Adolescents.

Nonsuicidal self-harm in youth: a population-based survey. Nixon MK - CMAJ - 29-JAN-2008; 178(3): 306-12


Talk with your kids about cutting

What is cutting?

Injuring yourself on purpose by making scratches or cuts on your body with a sharp object, enough to break the skin and make it bleed. The latest aggregated research has found generally similar rates of self-harm between girls and boys.

People may cut themselves on their wrists, arms, legs, or bellies. Some people self-injure by burning their skin with the end of a cigarette or lighted match.

Cutting is a way some people try to cope with the pain of strong emotions, intense pressure, or upsetting relationship problems. They may be dealing with feelings that seem too difficult to bear, or bad situations they think can't change.

This practice has long existed in secrecy. When cuts or burns heal, they often leave scars or marks. Cuts can be easily hidden under long sleeves. But in recent years, movies and TV shows have drawn attention to it -- prompting greater numbers of teens and tweens (ages 9 to 14) to try it.

Go to any school and ask, 'Do you know anyone who cuts?' Yeah, everybody knows someone. That might be a great way to start a conversation

What Parents Should Do

When parents suspect a problem, they are usually at a loss of how to approach their child. Be direct with your child. Don't act out of anger or let yourself become hysterical. But express concern. Say, 'We're going to get help for you.' It's better to err on the side of open communication. The kids may not talk until they're ready. It's better to open up the door, let them know you're aware of this. That you're not going to punish them, that you're just concerned. And if they don't come to you, go to someone.

Some parents mistake cutting for suicidal behavior so the kid gets dragged into the ER which often is a hostile environment for the cutter. Many kids who are not suicidal at all are being evaluated and even hospitalized as suicidal.

Psychotherapy should be the first step in treatment. Ask if the therapist has any expertise working with self-injurers. Some therapists have a fear reaction to it. The therapist needs to be comfortable with it.

The ultimate lynch pin is -- the child has to decide they're not going to do this anymore. Any ultimatum, bribery, or putting them in a hospital is not going to do it. They need a good support system. They need treatment for underlying disorders like depression. They need to learn better coping mechanisms.

Parents can help by providing emotional support, helping identify early warning signs, helping kids distract themselves, lowering the child's stress level, and providing supervision at critical times. But a parent can't do it for them. It takes a certain level of resource to be able to stop cutting, and many kids don't have those resources. They need to stay in therapy until they get to that point.

Kids who develop this behavior have fewer resources for dealing with stress, fewer coping mechanisms. As they develop better ways of coping, as they get better at self-monitoring, it's easier to eventually give up this behavior. But it's much more complicated than something they will outgrow.

What is cutting?

Emma's mom first noticed the cuts when Emma was doing the dishes one night. Emma told her mom that their cat had scratched her. Her mom seemed surprised that the cat had been so rough, but she didn't think much more about it.

Emma's friends had noticed something strange as well. Even when the weather was hot, Emma wore long-sleeved shirts. She had become secretive, too, like something was bothering her. But Emma couldn't seem to find the words to tell her mom or her friends that the marks on her arms were from something that she had done. She was cutting herself with a razor when she felt sad or upset.

Injuring yourself on purpose by making scratches or cuts on your body with a sharp object — enough to break the skin and make it bleed — is called cutting. Cutting is a type of self-injury, or SI. Most people who cut are girls, but guys self-injure, too. People who cut usually start cutting in their young teens. Some continue to cut into adulthood.

People may cut themselves on their wrists, arms, legs, or bellies. Some people self-injure by burning their skin with the end of a cigarette or lighted match.

When cuts or burns heal, they often leave scars or marks. People who injure themselves usually hide the cuts and marks and sometimes no one else knows.

Why Do People Cut Themselves?

It can be hard to understand why people cut themselves on purpose. Cutting is a way some people try to cope with the pain of strong emotions, intense pressure, or upsetting relationship problems. They may be dealing with feelings that seem too difficult to bear, or bad situations they think can't change.

Some people cut because they feel desperate for relief from bad feelings. People who cut may not know better ways to get relief from emotional pain or pressure. Some people cut to express strong feelings of rage, sorrow, rejection, desperation, longing, or emptiness.

There are other ways to cope with difficulties, even big problems and terrible emotional pain. The help of a mental health professional might be needed for major life troubles or overwhelming emotions. For other tough situations or strong emotions, it can help put things in perspective to talk problems over with parents, other adults, or friends. Getting plenty of exercise can also help put problems in perspective and help balance emotions.

But people who cut may not have developed ways to cope. Or their coping skills may be overpowered by emotions that are too intense. When emotions don't get expressed in a healthy way, tension can build up — sometimes to a point where it seems almost unbearable. Cutting may be an attempt to relieve that extreme tension. For some, it seems like a way of feeling in control.

The urge to cut might be triggered by strong feelings the person can't express — such as anger, hurt, shame, frustration, or alienation. People who cut sometimes say they feel they don't fit in or that no one understands them. A person might cut because of losing someone close or to escape a sense of emptiness. Cutting might seem like the only way to find relief or express personal pain over relationships or rejection.

People who cut or self-injure sometimes have other mental health problems that contribute to their emotional tension. Cutting is sometimes (but not always) associated with depression, bipolar disorder, eating disorders, obsessive thinking, or compulsive behaviors. It can also be a sign of mental health problems that cause people to have trouble controlling their impulses or to take unnecessary risks. Some people who cut themselves have problems with drug or alcohol abuse.

Some people who cut have had a traumatic experience, such as living through abuse, violence, or a disaster. Self-injury may feel like a way of "waking up" from a sense of numbness after a traumatic experience. Or it may be a way of reinflicting the pain they went through, expressing anger over it, or trying to get control of it.

What Can Happen to People Who Cut?

Although cutting may provide some temporary relief from a terrible feeling, even people who cut agree that it isn't a good way to get that relief. For one thing, the relief doesn't last. The troubles that triggered the cutting remain — they're just masked over.

People don't usually intend to hurt themselves permanently when they cut. And they don't usually mean to keep cutting once they start. But both can happen. It's possible to misjudge the depth of a cut, making it so deep that it requires stitches (or, in extreme cases, hospitalization). Cuts can become infected if a person uses nonsterile or dirty cutting instruments — razors, scissors, pins, or even the sharp edge of the tab on a can of soda.

Most people who cut aren't attempting suicide. Cutting is usually a person's attempt at feeling better, not ending it all. Although some people who cut do attempt suicide, it's usually because of the emotional problems and pain that lie behind their desire to self-harm, not the cutting itself.

Cutting can be habit forming. It can become a compulsive behavior — meaning that the more a person does it, the more he or she feels the need to do it. The brain starts to connect the false sense of relief from bad feelings to the act of cutting, and it craves this relief the next time tension builds. When cutting becomes a compulsive behavior, it can seem impossible to stop. So cutting can seem almost like an addiction, where the urge to cut can seem too hard to resist. A behavior that starts as an attempt to feel more in control can end up controlling you.

How Does Cutting Start?

Cutting often begins on an impulse. It's not something the person thinks about ahead of time. Shauna says, "It starts when something's really upsetting and you don't know how to talk about it or what to do. But you can't get your mind off feeling upset, and your body has this knot of emotional pain. Before you know it, you're cutting yourself. And then somehow, you're in another place. Then, the next time you feel awful about something, you try it again — and slowly it becomes a habit."

Natalie, a high-school junior who started cutting in middle school, explains that it was a way to distract herself from feelings of rejection and helplessness she felt she couldn't bear. "I never looked at it as anything that bad at first — just my way of getting my mind off something I felt really awful about. I guess part of me must have known it was a bad thing to do, though, because I always hid it. Once a friend asked me if I was cutting myself and I even lied and said 'no.' I was embarrassed."

Sometimes self-injury affects a person's body image. Jen says, "I actually liked how the cuts looked. I felt kind of bad when they started to heal — and so I would 'freshen them up' by cutting again. Now I can see how crazy that sounds, but at the time, it seemed perfectly reasonable to me. I was all about those cuts — like they were something about me that only I knew. They were like my own way of controlling things. I don't cut myself anymore, but now I have to deal with the scars."

You can't force someone who self-injures to stop. It doesn't help to get mad at a friend who cuts, reject that person, lecture her, or beg him to stop. Instead, let your friend know that you care, that he or she deserves to be healthy and happy, and that no one needs to bear their troubles alone.

Pressured to Cut?

Girls and guys who self-injure are often dealing with some heavy troubles. Many work hard to overcome difficult problems. So they find it hard to believe that some kids cut just because they think it's a way to seem tough and rebellious.

Tia tried cutting because a couple of the girls at her school were doing it. "It seemed like if I didn't do it, they would think I was afraid or something. So I did it once. But then I thought about how lame it was to do something like that to myself for no good reason. Next time they asked I just said, 'no, thanks — it's not for me.' "

If you have a friend who suggests you try cutting, say what you think. Why get pulled into something you know isn't good for you? There are plenty of other ways to express who you are.

Lindsay had been cutting herself for 3 years because of abuse she suffered as a child. She's 16 now and hasn't cut herself in more than a year. "I feel proud of that," Lindsay says. "So when I hear girls talk about it like it's the thing to do, it really gets to me."

Getting Help

There are better ways to deal with troubles than cutting — healthier, long-lasting ways that don't leave a person with emotional and physical scars. The first step is to get help with the troubles that led to the cutting in the first place. Here are some ideas for doing that:

Tell someone. People who have stopped cutting often say the first step is the hardest — admitting to or talking about cutting. But they also say that after they open up about it, they often feel a great sense of relief. Choose someone you trust to talk to at first (a parent, school counselor, teacher, coach, doctor, or nurse). If it's too difficult to bring up the topic in person, write a note.

