Self-harm often arrives like a private answer to unbearable feelings. It can be a way to make the noise inside seem smaller, to feel something when numbness takes over, or to punish shame that won’t quiet. It can leave people feeling ashamed, alone, and afraid to ask for help.
For parents and caregivers, the signs aren’t always obvious, often hidden behind long sleeves, vague explanations. A teen might explain away injuries as accidents, withdraw from friends, or spend more time alone. Families are left wondering: is this self-harm?
That’s why clear, non-judgmental information matters. Understanding what self-harm looks like, why it happens, and when to seek help can replace confusion with clarity and open the door to safer, more effective treatment.
At Suffolk DBT, we provide comprehensive DBT treatment for teens and adults, including individual therapy, DBT skills groups, and between-session support for families across Long Island and NYC.
What is Self-Harm?
Self-harm is any behavior someone uses to intentionally hurt themselves. It can take many forms, and it doesn’t always mean the person wants to die. In fact, many teens use self-harm as a way to cope with overwhelming emotions, numbness, or stress they can’t put into words.
Clinicians often separate non-suicidal self-injury (NSSI), which is an act done without conscious intent to die, from self-harm that involves suicidal intent. That distinction matters for how clinicians assess risk and plan care, but both deserve immediate attention and compassion.
A note for parents of teens who self-injure
If your teen is self-harming, it can feel frightening and confusing. One of the most important things to understand is that self-harm is usually not “attention-seeking” or “just a phase.” It serves a real purpose for the person in that moment, even if the choice is unsafe.
It’s crucial to think about self-harm in terms of its function—what it does for the person in that moment. For some, it’s about calming down, interrupting dissociation, showing pain they can’t express otherwise, or punishing themselves when shame feels unbearable.
Seeing self-harm in this light can shift the question from “Why would they do this?” to “What are they coping with?” That perspective opens the door to compassion and more effective support.
It also helps to remember that the behavior does not define your child. Using language like “a teen who self-harms” or “self-injury” reduces stigma and centers the person, not the behavior.
The goal isn’t to excuse self-harm, but to understand it so your teen feels safe enough to accept help and begin practicing healthier coping skills.
Types of Self-Harm
Self-harm doesn’t look the same for everyone. Some behaviors are more visible, like cuts or burns, while others are easier to hide, such as changes in eating, substance use, or emotional withdrawal. Knowing the different forms can help parents recognize what may be happening sooner.
Direct Physical Self-Injury
What it looks like: Repeated scratches or cuts, burns, or other deliberate wounds to the skin often found on the arms, thighs, or torso. Patterns sometimes include similar marks or scars in the same places.
Why someone might do it: Many people use this behavior to release unbearable emotions, interrupt dissociation, or gain a sense of control in chaotic situations. The act can become ritualized and provide short-term relief.
What to watch for: Fresh wounds, unexplained scars, frequent wearing of concealing clothing in warm weather, or stories about accidents that don’t add up. Secretive behavior around bathing or dressing may also appear.
Basic health risks: Infection, deep tissue damage, permanent scarring, and unintended severe bleeding. Any wound that will not stop bleeding, smells foul, or shows spreading redness needs prompt medical attention.
Hitting, Head Banging, Blunt Force
What it looks like: Striking oneself with hands or objects, repeatedly hitting the head against surfaces, or slamming parts of the body to cause pain. These acts may leave bruises, swelling, or signs of concussion.
Why someone might do it: To ground themselves, to discharge intense emotion, or to end a dissociative episode by forcing focus back into the body. For some, it’s a learned way to change internal sensations quickly.
What to watch for: Frequent unexplained bruises or headaches, complaints of dizziness, or behaviors that occur during periods of high stress. Family members may report sudden episodes.
Basic health risks: Concussion, internal injury, fractures, long-term neurological harm, and increased risk when the behavior escalates.
Body-Focused Repetitive Behaviors Such as Hair Pulling and Skin Picking
What it looks like: Recurrent hair pulling that causes noticeable hair loss or repeated skin picking that leads to sores or scabs. These behaviors can be episodic or chronic and may be hidden by scarves, makeup, or long sleeves.
Why someone might do it: These acts can soothe anxiety, reduce tension, or provide a momentary sense of relief. For some people, the behavior overlaps with impulse control conditions but functions like self-injury in relieving distress.
