Self-harm or self-injury is a deeply personal struggle that many individuals privately face when depression and anxiety become overwhelming and unmanageable. Those who engage in self-harming are often trying to cope with these intense feelings by creating a physical sensation to release it, or to feel as if they have some sort of control over their pain.

What is self-harm?

Self-harm, which may also be called self-injury, self-mutilation, or self-abuse is the act of deliberately causing harm to oneself. 

According to Alexandra Malin, Licensed Mental Health Counselor and Clinical Supervisor with Handel Behavioral Health, “Self-harm does not only involve causing physical pain to the body; it also involves putting oneself in a potentially dangerous situation, self-neglect, and doing something that goes against your core beliefs to inflict pain on yourself.” 

Examples of self-harm behaviors include:

• Cutting the skin 
• Burning the skin 
• Excessive rubbing, pinching, picking, or scratching one’s skin
• Hitting or punching oneself, or hitting/banging one’s head
• Piercing the skin with sharp objects
• Inserting objects under the skin or into body piercings
• Intentionally breaking bones
• Ingesting harmful chemicals
• Overeating or undereating
• Abusing alcohol or substances
• Sex as self-injury (SASI)

What are the Warning Signs of Self-Harm?

Self-harm can often be masked beneath the surface of a person’s outward appearance or behavior. Recognizing the signs of self-harm, particularly as a parent or teacher, can lead to early intervention and prevent further harm.

Common warning signs of self-harm include: 

1. Unexplained cuts, bruises, or burns particularly in areas that are easy to conceal like arms, wrists, or thighs
2. Wearing concealing clothing, even in warm weather, may suggest that someone is trying to hide the physical evidence of self-harm. 
3. Emotional withdrawal or isolation from friends, family, and social activities. 
4. Frequent expressions of self-criticism or negative self-talk that come from feelings of worthlessness or self-hatred. 
5. Mood swings or intense emotional relapse, such as shifting between deep sadness, irritability, or anger.
6. Preoccupation with or collection of sharp tools or objects (ex. razors not kept in the bathroom).
7. Behavioral changes and risk taking behaviors may indicate an attempt to numb or escape emotional pain, such as substance abuse, picking fights, or risky sexual behaviors.
8. Showing signs of depression or anxiety, such as persistent sadness, irritability, fatigue, or excessive worry

If you recognize any of these warning signs in a loved one, it’s imperative to take them seriously. Enter into a conversation as nonjudgmental as possible, and be aware that they may not open up right away about how they’re feeling. It is also important to not punish the behavior, as this may cause them to distrust opening up to you.

If you suspect your loved one is self-harming, or if you recognize these signs in yourself, know that early intervention and therapy can make a significant difference in managing self-harm and beginning the journey toward healing.

If Self-Harm a Mental Illness?

While self-harm itself is not a mental illness, it is rarely an isolated issue. Often there is an underlying mental health condition that leads to this unhealthy coping skill.

Common mental health conditions that accompany self-harm:

• Anxiety 
• Depression
• Bipolar Disorder
• Personality Disorder
• Substance Use Disorder
• Post-Traumatic Stress Disorder (PTSD)
• Trauma
• Eating Disorders
• Obsessive-Compulsive Disorder (OCD)
• Schizophrenia or Psychosis 
• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Chronic Stress or Burnout

Myths About Self-Harm

There are many misconceptions about self-harm that make it difficult to identify the signs and help those who are struggling.

Some of these myths include:

• Those who self-harm are trying to kill themselves. While self-harm is a warning sign of severe mental distress and a higher risk of suicide, the act itself is used as a coping mechanism. However, they should still be assessed for suicidal thoughts or ideation.
• Those who self-harm are only doing it for attention. If someone is showing their wounds or scars, it is better to think of it as “support-seeking”. More often they will go to great lengths to hide the evidence, such as wearing long sleeves or harming in discreet locations on their body, as they may feel shame about them.
• Only teenage girls self-harm. Adolescent girls are twice as likely to self-harm than boys, but with 17% of adolescents claiming to self-harm at least once, there’s still a significant risk of overlooking boys. Boys are less likely to disclose, or will seek other ways to hurt themselves (such as through fights). They are also more likely to need emergency care.
• Cutting is the only form of self-harm. As expressed above, there are many ways to self-harm and it is important to recognize other types. If you are only looking for wounds, you may miss the way abusing substances, disordered eating, or high risk sexual behaviors can be used to harm oneself.

What Does Therapy for Self-Harm Look Like?

Therapy is one of the most effective ways to address and heal from self-harm. Our therapists understand that the process of recovery is deeply personal and will work with clients to create a treatment plan that addresses their unique needs and concerns. 

Clients will begin to understand their behavior, develop healthier coping tools, and work through their emotional pain that underlies self-harm. The following is an overview of what therapy for self-harm typically involves at Handel Behavioral Health:

1. Building a safe and supportive therapeutic relationship. Clients will find a non-judgmental space where their emotions can be explored openly, allowing them to feel understood and supported. 
2. Identifying the causes and triggers of self-harm. This might include unresolved trauma, chronic stress, anxiety, depression, or feelings of emotional numbness. By understanding what drives the urge to self-harm, clients can begin to make sense of their behavior and address the root causes.
3. Developing healthier coping mechanisms. Therapists work with clients to help them learn new ways to manage intense emotions, which may include techniques such as mindfulness, breathing exercises, creative expression, and physical activity. 
4. Involving support systems: For individuals who feel isolated, having a support system can be a significant difference in maintaining progress from self-injurious behaviors. Therapists may recommend reaching out to family or friends for added support.
5. Cognitive-Behavioral Therapy (CBT). Therapists will help clients identify their negative or distorted thinking patterns that lead to their self-harm. By challenging these harmful thoughts and beliefs, clients can learn to reframe their thinking and develop healthier perspectives.
6. Dialectical-Behavioral Therapy (DBT). Therapists will emphasize emotional regulation, distress tolerance, and mindfulness to teach clients how to access their emotions and to change the behaviors that cause harm. 
7. Trauma-informed therapy. Clients will be able to explore past traumatic experiences in a safe and confidential environment so they may begin to understand how their past experiences may contribute to their current coping mechanisms. As clients process intense emotions, they can work towards healing and self-compassion. 
8. Medication (if necessary): Medication may be prescribed by your psychiatrist or psychiatric nurse practitioner in certain situations, especially if there are co-occurring conditions such as depression, anxiety, or PTSD. 

Start Working With a Therapist for Self-Harm in Massachusetts Today:

At Handel Behavioral Health, our therapists in Massachusetts are trained in the complexities of self-harm and can guide individuals toward understanding, managing, and ultimately overcoming these maladaptive behaviors. 

Our mental health professionals will help individuals recognize and heal the underlying causes of self-harm, including low self-esteem, anxiety, depression, trauma, family dysfunction and conflict. Individuals will then learn healthy coping techniques to manage intense feelings, rather than react to negative emotions with self-harming behaviors. 

If you or your loved one are seeking healthier ways to cope with life’s challenges, our therapists are here for you. 

To find online therapy for self-harm or a therapist for self-harm in-person in Massachusetts from our offices in Amherst, West Springfield, Wilbraham, Natick, or Franklin, contact us today at (413) 343-4357.

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