Identify the trouble that's triggering the cutting. Cutting is a way of reacting to emotional tension or pain. Try to figure out what feelings or situations are causing you to cut. Is it anger? Pressure to be perfect? Relationship trouble? A painful loss or trauma? Mean criticism or mistreatment? Identify the trouble you're having, then tell someone about it. Many people have trouble figuring this part out on their own. This is where a mental health professional can be helpful.

Ask for help. Tell someone that you want help dealing with your troubles and the cutting. If the person you ask doesn't help you get the assistance you need, ask someone else. Sometimes adults try to downplay the problems teens have or think they're just a phase. If you get the feeling this is happening to you, find another adult (such as a school counselor or nurse) who can make your case for you.

Work on it. Most people with deep emotional pain or distress need to work with a counselor or mental health professional to sort through strong feelings, heal past hurts, and to learn better ways to cope with life's stresses. One way to find a therapist or counselor is to ask at your doctor's office, at school, or at a mental health clinic in your community.

Although cutting can be a difficult pattern to break, it is possible. Getting professional help to overcome the problem doesn't mean that a person is weak or crazy. Therapists and counselors are trained to help people discover inner strengths that help them heal. These inner strengths can then be used to cope with life's other problems in a healthy way.

Teenage Cutting: A Trend on the Rise

Cutting is an increasingly popular behavior among teens—and it doesn't mean skipping classes, anymore. Cutting, with a paper clip, scissors, pen or other sharp object on the skin, is just one of a number of self-injurious behaviors that kids use to hurt themselves.

Wendy Lader, PhD, clinical director of S.A.F.E Alternatives and co-author of Bodily Harm, says self-harm is more prevalent than most people think. “Studies on adolescents in community samples report a lifetime prevalence between 15 and 20 percent,” she says.

So, why would kids purposefully cut themselves? The most common reason is control of emotions, according to Lader. “For kids experiencing intense emotions, it can be used to deaden the intensity. For those feeling a sense of numbness, it serves the opposite effect, helping them feel something,” Lader says.

Experts say for some adolescents, self-injury indicates other mental health concerns, such as depression. Others use is as a way to fit in with peers.

And this behavior can become addictive, according to Susan Bowman, licensed counselor and author of See My Pain: Creative Strategies and Activities for Helping Young People Who Self-Injure. “When kids cut themselves, it releases endorphins and they get a high from it,” she says. “It becomes a control issue: This is the way I release the pressure.”

There are clues that parents can watch for when it comes to self-injury. In addition to unexplained cuts and bruises, a change in communication, eating or sleeping patterns can be red flags. Though parents are understandably appalled at the thought of their child self-injuring, Bowman says this is exactly the reaction to avoid. “If you are shocked by a cut on their wrist, they may not trust you to accept and deal with what’s really bothering them,” she says. “They need caring and nurturing.”

So, how should you react? Here's some advice from the experts:

•Communication is key. “Listen. Speak calmly, without judging, while expressing your love and concern,” Lader says. “Don’t try to offer your opinion or fix the problem. The goal is to foster open communication,”

•Ask the right questions. Bowman says parents should use “what” and “how” questions, like “What makes you want to hurt yourself?”

• Positive attention is a valuable part of the healing process. “Kids need attention when they are using positive coping skills and talking about their problems,” Bowman says.

• Consider therapy. “A therapist can help determine if the child is experiencing some underlying issue that they don’t know how to identify or talk about,” says Lader. If you aren't sure how to choose a therapist, the school counselor might be a good place to start. Bowman also advises looking for someone experienced in adolescent issues, and specifically self-injury. “A combination of therapy techniques, such as cognitive, behavioral and creative arts therapy usually works best,” Bowman says.

Self-injury is a cry for help. Kids engaging in these behaviors desperately need parents to provide understanding and a willingness to listen.

Cutting and Self-Harm: Warning Signs and Treatment

Parents should watch for symptoms and encourage kids to get help.

Cutting. It's a practice that is foreign, frightening, to parents. It is not a suicide attempt, though it may look and seem that way. Cutting is a form of self-injury -- the person is literally making small cuts on his or her body, usually the arms and legs. It's difficult for many people to understand. But for kids, cutting helps them control their emotional pain, psychologists say.

This practice has long existed in secrecy. Cuts can be easily hidden under long sleeves. But in recent years, movies and TV shows have drawn attention to it -- prompting greater numbers of teens and tweens (ages 9 to 14) to try it.

It's clear that estrogen is closely linked with women's emotional well-being. Depression and anxiety affect women in their estrogen-producing years more often than men or postmenopausal women. Estrogen is also linked to mood disruptions that occur only in women -- premenstrual syndrome, premenstrual dysphoric disorder, and postpartum depression. Exactly how estrogen affects emotion is much less straightforward. Is it too much estrogen? Not enough? It turns out estrogen's emotional effects...

"We can go to any school and ask, 'Do you know anyone who cuts?' Yeah, everybody knows someone," says Karen Conterio, author of the book, Bodily Harm. Twenty years ago, Conterio founded a treatment program for self-injurers called SAFE (Self Abuse Finally Ends) Alternatives at Linden Oak Hospital in Naperville, Ill., outside of Chicago.

Picture of an Unhappy Kid

Her patients are getting younger and younger, Conterio tells WebMD. "Self-harm typically starts at about age 14. But in recent years we've been seeing kids as young as 11 or 12. As more and more kids become aware of it, more kids are trying it." She's also treated plenty of 30-year-olds, Conterio adds. "People keep doing it for years and years, and don't really know how to quit."

The problem is particularly common among girls. But boys do it, too. It is an accepted part of the "Goth" culture, says Wendy Lader, PhD, clinical director for SAFE Alternatives.

Being part of Goth culture may not necessarily mean a kid is unhappy.

Lader says "I think kids in the Goth movement are looking for something, some acceptance in an alternative culture. And self-injury is definitely a coping strategy for unhappy kids."

Very often, kids who self-harm have an eating disorder. "They may have a history of sexual, physical, or verbal abuse," Lader adds. "Many are sensitive, perfectionists, overachievers. The self-injury begins as a defense against what's going on in their family, in their lives. They have failed in one area of their lives, so this is a way to get control."

Self-injury can also be a symptom for psychiatric problems like borderline personality disorder, anxiety disorder, bipolar disorder, schizophrenia, she says.

Yet many kids who self-injure are simply "regular kids" going through the adolescent struggle for self-identity, Lader adds. They're experimenting. "I hate to call it a phase, because I don't want to minimize it. It's kind of like kids who start using drugs, doing dangerous things."

Blunting Emotional Pain

Psychiatrists believe that, for kids with emotional problems, self-injury has an effect similar to cocaine and other drugs that release endorphins to create a feel-good feeling.

"Yet self-harm is different from taking drugs," Conterio explains. "Anybody can take drugs and feel good. With self-injury, if it works for you, that's an indication that an underlying issue needs be dealt with -- possibly significant psychiatric issues. If you're a healthy person, you might try it, but you won't continue."

Self-harm may start with the breakup of a relationship, as an impulsive reaction. It may start simply out of curiosity. For many kids, it's the result of a repressive home environment, where negative emotions are swept under the carpet, where feelings aren't discussed. "A lot of families give the message that you don't express sadness," says Conterio.

It's a myth that this behavior is simply an attention-getter, adds Lader. "There's a [painkiller] effect that these kids get from self-harm. When they are in emotional pain, they literally won't feel that pain as much when they do this to themselves."

What It Looks Like

David Rosen, MD, MPH, is professor of pediatrics at the University of Michigan and director of the Section for Teenage and Young Adult Health at the University of Michigan Health Systems in Ann Arbor.

He offers parents tips on what to watch for:

Small, linear cuts. "The most typical cuts are very linear, straight line, often parallel like railroad ties carved into forearm, the upper arm, sometimes the legs," Rosen tells WebMD. "Some people cut words into themselves. If they're having body image issues, they may cut the word 'fat.' If they're having trouble at school, it may be 'stupid,' 'loser,' 'failure,' or a big 'L.' Those are the things we see pretty regularly."

Unexplained cuts and scratches, particularly when they appear regularly. "I wish I had a nickel for every time someone says, 'The cat did it,'" says Rosen.

Mood changes like depression or anxiety, out-of-control behavior, changes in relationships, communication, and school performance. Kids who are unable to manage day-to-day stresses of life are vulnerable to cutting, says Rosen.

Over time, the cutting typically escalates -- occurring more often, with more and more cuts each time, Rosen tells WebMD. "It takes less provocation for them to cut. It takes more cutting to get the same relief -- much like drug addiction. And, for reasons I can't explain but have heard often enough, the more blood the better. Most of the cutting I see is quite superficial, and looks more like scratches than cuts. It's the sort that when you put pressure on it, it stops the bleeding."

What Parents Should Do

When parents suspect a problem, "they are at a loss of how to approach their child," Conterio says. "We tell parents it's better to err on the side of open communication. The kids may talk when they're ready. It's better to open up the door, let them know you're aware of this, and if they don't come to you, go to someone else ... that you're not going to punish them, that you're just concerned."

Be direct with your child, adds Lader. "Don't act out of anger or let yourself become hysterical -- 'I'm going to watch you every second, you can't go anywhere.' Be direct, express concern. Say, 'We're going to get help for you.'"