What to watch for: Hidden hair loss, open sores, scabbed areas that don’t heal, and significant time spent on the behavior. Avoidance of social situations or changes in grooming habits are clues.
Basic health risks: Scarring, infection, hair loss that may be hard to reverse, and emotional distress tied to appearance concerns.
Indirect or Self-Destructive Behaviors Such as Substance Misuse, Disordered Eating, and Reckless Driving
What it looks like: Patterns of heavy alcohol or drug use, chronic restrictive eating or binge purge cycles, repeated risky driving or dangerous sexual behavior. These actions may be less obviously labeled as self-harm yet serve similar functions.
Why someone might do it: To numb emotional pain, to punish oneself, to seek escape, or to test limits in a way that expresses inner turmoil. These behaviors often develop when other coping options are unavailable.
What to watch for: Escalating use of substances, frequent accidents or legal problems, sudden loss of weight, or withdrawal from responsibilities. Interpersonal chaos and inconsistent functioning at work or school are common signs.
Basic health risks: Overdose, organ damage, long-term metabolic harm, accidents causing injury or death, and compounding mental health problems.
Important note about self-poisoning
Self-poisoning or intentional overdose is handled differently because it often involves suicidal intent or life-threatening toxicity. If you suspect a teen has taken an overdose or swallowed a harmful substance, treat it as a medical emergency—call 911 or go to the nearest emergency room immediately. In the U.S., you can also contact 988 for the Suicide & Crisis Lifeline.
Why People Self-Harm: Common Functions
People rarely hurt themselves for no reason. What looks like a destructive choice is often a learned way to get through something unbearable.
- Regulate emotion — create a momentary shift from chaos to something tolerable.
- Stop dissociation — snap back into the body when numbness or detachment feels unsafe.
- Feel something — break through emotional numbness with a physical sensation.
- Self-punish — try to atone for shame or perceived failures.
- Communicate distress — show pain when words feel impossible or invisible.
- Regain control — use a predictable action when life feels unpredictable.
These are coping strategies that often “work” in the short term by changing how someone feels right now. That short-term effectiveness is why the behavior can become automatic. DBT reframes self-harm as an important signal worth paying attention to. But with treatment, skills can replace harmful habits by giving safer, teachable ways to manage urges and emotional crises.
Distress tolerance, emotion regulation, mindfulness, and interpersonal skills offer practical alternatives, and Suffolk DBT’s skills groups and DBT programs focus on teaching these replacements in a supportive setting.
Self-Harm Examples & How Parents Can Help
Regulate strong emotion
Example: After a fight with a friend, your teen makes shallow cuts on their forearm to “feel something different.”
Parent response: Stay calm, treat the wound, say, “I can see you were in a lot of pain — I’m glad you told me,” and ask if they want help using a grounding skill now.
Stop dissociation / snap back into the body
Example: Your teen says they “went somewhere” during an argument and later notices bruises from hitting themselves.
Parent response: Offer gentle grounding (5–4–3–2–1 sensory check), sit with them briefly, and contact their clinician to add safer grounding alternatives to their plan.
Feel something when numb
Example: After weeks of emotional shutdown, your child seeks out strong physical sensations (punching a pillow, picking skin).
Parent response: Offer safe sensory substitutes (cold pack, textured object) and arrange a conversation with a therapist about healthy sensory options.
Communicate distress when words are hard
Example: A previously outgoing teen suddenly wears long sleeves and refuses to explain injuries.
Parent response: Name what you see (“I noticed the cuts on your arm; I’m worried”), stay nonjudgmental, and invite them to talk or choose who they want present for help.
Self-punish (shame-driven behavior)
Example: After failing a test, your teen makes themselves hurt to “pay for it.”
Parent response: Avoid blame. Validate emotion (“You sound really upset”), focus on safety, and connect them with supports that address shame and coping skills.
Regain control
Example: Chaos at home or school → teen creates a predictable self-harm ritual that feels “manageable.”
Parent response: Offer small, safe choices and help them build structured alternatives (scheduled activities, step-by-step coping routines) with a clinician’s guidance.
Quick parent tips when you discover self-harm
- Stay calm and avoid punishment or lectures—those increase shame and secrecy.
- Ensure immediate safety: treat wounds medically and remove or secure anything dangerous if it can be done safely. If you are concerned about suicide or an overdose, call 911 or go to the ER now (in the U.S., you can dial 988 for crisis support).