Parents often mistake cutting for suicidal behavior. "That's usually when they have finally seen the cuts, and they don't know how to interpret it," explains Rosen. "So the kid gets dragged into the ER. But ER doctors aren't always used to seeing this, and find it difficult to understand whether it's suicidal or self-injurious behavior. Many kids who are not suicidal at all are being evaluated and even hospitalized as suicidal."

Unfortunately, "the attitude in hospital emergency rooms can be very cavalier and harsh about self-injurers," adds Lader. "There's a lot of dislike, because it's a self-made injury, so ER personnel can be very hostile. There are all kinds of stories of girls getting stitched without anesthetic. The thing is, after they've self-injured, the girls are calmer -- so when they're getting stitches, they feel the pain. Yet the doctor is angry, wants to get this over with."

Psychotherapy should be the first step in treatment, Lader adds. The SAFE web site has a list of doctors who have been to her lectures, who want to work with self-injurers. With other therapists, ask if they have any expertise in working with self-injurers. "Some therapists have a fear reaction to it. The therapist needs to be comfortable with it," she advises.

However, the girl or boy must be ready for treatment, says Rosen.

"The ultimate lynch pin is -- the child has to decide they're not going to do this anymore," he tells WebMD. "Any ultimatum, bribery, or putting them in a hospital is not going to do it. They need a good support system. They need treatment for underlying disorders like depression. They need to learn better coping mechanisms."

When An Inpatient Program Is Necessary

When kids just can't break the cycle through therapy, an inpatient program like SAFE Alternatives can help.

In their 30-day program, Lader and Conterio only treat patients who voluntarily request admission. "Anybody who can't perceive that they have a problem will be hard to treat," says Conterio. Those who come to us have recognized that they have a problem, that they need to stop. We tell them in the acceptance letter we send them, 'This is your first step toward empowering yourself.'"

When admitted to SAFE, patients sign a contract that they won't self-injure during that time. "We want to teach them to operate in the real world," says Lader. "That means making choices in response to emotional conflict -- healthier choices, rather than just self-injuring to feel better. We want them to understand why they are angry, show them how to handle their anger."

Although self-harm is not allowed, "we don't take away razors," Conterio adds. "They can shave. We don't take belts or shoe laces. The message we're sending is, 'We believe you're capable of making better choices.'"

Turning Inward to Heal

Many kids haven't thought about it at all -- exactly why they self-injure, says Lader. "It's like any addiction, if I can take a pill or self-medicate in some way, why deal with the problem? We teach people that cutting only works in the short term, and that it will only get worse and worse."

When kids learn to face their problems, they will quit self-harming, she adds. "Our goal is to get them to communicate what's wrong. Babies don't have the capacity for language, so they use behavior. These adolescents regress to that preverbal state when they self-harm."

Individual and group therapy are the hubs of this treatment program. If there is underlying depression or anxiety, antidepressants may be prescribed. The patients also write regularly in their journals -- to learn to explore and express their feelings.

Helping them gain self-respect and self-esteem is a critical treatment goal, Conterio tells WebMD.

"Many kids have difficulty dealing with situations and people that make them angry," Lader adds. "They don't have great role models for that. Saying no, standing up to people -- they don't really believe they're allowed to do that, especially girls. But if you can't do that, it's very difficult to maneuver the world, survive in the world without someone stronger, more capable than you to fight your battles."

Circular negative thinking keeps kids from developing self-esteem. "We help them empower themselves, take risks in confrontation, change how they view themselves," says Conterio. "If you can't set limits on someone else's behavior, stand up to them -- you can't like yourself. Once these girls learn to take care of themselves, stand up for what they want, they will like themselves better."

"We want them to get to the point where they believe, 'I am somebody, I do have a voice, I can make changes, instead of, 'I'm nobody,'" she says.

Staying Safe

One study of the SAFE program showed that, two years after participating, 75% of patients had a decrease in symptoms of self-injury. An ongoing study is indicating a decrease in hospitalizations and emergency room visits.

"I've been doing this for 20 years, and the success rate is far greater than the failure rate," says Conterio. "We truly believe that if people can continue to make healthy choices, they won't go back to self-harm. We get emails that are a blast from the past. Some patients do extremely well. Others regress. Others have finally decided to do the work they learned here. When they apply it, they do well. It all goes back to choice."

The bottom line: "When kids decide they don't want to cut any more - and they get stressed again -- they have to be able to manage stress as it arises," Rosen says. "They can't succumb to cutting. People who can figure out some alternative way to manage stress will eventually quit it."

Parents can help by providing emotional support, helping identify early warning signs, helping kids distract themselves, lowering the child's stress level, and providing supervision at critical times, Rosen says. "But a parent can't do it for them. It takes a certain level of resource to be able to stop cutting, and many kids don't have those resources. They need to stay in therapy until they get to that point."

Self-harm is not a problem that kids simply outgrow, Rosen adds. "Kids who develop this behavior have fewer resources for dealing with stress, fewer coping mechanisms. As they develop better ways of coping, as they get better at self-monitoring, it's easier to eventually give up this behavior. But it's much more complicated than something they will outgrow."

Wound Locations

On what areas of your body have you intentionally hurt yourself?

  • Wrists
  • Hands
  • Arms
  • Fingers
  • Calves or ankles
  • Thighs
  • Stomach or chest
  • Back
  • Buttocks
  • Head
  • Feet
  • Face
  • Lips or tongue
  • Shoulders or neck
  • Breasts
  • Genitals or rectum


Quick Facts on Self-Injury

A guide to information about suicide and self-injury, including what drives self-injury, what are the signs and symptoms, how is it treated, what are the risk factors for suicide, and what to do if you're worried that a child might be suicidal.

A brief overview of the signs of self-injury and how it's treated in children and adolescents.

Self-injury is characterized by deliberately injuring oneself to alleviate some kind of emotional distress. The most common form of self-injury is cutting or scratching the skin, but people also self-injure by burning themselves, picking at skin and wounds, or hitting themselves. Self-injury is more common in girls than boys, and onset is often around puberty.

Signs Your Child May Be Self-Harming:

  • Talking about self-injury
  • Suspicious-looking scars
  • Wounds that don't heal or get worse
  • Cuts on the same place
  • Increased isolation
  • Collecting sharp tools such as shards of glass, safety pins, nail scissors, etc.
  • Wearing long-sleeved shirts in warm weather
  • Avoiding social activities
  • Wearing a lot of band aids
  • Refusing to go into the locker room or change clothes in school

How to Help

If you discover that a child has been hurting herself it's important to have her evaluated by an experienced mental health professional to find out why she is self-injuring and what emotional difficulties she's experiencing.


  • Dialectical behavior therapy (DBT): In this kind of therapy a psychologist works with your child to help her learn how to tolerate uncomfortable feelings like anger, anxiety and rejection without resorting to cutting.
  • Cognitive behavioral therapy (CBT): In CBT, a psychologist teaches your child to recognize and challenge negative, distressing thoughts, and train herself to think outside of them.
  • Family therapy: If there are distressing things going on at home—conflict, job loss, a death—family therapy may be helpful.


Often, if there is another disorder involved, a doctor will prescribe medication to treat that condition. The combination of medication and psychotherapy is very successful at treating kids who self-harm.

Cutting/Self Harm

This article focuses on repetitive self-harm, not on severe self-harm inflicted during psychosis . For forms of self-harm related to body image, sexuality and wartime, see Body modification , Algolagnia and Self-inflicted wound respectively.

Self-harm (SH) or deliberate self-harm (DSH) includes self-injury (SI) and self-poisoning and is defined as the intentional, direct injuring of body tissue without suicidal intent. These terms are used in the more recent literature in an attempt to reach a more neutral terminology. The older literature, especially that which predates the DSM-IV-TR, almost exclusively refers to self-mutilation. The term is synonymous with "self-injury."[1][2][3] The most common form of self-harm is skin-cutting but self-harm also covers a wide range of behaviours including, but not limited to, burning, scratching, banging or hitting body parts, interfering with wound healing, hair-pulling (trichotillomania ) and the ingestion of toxic substances or objects.[2][4][5] Behaviours associated with substance abuse and eating disorders are usually not considered self-harm because the resulting tissue damage is ordinarily an unintentional side effect.[6] However, the boundaries are not always clear-cut and in some cases behaviours that usually fall outside the boundaries of self-harm may indeed represent self-harm if performed with explicit intent to cause tissue damage.[6] Although suicide is not the intention of self-harm, the relationship between self-harm and suicide is complex, as self-harming behaviour may be potentially life-threatening.[7] There is also an increased risk of suicide in individuals who self-harm[4][8] to the extent that self-harm is found in 40–60% of suicides.[9] However, generalising self-harmers to be suicidal is, in the majority of cases, inaccurate.[10][11]

Self-harm in childhood is relatively rare but the rate has been increasing since the 1980s.[12] Self-harm is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as a symptom of borderline personality disorder . However patients with other diagnoses may also self-harm, including those with depression , anxiety disorders, substance abuse , eating disorders , post-traumatic stress disorder , schizophrenia , and several personality disorders .[2] Self-harm is also apparent in high-functioning individuals who have no underlying clinical diagnosis.[6] The motivations for self-harm vary and it may be used to fulfill a number of different functions.[13] These functions include self-harm being used as a coping mechanism which provides temporary relief of intense feelings such as anxiety, depression, stress, emotional numbness and a sense of failure or self-loathing . Self-harm is often associated with a history of trauma and abuse, including emotional abuse , sexual abuse , drug dependence , eating disorders , or mental traits such as low self-esteem or perfectionism . There is also a positive statistical correlation between self-harm and emotional abuse.[14][15] There are a number of different methods that can be used to treat self-harm and which concentrate on either treating the underlying causes or on treating the behaviour itself. When self-harm is associated with depression , antidepressant drugs and treatments may be effective.[8] Other approaches involve avoidance techniques, which focus on keeping the individual occupied with other activities, or replacing the act of self-harm with safer methods that do not lead to permanent damage.[16]

Self-harm is most common in adolescence and young adulthood, usually first appearing between the ages of 12 and 24.[1][5][6][17][18] However, self-harm can occur at any age,[13] including in the elderly population.[19] The risk of serious injury and suicide is higher in older people who self-harm.[18] Self-harm is not limited to humans. Captive non-human animals are also known to participate in self-mutilation, such as captive birds and monkeys.[20][21]

Warning Signs

  • Fresh cuts and scratches
  • Scars, burns, bruises, cuts appearing in the same place over and over
  • Wounds that don’t heal
  • Hair loss or bald spots
  • Keeping sharp objects around
  • Wearing long sleeves and long pants even in hot weather
  • Mood changes
  • Social withdrawal
  • Change in school performance
  • Inability to handle stress
  • Claiming to have accidents frequently (trips, falls, etc.)

If you notice any of these warning signs in a friend or loved one, you should talk to them and express your concerns; let them know that help is available. Remember that the person is already experiencing emotional pain, so it’s important to be caring and compassionate. Don’t judge them or make them feel bad about their behavior.

Gender differences

The latest aggregated research has found generally similar rates of self-harm between men and women.[69] However, much of the past research has indicated that up to four times as many females as males have direct experience of self-harm.[10] Nevertheless, caution is needed in seeing self-harm as a greater problem for females, since males may engage in different forms of self-harm which could be easier to hide or explained as the result of different circumstances.[5] For example, men more frequently report burning and hitting themselves, whereas women are more likely to report cutting and burning themselves.[69] Hence, there remain widely opposing views as to whether the gender paradox is a real phenomenon, or merely the artifact of bias in data collection.[67]

Does Cutting Mean That Someone Is Suicidal?

Question: My teenage daughter has been cutting herself. Does this mean she is suicidal? Why does she want to hurt herself like this?

Answer: While it might seem like she is hurting herself because she wants to commit suicide—after all, cutting the wrists is one method that people use to kill themselves—this isn't necessarily what her intentions are. People who injure themselves by cutting, scratching, burning and other methods of self-harm are often doing it as a way to relieve their emotional suffering.

While it might seem counterintuitive that causing oneself physical pain could help emotional pain, many cutters report that this is exactly what happens. Cutting causes the release of chemicals called endorphins. Endorphins are the body's own natural painkillers and they help it to cope with the stress and pain associated with injury. They can also help dampen emotional pain.

Other reasons that self-injurers often give for cutting and self-harm are: releasing anger, slowing down racing thoughts and coping with dissociation or flashbacks. When dissociation or flashbacks occur, the physical sensations of pain are a way for the person to ground themselves back in reality.

While I can't say for certain whether your daughter is experiencing any thoughts of suicide, one thing I do feel fairly certain of is that she is going through quite a bit of emotional turmoil and needs your help and support. You will need to do what you can to ensure that she gets professional treatment with both medications (to help quell the feelings that are driving her urges to hurt herself) and therapy (to help teach her better ways to deal with her feelings).

Please be aware that this is not just a passing phase that she is going through or a cry for attention. You should take this quite seriously. Cutting can be very addictive and hard to stop without assistance. There is also the risk that she may accidentally hurt herself more seriously than she intends to.


Alderman, Tracy. "Myths and Misconceptions of Self-Injury: Part II." Psychology Today. Sussex Publishers, LLC. Published: Ocobert 22, 2009. Accessed: June 28, 2015.

Ferrales, Diana and Sonja Koukel. "Teens and Self-Cutting (Self-Harm): Information for Parents: Guide I-104." New Mexico State University. New Mexico State University Board of Regents. Accessed: June 28, 2015.

Lohmann, Raychelle Cassada. "Understanding Suicide and Self-Harm." Psychology Today. Sussex Publishers, LLC. Published: October 28, 2012. Accessed: June 28, 2015.


It concerns me that you are, probably unintentionally, aiding the concept that girls are the only ones that self-harm. While you do use the word "people" at times, I have yet to find a comment from you that says that boys self-harm at about the same rate as girls, though their self harm is more around burning and scratching. With headings like "Does someone who cuts herself want to die?" makes it look like victomology and does not address the real issue that it's not just a girl's issue by any means. How different would that article and others you write, to acknowledge the surprising statistic that self-harm is about equally practiced by girls and boys. Wouldn't your readers be shocked by that information? Changing the title of that article to "Does someone who cuts themselves want to die?" would give you a chance to talk about the issue of equality and differenecs and bring this hidden fact to light.


How do I knows if my friend is self-injuring?

Sometimes it’s hard to know if a friend is self-injuring. For many people, self-injury is secretive. It is hard to talk about – even with a close friend.

This secrecy itself may be a signal that something is wrong – especially if this is out of the ordinary for your friend (e.g., you notice your friend doesn’t want to hang out with anyone any more).

Another important sign to look for is a significant change in your friend’s mood or behavior. If you notice that your friend is withdrawing from you or others and feeling down for a prolonged period of time, there may be something going on. As a friend, checking in to see what might be going on for your friend and expressing your concern is okay (we provide a few steps on how to bring up self-injury with your friend, below).

Often, when people self-injure, they experience more negative moods (e.g., sadness, stress, anxiety, frustration); they may also become more distant.

Here are a few other possible signs of non-suicidal self-injury that are important to be aware of:

1. Unexplained cuts, burns or bruises; these typically occur on the arms, legs and stomach.

2. Finding razors, knives or other items that may be used to self-injure.

3. Noticing that your friend is spending less time with you, other friends, or family members, and there is no real reason for this. They may spend much more time alone, may not answer your calls, or may not respond to your texts like they used to.

4. Noticing that your friend is wearing clothing that doesn’t quite match the weather (e.g., wearing a long-sleeved shirt and pants on hot summer days). Your friend may be hiding scars, wounds, or bruises by wearing clothing or bracelets that cover body parts where he or she self-injures.

These signs do not mean that your friend is definitely self-injuring, just that he/she might be. You should talk with your friend if you suspect self-injury, as something else besides self-injury could be going on.

How do I talk to my friend about self-injury?

Here are a few things that may be helpful when talking about self-injury with your friend:

1. Choose a good time to speak with your friend. It is best to talk privately in a place where you can both be comfortable and calm.

2. Be honest with your friend about how worried you are.

3. Be aware of how you feel. If you feel really upset, it may not be a good time to have the conversation and you may need to take some time for yourself first. It is important to remain calm and avoid reacting strongly because it was probably very difficult for your friend to tell you in the first place.

4. Focus the conversation on your friend’s feelings and emotions, rather than his/her self-injury.

5. Do not judge your friend or make threats (e.g., they have to stop or else you won’t talk to them anymore). Your friend has come to you because they trust that you will be supportive during this difficult time.

6. Do not promise your friend that you can keep his/her self-injury a secret. Make sure your friend knows that you are worried, you care about him/her, and that it is important to you that they stay safe and get help. You cannot stop someone from self-injuring, but you can help them find someone who can provide the professional support they need.

7. Don’t be afraid to ask your friend questions about his/her self-injury but don’t put the pressure on. Some people have difficulty talking about it. Expressing your support and helping your friend find someone they feel comfortable talking to is most important.

8. Understand that people do not self-injure just for attention or “drama”, if they are doing this they need to be taken seriously and supported. This can be difficult at times, but it is important to not dismiss your friend’s self-injury as unimportant, manipulative or attention-seeking

If your friend does not want to talk about it, that’s okay. It can be difficult at first. Continue to let your friend know that he/she is not alone and that you are there to support him/her. Let your friend know that you are concerned and that you will be there to listen when they are ready.

Six types:

1. neurotic – nail-biters, pickers, extreme hair removal and unnecessary cosmetic surgery.

2. religious – self-flagellants and others.

3. puberty rites – hymen removal, circumcision or clitoral alteration.

4 .psychotic – eye or ear removal, genital self-mutilation and extreme amputation

5. organic brain diseases – which allow repetitive head-banging, hand-biting, finger-fracturing or eye removal.

6. conventional – nail-clipping, trimming of hair and shaving beards.[84]


Examples of Behavior

Degree of Physical Damage

Psychological State

Social Acceptability


Ear-piercing, nail-biting, small tattoos, cosmetic surgery (not considered self-harm by the majority of the population)

Superficial to mild


Mostly accepted


Piercings, saber scars, ritualistic clan scarring, sailor and gang tattoos

Mild to moderate

Benign to agitated

Subculture acceptance


Wrist- or body-cutting, self-inflicted cigarette burns and tattoos, wound-excoriation

Mild to moderate

Psychic crisis

Accepted by some subgroups but not by the general population


Auto-castration, self-enucleation, amputation


Psychotic decompensation


Why Go to Therapy?

A professional answers teens' questions

Many of us have been to therapy, whether by choice or by force. We’ve sat in a chair week after week talking—or not talking—about our problems. However, we often don’t really understand the purpose of therapy. We’ve come up with our own definitions for our therapists: “That crazy lady who asks all the questions,” or, “That man who’s always in my business.”

At Represent, many of us writers wanted to know how therapy is supposed to work and how a relationship with a therapist can be healing. So last year a group of us interviewed therapist Carrie King, director of the Children’s Psychotherapy Project in Brooklyn, NY, to sort out all of the ideas we have about therapy.