- Ask simple, open questions: “Can you tell me what happened?” or “What helped you feel this way?”
- Validate feelings, not the behavior: “I can see you were in a lot of pain. I’m glad you told me.”
- Get help: contact a clinician for a safety plan and evaluation; consider urgent care or emergency services if safety is compromised.
Health Risks and When to Get Immediate Help
Physical and long-term harms can follow from any form of self-harm, whether direct or indirect.
- Immediate physical risks: infection, heavy blood loss, nerve or tendon damage, deep tissue injury, and permanent scarring.
- Indirect harms: organ damage from repeated substance misuse or poisoning, metabolic harm from disordered eating, and accidents from reckless behavior.
- Medical emergencies: accidental overdose, loss of consciousness, breathing problems, or wounds that will not stop bleeding.
Red flags that require urgent attention include any suicidal intent or a recent suicide attempt, rapidly increasing frequency or severity of self-harm, inability to resist urges, wounds that are worsening or show signs of infection, or any event where breathing, consciousness, or safety is compromised.
In those situations, seek emergency care immediately. Call 911 or your local emergency number, or, in the United States, dial 988 for the Suicide & Crisis Lifeline. If you’re worried but not in immediate danger, contacting a clinician, a trusted provider, or a local crisis service is an important next step.
How DBT Helps: Practical Skills and Approaches
DBT organizes treatment around four core modules that together reduce the urge to self-harm by changing how people notice, tolerate, and respond to intense states.
Mindfulness fosters a steady awareness of urges and the accompanying thoughts, making those moments feel less automatic.
Distress tolerance teaches ways to survive a crisis without making things worse, which can shorten the window where self-harm feels like the only option.
Emotion regulation provides tools for identifying emotions, reducing their intensity, and taking actions that lead to safer, long-term relief.
Interpersonal effectiveness strengthens how people ask for what they need and set limits, so relationships feel less chaotic and more supportive.
In practice, this means learning concrete tools such as grounding strategies to ride out an urge, “urge surfing” techniques to notice impulses without acting on them, and crisis skills to stabilize intense emotions. Over time, these skills replace self-harm with safer habits.
At Suffolk DBT, we provide comprehensive DBT programs for teens, adults, and families. With consistent coaching, practice, and support, teens and families learn that self-harm doesn’t have to be the only way to cope.
Our Therapists are available outside of their sessions for skills coaching which is how to get through a crisis without making things worse. It often prevents hospitalization and keeps our clients safe. They are not alone with our team approached therapy.
Safety Resources and Next Steps
If self-harm is happening now, reach out for immediate help. Call emergency services or a local crisis line if there is any risk to life or safety. In the United States, dial 988 for the Suicide and Crisis Lifeline.
If the situation is not an emergency, the next step is reaching out for professional help. A clinician can:
- Build a personalized safety plan with your teen
- Teach skills that replace self-harm urges with safer coping tools
- Help the family support recovery in practical ways
Parents can also take small, immediate steps by:
- Talking with one trusted person about what’s happening (breaking secrecy reduces shame)
- Removing or securing dangerous items when it can be done safely
- Asking for a “warm handoff” to a mental health provider, so your teen doesn’t feel left alone in finding care
If you’re looking for a comprehensive DBT program, Suffolk DBT offers targeted, effective treatment for self-harm for individuals and families on Long Island and in NYC.
FAQs
Is self-harm the same as wanting to die?
Not always. Some self-harm is meant to relieve pain or feel real rather than to end life. Any self-harm should be taken seriously and assessed for suicide risk.
Will asking someone about self-harm make them do it more?
No. Compassionate, direct questions open space for help. People are more likely to get support when someone asks and listens without judgment.
Can self-harm stop?
Yes. Many people reduce or stop self-harm with skills practice, support from family, clinicians, and peers, and DBT skills. In DBT it is the first thing that we focus on in treatment. Our clients graduate from DBT no longer engaging in self harm. After all how can you have a life worth living while hurting yourself?
Where can I learn DBT skills?
DBT skills are best learned through a combination of skills groups and individual therapy. At Suffolk DBT, we offer DBT skills groups, family skills learning, in-person therapy, and telehealth sessions when needed. Consistent practice is key—just as Mozart didn’t master the piano on his first try, building these skills takes time, guidance, and regular application in daily life.