Working Out the Past

King was short and slim, empathetic but with a sharp tongue. She told us that most kids in care have been through traumatic experiences and that spending time in a safe place thinking about what has happened to you is important, because traumas can have a lasting impact. Even if years have passed, your mind and body may still be working out an understanding of a traumatic event that happened to you when you were much younger.

Your feelings might come out through harmful behaviors like self-mutilation (hurting yourself) or eating disorders (bulimia, anorexia or binge eating). These are all signs that your mind and body are trying to work out what happened to you.

If you were physically or sexually abused, you might never have fully allowed yourself to experience the feelings associated with what happened. Those feelings can come back in ways that may feel strange to you. For instance, some people develop panic attacks (a sudden feeling of intense anxiety, shortness of breath, sweating and trembling), or hypervigilance (an unusually high awareness of surroundings), or dissociation (a feeling of being separate from yourself and away from your body).

“Kids who are molested grow up wondering if they’re good,” King told us. “They ask questions like: ‘Is who I am good enough? Am I good enough in relationships? Am I good enough as a friend?’” Her message was clear: although the abuse many of us endured was not our fault, it often leaves us feeling tainted, unworthy, or like we’re bad inside.

The Risk of Getting Hurt Again

King told us that if you don’t come to an understanding of what happened to you in the past, you might put yourself at a greater risk of being abused again. Many times, people who have suffered a trauma seek out experiences that feel similar to those that led to the painful experience. Just as you may replay the trauma in your head, trying to understand what happened or why, you may unconsciously replay the trauma in your life.

King researched factors that affect whether adult women who had been sexually abused in the past were sexually abused again. She found two things: First, because it feels so bad to be abused, some women got depressed and started drinking or doing drugs. “Anyone on drugs or drinking is at a higher risk of being sexually assaulted,” King said, because they are not always aware of their surroundings or what’s happening to them.

Second, some women feel so badly about themselves because of their past abuse that their vision of who they are and what their body means to them changes. “They lose an attachment to or respect for their bodies,” King said. So when there were danger signs, these women didn’t take action to protect their bodies from harm.

“A repetition of the trauma (being abused in a similar way as in the past) shows you there’s still something you need to understand about how you think about what happened, or what it means to you, and how you approach your body and your life as a result,” she said.

Why We Build Walls. . .

Because of betrayals we’ve experienced in past relationships, many of us feel unsure about getting into new relationships. To protect ourselves from harm, we may build boundaries and walls inside to shield ourselves from people or situations that we fear may hurt us.

But those walls—like reacting to other people with distrust or hostility—can also make us feel isolated or misunderstood. We asked if it’s possible to loosen our boundaries so we can truly become close to others, and how we could go about doing that without making ourselves unsafe.

“You built that boundary because you love yourself and you had the will to survive,” King said. “But when the danger is not there anymore, you have to let go of those boundaries.” King told us that you can take certain steps to help you rethink how you approach others.

. . .And How to Take Them Down

The first step is to acknowledge that you built those walls for a reason: you needed to protect yourself from danger.

The second is asking yourself, “Why did I build this?” Looking back at what you didn’t have as a child (like protection or consistent love) and figuring out if you have it now or not is a lot of work. It means considering your past and seeing how many things in your life have changed, investigating your mind and environment consciously and seeing how safe you really are now.

The third step is to begin to take the boundary down. That’s a huge thing to do because you’re making yourself vulnerable and leaving the familiar. Say one of your former foster parents abused you by constantly cutting you down. You might have become hostile and untrusting of people, fearing that they will do the same thing. But once you become aware of this pattern you decide to try to let go of your hostility and distrust and connect to positive, caring friends and adults. That’s a great goal, but scary. You are leaving the ways of acting that you are familiar with and trying out a new way of relating to people that you hope will be better. But acting more openly might lead to getting hurt again.

When taking any risk, it’s best to have someone safe to return to for support and to reflect on the feelings that risk-taking raises inside of you. That’s where a therapist can be more helpful than a friend or even a mentor. “It’s very hard for a friend to help you feel safe enough to take such enormous risks. In most cases, it takes someone who is trained,” King said.

Seeing the Big Picture

King told us that therapists can often help their clients hear themselves. She gave us an example of a girl who says she wants to settle down, but is constantly going from guy to guy. “I would try to get her to figure out why she’s going from guy to guy if she wants to be connected to one person,” she said.

A therapist can help you think about your experiences in new ways. “Sometimes you spend so much time in your own head, you lose the creativity of thinking about your problems in a different way. Telling someone else and hearing their ideas on your problems can be good,” she told us.

Many of us believed that our therapists’ main job is to give advice on the day-to-day goings-on in our lives. But King told us that she is not there to give advice and solve problems; she’s there to observe and notice her clients’ behaviors and to pay attention to the larger themes in their lives, such as the main emotions they feel, experiences they seek out and patterns of their behavior.

She said therapists are trained to see the big picture. “We try to look for what’s behind all the details of a story: the rage, or the fear of being left again, or the worry about what’s going to become of you. Those are the bigger things, the big umbrella sort of piece behind many of your stories,” she said.

We thought therapists must become bored listening to their clients for hours, but King said even boredom can be useful. “When someone is telling a big long boring story, I use it to think, ‘What’s happening here? Why am I feeling bored’?” Sometimes people go on and on about something unimportant to avoid talking about something real or important. If the therapist points that out, they can at least talk about why the client is avoiding a more important conversation.

Speaking with Dr. King made therapy seem less scary and threatening. She helped us see that with the right person, therapy is a place where you have the freedom and safety to think and talk about painful experiences in your past, and to get help changing harmful patterns of thinking or acting, so you don’t get hurt again.

Self-injury Awareness Day (SIAD) is an annual global awareness event/campaign on March 1, where on this day, and in the weeks leading up to it, some people choose to be more open about their own self-harm, and awareness organizations make special efforts to raise awareness about self-harm and self-injury. Some people wear an orange awareness ribbon, wristband, or beaded bracelet to encourage awareness of self-harm. and and - (March 1)

Self-mutilation rampant at 2 Ivy League schools

Survey: 17 percent at Cornell and Princeton purposely cut themselves

Sarah Rodey, 20, a University of Illinois student began self-injuring by cutting herself, a disturbing phenomenon that counselors say is happening at colleges, high schools and middle schools nationwide.

Nearly 1 in 5 students at two Ivy League schools say they have purposely injured themselves by cutting, burning or other methods, a disturbing phenomenon that psychologists say they are hearing about more often.

For some young people, self-abuse is an extreme coping mechanism that seems to help relieve stress; for others it’s a way to make deep emotional wounds more visible.

The results of the survey at Cornell and Princeton are similar to other estimates on this frightening behavior. Counselors say it’s happening at colleges, high schools and middle schools across the country.

Separate research found more than 400 Web sites devoted to subject, including many that glorify self-injury. Some worry that many sites serve as an online subculture that fuels the behavior — although whether there has been an increase in the practice or just more awareness is unclear.

Sarah Rodey, 20, a University of Illinois student who started cutting herself at age 16, said some online sites help socially isolated kids feel like they belong. One of her favorites includes graphic photographs that the site warns might be “triggering.”

“I saw myself in some of those pictures, in the poems. And because I saw myself there, I wanted to connect to it better” by self-injuring, Rodey said.

The Web sites, recent books and media coverage are pulling back the curtain on the secretive practice and helping researchers better understand why some as young as grade-schoolers do it.

“You’re trying to get people to know that you’re hurting, and at the same time, it pushes them away” because the behavior is so distressing, said Rodey, who has been diagnosed with bipolar disorder.

The latest prevalence estimate comes from an analysis of responses from 2,875 randomly selected male and female undergraduates and graduate students at Cornell and Princeton who completed an Internet-based mental health survey.

Seventeen percent said they had purposely injured themselves; among those, 70 percent had done so multiple times. The estimate is comparable to previous reports on U.S. adolescents and young adults, but slightly higher than studies of high school students in Australia and the United Kingdom.

'An increasing phenomenon'

The study appears in this month’s issue of Pediatrics, released Monday. Cornell psychologist Janis Whitlock, the study’s main author, also led the Web site research, published in April in Developmental Psychology.

Among the Ivy League students who harmed themselves, about half said they’d experienced sexual, emotional or physical abuse that researchers think can trigger self-abuse.

Repeat self-abusers were more likely than non-injurers to be female and to have had eating disorders or suicidal tendencies, although self-injuring is usually not considered a suicide attempt.

Greg Eels, director of counseling and psychological services at Cornell, said the study’s findings are not surprising. “We see it frequently and it seems to be an increasing phenomenon.”

While Eels said the competitive, stressful college environment may be particularly intense at Ivy League schools, he thinks the results reflect a national problem.

Dr. Daniel Silverman, a study co-author and Princeton’s director of health services, said the study has raised consciousness among his staff, who are now encouraged to routinely ask about self-abuse when faced with students “in acute distress.”

“Unless we start talking about it and making it more acceptable for people to come forward, it will remain hidden,” Silverman said.

Some self-injurers have no diagnosable illness but have not learned effective ways to cope with life stresses, said Victoria White Kress, an associate professor at Youngstown State University in Ohio. She consults with high schools and says demand for her services has risen in recent years.

Psychologists who work with middle and high schools “are overwhelmed with referrals for these kids,” said psychologist Richard Lieberman, who coordinates a suicide prevention program for Los Angeles public schools.

He said one school recently reported several fourth-graders with burns on their arms, and another seeking help for “15 hysterical seventh-grade girls in the office and they all have cuts on their arms.”

In those situations, Lieberman said there’s usually one instigator whose behavior is copied by sympathetic but probably less troubled friends.

Rodey, a college sophomore, said cutting became part of her daily high school routine.

“It was part of waking up, getting dressed, the last look in the mirror and then the cut on the wrist. It got to be where I couldn’t have a perfect day without it,” Rodey said.

“If I was apprehensive about going to school, or I wasn’t feeling great, I did that and I’d get a little rush,” she said.

Whitlock is among researchers who believe that “rush” is feel-good hormones called endorphins produced in response to pain. But it is often followed by deep shame and the injuries sometimes require medical treatment.

Vicki Duffy, 37, runs a Morris County, N.J., support group and said when she was in her 20s, she had skin graft surgery on her arms after burning herself with cigarettes and a fire-starter. After psychological and drug treatment, she stopped the behavior 10 years ago.

Author of the 2004 book “No More Pain: Breaking the Silence of Self-Injury,” Duffy recalled being stopped on the street by a 70-year-old woman who saw her scarred arms and said, “’I used to do that.”’

Rodey said she stopped several months ago with the help of S.A.F.E. (Self-Abuse Finally Ends) Alternatives treatment program at a suburban Chicago hospital. Treatment includes behavior therapy and keeping a written log to track what triggers the behavior.

Rodey said she feels “healed” but not cured “because it’s something I will struggle with the rest of my life. Whenever I get really stressed out, that’s the first thing I think about.”

Dear Abby

The thing that comes to mind when I look at my friends is, "How much did you cut today?" It hurts my heart to know they do it. A couple of them do it on their legs. They wear pants in the summer so no one can see the nasty gashes and scars. My other friends do it on their arms and wear long-sleeved shirts or sweater-shirts in 80-degree weather. It's scary knowing some of your closest friends do this.

I am only 14 and I am crying out for help. What can I say or do to make them stop? I feel like if I tell them, they'll feel bad and cut more and I really don't know what to do. I don't think they realize how much this hurts not just them, but me. Please print this soon.

Frightened and Worried in Minnesota:

Dear Frightened:

You are right to be worried about your friends. They are in serious trouble. Strange as it may seem, people who cut themselves do it to distract themselves from their emotional pain. Cutting is usually a symptom of a serious emotional problem, and often cutters need professional intervention to stop their compulsion.

One would think that a child's parents would recognize that something was wrong when the young person habitually wears clothing that is inappropriate for the season - but apparently your friends' parents are too focused on something else to notice.

Your friends are sick, and they're not likely to listen to you at this point. That's why you must tell your parents what is going on, so they can tell the other adults that their children are in need of treatment - and the sooner the better.

Editor's Note: Another option is to talk to your school's counselor. Too often the emotional/physical/sexual abuse that creates emotional pain comes from the parents of the cutters. Even if this isn't so, it's not a bad idea to guarantee outside sources are involved in the situation.

Painful feelings may include

Feeling abandoned

Feeling afraid

Feeling threatened

Feeling alone, isolated

Feeling misunderstood

Feeling judged

Feeling unaccepted

Feeling rejected

Feeling controlled

Feeling powerless

Feeling untrusted

Feeling untrusting

Feeling unsafe

Feeling trapped

Feeling imprisoned

Feeling not listened to

Feeling unheard

Feeling failful

Feeling abnormal

Feeling confused

Feeling guilty

Feeling responsible

Feeling overwhelmed

Feeling unloved

Feeling uncared about

Feeling punished

Feeling hated

Source: alone and unsafe

What is Self-Injury?

Non-suicidal self-injury (NSSI), also referred to as self-injury or self-harm, is the deliberate and direct destruction of one’s body tissue without suicidal intent and not for body modification purposes. Therefore this definition does not include tattooing or piercing, or indirect injury such as substance abuse and eating disorders. Also, this type of self-injury is different than “self-injurious behaviors” (SIB) which are commonly seen among individuals with intellectual and developmental disabilities.

Self-injury Methods

The most common methods of self-injury include cutting, burning, scratching, and bruising. These injuries can range in severity from minor to moderate. Self-injury can start at any age, but most people who self-injure start when they are teenagers. Many people who start self-injuring in their teens continue into adulthood, while others may start self-injuring as adults. Although any one at any age may begin to engage in self-injury, research shows that the most common age of onset for self-injury is early adolescence, more than half of young adults who have engaged in self-injury recall starting at this time, however slightly less than a quarter recall starting before age 12.


Between 14 to 24% of youth and young adults in the community report engaging in self-injury at least once in their life. Some studies have found even higher percentages if they provide comprehensive checklists of the different types of possible self-injury methods or if they advertise their study as one about self-injury.

14-24% of youth and young adults have self-injured at least once.
One quarter of these have done it many times.

What are common misconceptions about NSSI?

Self-injury is a failed suicide attempt

Self-injury is NOT an attempt to die. Most people who self-injure say they do it to feel better, to express their pain and/or to stop feeling numb. In fact, some people who self-injure even say they do it to stop themselves from acting on urges and thoughts to kill themselves. Although self-injury and suicide attempts are different behaviors, many individuals who self-injure also may struggle at times with suicidal feelings.

The injury isn’t very bad, so it isn’t serious

The seriousness of a person’s distress is NOT related to the severity of the self-injury. Research has shown that self-injury is related to emotional difficulties, distress and sometimes suicidal feelings. Therefore, any degree of self-injury needs to be taken seriously.

Self-injury is just an attempt to get attention

Self-injury is NOT about trying to get attention. Self-injury is often done in private and many people keep it a secret from others. Some people who self-injure never tell anyone about it. If they tell someone, they may be more inclined to tell a friend or to share their self-injury experiences online.

Because many individuals who self-injure have difficulties telling others how they feel some may use self-injury to show others the distress they find hard to put into words. This is not about trying to get attention but about an attempt to communicate their pain or intense emotions.

People who self-injure have a personality disorder

Many people who self-injure do NOT have a personality disorder. Sometimes self-injury is a symptom of borderline personality disorder (BPD)—a mental health illness involving a long-term pattern of difficulties dealing with emotions, impulsivity, and unstable relationships—but a diagnosis of BPD cannot be made based on self-injury alone. There are other symptoms of BPD that must be present in order to receive this diagnosis and many people who self-injure do not have these other symptoms.

Self-injury is a sign that someone has been abused

Although self-injury is quite prevalent amongst individuals with a history of abuse, not everyone who has been abused will self-injure and not everyone who self-injures has been abused. It is very important not to assume that self-injury is an indicator of abuse.

People who self-injure don’t feel pain

People who self-injure DO feel pain. Sometimes when a person feels numb, or like they are separated from their body, the purpose of self-injury is to feel pain (that is, the goal is to feel something, even if it is pain). However, some individuals who self-injure say that sometimes they do not feel the pain, that they feel disconnected from their body during the self-injury but this is not always the case.

Self-injury is a phase or a teen fad that people grow out of

Self-injury is NOT a trend, a fad, or a phase. Self-injury is an attempt to cope with some very difficult feelings. It is often referred to as a ‘maladaptive coping strategy.’ Research shows that using self-injury at any point in one’s life is a sign that the person is struggling to cope. Most people do not grow out of self-injury without finding healthier ways to cope. This can be very difficult and may require professional help. Self-injury doesn’t get better on its own.

Most people who self-injure say they do it to feel better,
to express their pain and/or to stop feeling numb.

How common is non-suicidal self-injury?

By the numbers

Non-suicidal self-injury is quite common, with about 14 to 24% of teens reporting self-injuring at least once and about a quarter of those having done it many times. Similar rates of self-injury have been found amongst college students. However, in later adulthood the occurrence of self-injury seems to be somewhat less, with about 1 in 20, or approximately 4%, of adults indicating they have self-injured. Because almost all the research on this has been done over the last decade, it is unclear whether it is increasing or if as youth and young adults mature they learn healthier coping and the use of self-injury decreases. Further research is needed to understand why the prevalence is different amongst older adults. In any case, non-suicidal self-injury is not a rare or unusual occurrence amongst youth and young adults.

Who is at risk for non-suicidal self-injury?

One of the most commonly found risk factors for non-suicidal self-injury is having difficulties with regulating emotions. This means individuals who experience intense negative emotions that they find intolerable, which is often combined with difficulty expressing emotions, are more at risk for self-injury. There may be many reasons for these difficulties, including past life experiences and/or temperament

Research has shown that in adolescent samples females are more likely to report having self-injured. However, by late adolescence or young adulthood, males and females report similar rates of self-injury. Research has also shown that females may be more likely to seek help or report their self-injury than males, leading professionals and the general public to mistakenly think of self-injury as a “female” behavior. So, while many people think females are more at risk for self-injury this is not the case.

In addition, some research has indicated that being a member of a group that is likely to experience social prejudice (i.e., a group that is marginalized) may increase the risk for self-injury. For example some research has shown that people who are lesbian, gay, bisexual or transgendered may be more likely to engage in self-injury. With more stress in one’s life, it can be more difficult to cope.

People who self-injure sometimes have mental health difficulties such as depression, post-traumatic stress disorder (PTSD), or eating disorders. However, many people who self-injure do not have a mental illness. This is not to say that self-injury is not serious though, self-injury is a sign of significant distress.

Professionals and the general public mistakenly
think of self-injury as a “female” behavior

Why do people engage in NSSI?

As noted above, one of the most common reasons for self-injuring is to deal with intense negative emotions (like sadness, stress and anger) and thoughts (such as negative thoughts about oneself). These feelings or thoughts are felt to be so intense and overwhelming that they are intolerable.

People who self-injure frequently report that following the self-injury they experience a “relief” from these negative emotions/thoughts for a short time.

Sometimes people self-injure to punish themselves for things they feel guilty about, or when they are really hard on themselves and feel they have not done well enough.

Some people self-injure to reconnect with themselves and others (that is, to feel something, even if it is pain). Some people use self-injury as a way to tell others about how they feel.

There are many other reasons for self-injuring and someone may self-injure for more than just one reason or the reason for the self-injury may change over time as the self-injury continues. As anyone who self-injures will tell you, it is very hard to say “why” they self-injure, it is a complex combination of things – however they do know that they are doing this to try to feel better in one way or another.

Self-Injury as maladaptive coping

People who self-injure have a hard time dealing with their feelings. Instead of being able to cope with an intense emotion (such as sadness or anger), they use self-injury to reduce, manage, or escape from these feelings. Because for some people the self-injury brings relief, it is tempting to keep using it to cope with these difficult feelings. However, the more often individuals use self-injury to cope, the more likely they are to self-injure when they have difficult feelings in the future. Many people who self-injure report feeling that they “can’t stop” or that they “are addicted” to self-injury. It is important to break the cycle early on as it becomes increasingly difficult to stop.

Non-suicidal self-injury is not a suicide attempt because it is done as an effort to feel better,
not to end life – dying is not the goal of self-injury.

However, some people who self-injure also experience depression. People who are depressed have a lot of negative thoughts (about themselves, others, the world around them, and their future), they may feel hopeless and as if they are a burden to others. These feelings CAN lead to suicidal thoughts and actions. People who self-injure are at a higher risk for suicide when their distress is greater than their ability to cope. Sometimes people may self-injure as a way to cope, and to stop themselves from acting on these thoughts and urges of suicide.

In any case, because we know that those who self-injure are also at greater risk for attempting suicide at some point (even though these are different behaviors), anyone who self-injures should be evaluated for possible suicide risk.

Is non-suicidal self-injury contagious?

Self-injury is NOT contagious. Self-injury is usually done in private and differs from person to person (in terms of how, where, and why it is done). People only self-injure when the self-injury fills a need for that person. People who already use healthy ways to cope with distress and difficult emotions are unlikely to start self-injuring after learning that someone else self-injures. People who find it hard to cope with difficult feelings may be more likely to try out unhealthy ways of coping (such as self-injury) after learning that a friend does it.

While you can’t “catch” self-injury, knowing someone who self-injures can increase the chance
that someone will self-injure if he/she already has difficulty coping with difficult emotions.

Self-injury in the media

Self-injury is becoming more popular as a subject in music, television shows, and websites. Many celebrities talk about their own self-injury. It is important that people know what self-injury is and that there is help for it. These media help to spread awareness about self-injury. However, some depictions of self-injury can be triggering for those who self-injure; sometimes they can also make self-injury seem okay or even glamorous. It is important to remember though that people who self-injure report that once you start it can be hard to stop and that they feel like self-injury takes over their lives. Self-injury needs to be taken seriously.

Can people stop self-injuring?

Self-injury is not a life-sentence. People CAN and DO STOP self-injuring. However, the longer a person self-injures, the more difficult it can be to stop. It is important to remember that stopping a behavior that has become a frequently used maladaptive coping strategy will take time and effort and having support in doing this would be helpful.

Many people who self-injure do it in private and work very hard to keep it a secret. In these cases, the self- injury may sometimes be accidentally discovered. Some people who self-injure will tell one or two close friends or family members; often they will tell others who self-injure when they’re online. Other people who self-injure will talk to a professional (like a counsellor, psychologist or a doctor) about their self-injury.

It is important that people who self-injure are provided with helpful resources and, if they are open to it, professionals who can support them in their efforts to cope better. Mental health professionals (such as counsellors, social workers, psychologists and psychiatrists) are trained to help people learn healthier ways to cope, and can be helpful in supporting someone who self-injures.

This website has current best practice information and resources that can be shared with the professional (click here). Some people who self-injure are not ready and/or willing to seek professional help. It is possible to learn healthier ways to cope without a professional but it may be extremely difficult. Resources on this website for those who self-injure can help in efforts to recover (click here).

People who self-injure cannot be forced to stop. Sometimes people who self-injure do not want to stop self-injuring. Remember that self-injury serves a purpose and stopping can be difficult. When people who self-injure start learning healthy ways to cope, then they find stopping self-injury easier.

You cannot force someone to stop self-injuring;
with support, many will choose to stop.

Where can I find more information?

These resources are recommended for anyone wanting to learn more about self-injury. This includes people who self-injure, family, friends, and professionals.


Conterio, K. & Lader, W., & Bloom, J. (1998). Bodily Harm: The breakthrough healing program for self-injurers. New York: Hyperion.

Gratz, K.L., & Chapman, A.L. (2009). Freedom from self-harm: Overcoming self-injury with skills from DBT and other treatments. Oakland: New Harbringer.

Hollander, M. (2008). Helping teens who cut: Understanding and ending selfinjury. New York, NY: Guilford Press.


Safe Alternatives (SAFE)

Cornell Research Program on Self-injurious Behaviors

Recover Your Life

Research Articles and Texts

Klonsky, E.D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27, 226-239.

Nock, M.K. (2009) Understanding non-suicidal self-injury: Origins, assessment, and treatment. Washington, DC: American Psychological Association.

Nock, M.K. (2009). Why do people hurt themselves? New insights into the nature and functions of non-suicidal self-injury. Current Directions in Psychological Science, 18, 78-83.

Whitlock, J.L, Eckenrode, J. & Silverman, D. (2006). Self-injurious behaviors in a college population. Pediatrics, 117, 1939-1948.

Adolescents who self-harm more likely to commit violent crime

Young people who self-harm are three times more likely to commit violent crime than those who do not, according to new research from the Center for Child and Family Policy at Duke University.

The study also found young people who harm themselves and commit violent crime -- "dual harmers" -- are more likely to have a history of childhood maltreatment and lower self-control than those who only self-harm. Thus, programs aimed at preventing childhood maltreatment or improving self-control among self-harmers could help prevent violent crime, the authors state.

Rates of self-harm -- deliberately harming oneself, often by cutting or burning -- have increased substantially among adolescents in recent years both in the United States and the United Kingdom. In the U.S., roughly one in four teenage girls try to harm themselves and one in 10 teenage boys. In the U.K., the yearly incidence of self-injury among teenage girls has risen by nearly 70 percent in three years.

"We know that some individuals who self-harm also inflict harm on others," said Leah Richmond-Rakerd, lead author of the study. "What has not been clear is whether there are early-life characteristics or experiences that increase the risk of violent offending among individuals who self-harm. Identifying these risk factors could guide interventions that prevent and reduce interpersonal violence."

In the study, published in The American Journal of Psychiatry, Richmond-Rakerd and researchers from Duke and King's College London compared young people who engage in "dual-harm" behavior with those who only self-harm.

Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative U.K. cohort of 2,232 twins born in 1994 and 1995 who have been followed across the first two decades of life. Self-harm in adolescence was assessed through interviews at age 18. Violent offenses were assessed using a computer questionnaire at age 18 and police records through age 22.

"By comparing twins who grew up in the same family, we were able to test whether self-harm and violent crime go together merely because they come from the same genetic or family risk factors," said Terrie E. Moffitt of Duke University, founder of the E-Risk Study. "They did not. This means that young people who self-harm may see violence as a way of solving problems and begin to use it against others as well as themselves."

Researchers also found that those who committed violence against both themselves and others were more likely to have experienced victimization in adolescence. They also had higher rates of psychotic symptoms and substance dependence.

"Our study suggests that dual-harming adolescents have experienced self-control difficulties and been victims of violence from a young age," said Richmond-Rakerd. "A treatment-oriented rather than punishment-oriented approach is indicated to meet these individuals' needs."

Additional recommendations include:

After incidents of self-harm, clinicians should routinely evaluate a person's risk of suicide. Clinicians should also assess a person's risk of committing acts of violence against others.

Improving self-control among self-harmers could help prevent violent crime. Self-harming adolescents should be provided with self-control training, which may reduce further harmful behaviors.

Self-harm and violent crime have largely been studied separately within the fields of psychology, psychiatry and criminology. Interdisciplinary research should be pursued, since it could yield new insights.


This research was supported by the National Institute of Child Health and Human Development (NICHD) (HD077482), the Jacobs Foundation and the Avielle Foundation. Leah S. Richmond-Rakerd was supported by a postdoctoral fellowship provided by the NICHD (T32-HD007376) through the Center for Developmental Science at the University of North Carolina at Chapel Hill. The E-Risk Longitudinal Twin Study is funded by the UK Medical Research Council (grant G1002190).

Do Men Self-Injure? Male and female patterns of self-harm.

In gathering data for our new book, The Tender Cut (NYU Press), we realized that most of the literature on self-injury suggested that women are more frequent cutters, burners, branders, etc. than men. Some studies noted as high a figure as 85 percent women. Yet we suspected that there were more men out there than that, and that the male population was growing. Our data, gathered over the last ten years and based on more than 135 in-depth life history interviews with self-injurers located all over the world and tens of thousands of Internet messages and emails including those posted publicly and those written to and by us, offered an excellent vantage point to see if these gendered assumptions were valid.

One of the problems with the existing research is that it has been so heavily based on inpatient hospital and clinic populations. Yet sociological studies of health show that men are much less likely than women to go to the doctor, to go to the hospital, or to seek medical care.

First, it is certainly true that women self-injure more than men. They self-injure in larger numbers partly because their gender role socialization inclines them toward it. When women get upset, they are taught to turn their feelings inward and take it out on themselves. Connie (pseudonym), a 19-year-old college student who had a lot of familial conflict, told us, "This was the only thing that would calm me down when I was just so angry. And I wanted to punch walls and stuff like that but I didn't want to be so loud about it. So, it was taking anger out on myself." Penelope noted that, "Like with my dad, I feel, like, all my anger at him but I can't take it out on him 'cause he'll kick me out of the house, so I just take it out on myself instead."

Women are also socialized to lodge their self-identify heavily within their bodies, since so much of their value and self-worth in the relationship marketplace resides in their looks. Being a woman of any age in today's society means struggling to meet cultural appearance norms (i.e., be thin, be pretty, be fit but not too muscular). For people who fail to live up to the standards of fashion models, this may create anxiety, depression, and feelings of failure. This excessive focus on embodiment leads women to think that if they can control their bodies, they can control their selves. Injuring their bodies gives them a feeling of control over their emotions. This is the same sociological impulse that leads so many of them to engage in eating disorders.

So, although women still self-injure more than men, the practice is spreading into wider groups of men, and, over time, we should expect to become aware of more boys and men engaging in it.

Third, our research suggests that there are distinctly "feminine" and "masculine" ways of self-injuring. Women tend to make smaller cuts in hidden places with sharp implements (such as exacto blades, straight-edge blades, and broken razor cartridges) and to hide their behavior.

When men and women conform to these gendered ways of injuring, they are (relatively speaking) more accepted. Lisa told us that she went inward toward self-destruction, "Probably because I didn't want people to know. I didn't want to ruin my future because I wanted to show people that I could be okay, eventually, but I wasn't at the time." Guys who follow their gender norms seem able to self-injure more openly without reprimand. Ben struggled with an abusive father, and everyone knew that he was beaten regularly. So when he made large, bold cuts on his arms and didn't try to hide them, nobody asked him about these; it was taken as an understood response. In fact, committing violent acts upon one's body is a more acceptable and manly behavior (like some masculine rites of homo-social bonding behavior such as getting drunk with a group of friends and branding themselves), and many women noted that male self-injurers whom they knew seemed to be able to "pull it off better." Sam, the former Marine, agreed, saying, "In a sense, the more you could tolerate, the more 'manly' you were. I knew of a sergeant who shot up Jack Daniels intravenously and everyone thought that was 'hardcore." I don't remember feeling like the Marines thought I was unmasculine for SI."

When people deviate from these masculine and feminine ways of self-injuring, however, they are more likely to be negatively sanctioned. Penelope, quoted above, reflected that she turned her anger inward precisely because she feared the reaction of others if she (like guys) turned it outward, or against others. Women who flaunt their injuring too openly may also be chastised as "posers," "emo cutters," or condemned for "crying for help" (even if they need it). If they make larger cuts or burns, or if they do these to their faces, chests, or arms, they may be considered unfeminine and be more highly stigmatized.

There is, thus, a highly gendered component to the causes, population, and manner of self-injuring that is shifting in some ways and not in others.

The Changing Gender Ratio in Occurrence of Deliberate Self-Harm Across the Lifecycle


Abstract. Background: Overall gender ratios are often quoted in studies of deliberate self-harm (DSH) patients, almost always with higher rates in females than males. Reporting a ratio across all ages may conceal important variations in the gender ratio across the life cycle. Method: Analysis was done of the gender ratio by age groups in rates of DSH in a consecutive sample of DSH patients presenting to a general hospital over a 10-year period. The patients were identified through a well-established monitoring system. Results: The study sample included 2,189 female and 1,439 male patients. While the overall gender rate ratio was 1.5 females to each male, the ratio varied considerably by age group: 8:1 in 10-14-year-olds, 3.1:1 in 15-19-year-olds, 1.6:1 in 20-24-year-olds, approximately 1.3:1 in 25-49-year-olds, and 0.8:1 in people aged 50 years and over. Conclusion: Statements about overall gender ratios for DSH conceal important changes in the ratio across the life cycle. These changes probably reflect differences in development and problems faced in adolescence, changes in motivation for DSH with age, and the closer resemblance of DSH to suicide in older age groups.

The Relationship of Digit Ratio (2D:4D) and Gender-Role Orientation in Four National Samples


The ratio of second to fourth finger length (2D:4D ratio) is sexually dimorphic with women having higher 2D:4D ratio than men. Recent studies on the relationship between 2D:4D ratio and gender-role orientation yielded rather inconsistent results. The present study examines the moderating influence of nationality on the relationship between 2D:4D ratio and gender-role orientation, as assessed with the Bem Sex-Role Inventory, as a possible explanation for these inconsistencies. Participants were 176 female and 171 male university students from Germany, Italy, Spain, and Sweden ranging in age from 19 to 32 years. Left-hand 2D:4D ratio was significantly lower in men than in women across all nationalities. Right-hand 2D:4D ratio differed only between Swedish males and females indicating that nationality might effectively moderate the sexual dimorphism of 2D:4D ratio. In none of the examined nationalities was a reliable relationship between 2D:4D ratio and gender-role orientation obtained. Thus, the assumption of nationality-related between-population differences does not seem to account for the inconsistent results on the relationship between 2D:4D ratio and gender-role orientation.

More youth ar attempting suicide and it's unclear why

Nearly 1 in 4 teen girls in the US self-harm, massive high school survey finds

Self-harm or self-injury, the act of hurting oneself on purpose, affects nearly 1 in 4 teenage girls in the United States.

That’s according to a new study recently published in the American Journal of Public Health, for which researchers at the University of Portland in Oregon assessed the prevalence of non-suicidal self-injury among adolescents through the 2015 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System.

The YRBSS featured information on 64,671 public high school students ages 14-18 from 11 states via ongoing school-based national, state, tribal and large urban school district surveys representative of high school students in America, plus one-time national and special-population surveys.

Participants in the 11 states — Arizona, Connecticut, Delaware, Florida, Idaho, Kentucky, Massachusetts, Nevada, New Hampshire, New Mexico and Vermont — answered at least 89 questions about demographics; unintentional injuries and violence; tobacco use; alcohol and drug use; sexual behaviors; body weight and diet behaviors; physical activity and other health-related topics.

A sample question addressing NSSI may read: “During the past 12 months, how many times did you do something to purposely hurt yourself without wanting to die, such as cutting or burning yourself on purpose?” with choice options of “0 times,” “1 time,” “2 or 3 times,” “4 or 5 times” and “6 or more times.”

Questionnaires were administered and collected during a single class period, according to the study.

What exactly is self-harm?

“Self-harm or self-injury means hurting yourself on purpose,” according to the National Alliance on Mental Illness. “One common method is cutting yourself with a knife. But any time someone deliberately hurts herself is classified as self-harm. Some people feel an impulse to burn themselves, pull out hair or pick at wounds to prevent healing. Extreme injuries can result in broken bones.”

It isn’t a mental illness, “but a behavior that indicates a lack of coping skills” that may be associated with illnesses such as borderline personality disorder, depression, eating disorders, anxiety or posttraumatic distress disorder.

Key Findings

Overall, 17.6 percent of survey respondents in the University of Portland study reported at least one NSSI act in the previous year.

“The numbers are very disturbing,” study co-author Nick McRee told BuzzFeed News. “They suggest that the behavior is not concentrated among a small number of disturbed youths, but in fact, it is a fairly common type of behavior among adolescents in general.”

The rate of boys reporting self-harm without wanting to die over the past year ranged between 6.4 percent to 14.8 percent. The rate for girls was twice as high.

In fact, in some states, such as Idaho, the rate of self-harm for teenage girls was as high as 31 percent.

They were also more likely than boys to report experiencing most of the health risks believed to be associated with NSSI, authors wrote. Such health risks include depression, suicidal thoughts, forced sex and cyber bullying.

Still, more than 1 in 10 high school boys in the analyses reported NSSI.

Across the board, prevalence of NSSI appeared to decline with age. Among 14-year-olds, 19.4 percent reported at least one incident of NSSI. Among 18-year-olds, the rate dropped to 14.7 percent.

“No particular racial or ethnic group is immune from NSSI, though rates were higher among Native Americans, Hispanics, and Whites than they were among Asians and Blacks,” authors wrote.

In fact, more than 20 percent of adolescents identifying as Native American reported NSSI, compared to just over 12 percent of African-American youth.

“Our findings indicate that the scope of NSSI among adolescents is so widespread that individual clinical and therapeutic interventions may be insufficient to address this public health problem,” report authors wrote.

The researchers hope school-based and community health programs will better address the identified risk factors. Additionally, they wrote, because many factors associated with NSSI can also be linked to other mental health problems, “efforts to prevent NSSI should be incorporated into broader efforts to address mental health among children and adolescents.”


Some limitations the scientists addressed include lack of insights about the severity of injuries or how participants felt about their behavior, suggesting the evidence lacks in-depth analyses common in clinical samples.

Questionnaires also didn’t include questions about other factors associated with NSSI, such as family dynamics.

Future research should focus on whether the high rates of NSSI reflect a trend or just evidence of public recognition of the phenomenon, authors wrote. Additionally, researchers believe more investigation is needed to understand whether the observed NSSI decline by age continues beyond high school or has lasting effects.

Read the full study at

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Pain generated or sustained by the mind
needs the body mainly in order to give suffering a location.

One can paint a pretty picture but this story has a twist.
The paintbrush is a razor and the canvas is the wrist

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