Megan Polanin and Meg Seymour, PhD & Rebecca Cooper, National Center for Health Research
What is self-injury?
Self-injury, also called self-harm, is when someone harms themselves on purpose. This article focuses on when people injure themselves without trying to commit suicide, which is called “non-suicidal self-injury.” Self-injury usually does not end in death, but people who self-injure are also more likely to commit suicide than others.1 In fact, a history of self-injury is one of the strongest predictors that someone will die by suicide.2 For more information about which factors increase teens’ and young adults’ likelihood of attempting suicide and how to help prevent it, see these articles. If you or someone you know is thinking of suicide, please reach out to someone here for help.
A 2018 study of over 64,000 teens across the United States found that almost 18% had purposely injured themselves in the past year.3 One of the most common methods of self-injury is cutting, through there are other methods as well.4 Self-injury is more common among younger teens and among girls.3 Some teens might self-injure several times and then stop, but cutting can become a frequent pattern for others.
How often is this happening?
Self-injury is more common among teen girls than among boys. In addition, the rates of teen girls self-injuring have been increasing in recent years.
A 2017 study looked at emergency room admissions at 66 American hospitals between 2001 and 2015.5 Across those hospitals, there were over 40,000 first-time admissions due to self-injury (poisoning, burning, cutting with a dull/sharp object). The number of these visits for girls started to increase in 2009. Self-injury cases continued to rise until the end of the study in 2015. The biggest increase was among girls ages 10-14, where the rates of self-injury increased by almost 19% between 2009 and 2015. The rate of self-injury did not increase for boys.5
Why is this happening?
Psychologists believe that the main reason people self-injure is to try to regulate their emotions. People self-injure to manage distressing emotions.6 It helps them calm down when they are distressed, and they can even describe it as enjoyable and comforting.7 Of course, this relief is only temporary, and self-injury is harmful both physically and mentally.
Distressing emotions are increasing among adolescent girls, which might be why self-injuring behaviors are increasing. A 2019 study found that depression is increasing among all teens, but particularly among teen girls. As many as 20% of teenage girls experience depression.8 Consistent feelings of depression increase the likelihood that an adolescent will self-injure,9 so the increase in depression among teen girls may be responsible for the increase in self-injury.
This brings up another question: Why is depression increasing among teen girls? Researchers think that it may be due to greater use of social media and decreased sleep. The two may even be related, since using social media at night leads to poor sleep.8 The number of hours that teens spend online per day is associated with increased likelihood of depression, and the relationship between social media use and depression is stronger among teen girls than boys.10 Teenage girls are also more likely than boys to report that they are online “almost constantly.”11
Cyberbullying is another increasing problem among teens. Girls are over 3 times more likely to be cyberbullied than boys are.12 Online bullying is particularly difficult to face because the victims can’t get away from it, it stays online, and teachers and parents are often unaware that it is happening and thus do not intervene. Research has shown that teens who have been cyberbullied are over twice as likely to self-injure than others.13
For more information about teen social media use and its relationship to mental health, you can read this article.
What Can Parents Do?
Because self-injury behaviors are increasing among youth, concerned parents should take extra precautions. Here are some things to help keep children safe:
Notice signs. Parents often notice emotional changes in a child before they ever notice physical harm. Changes in a child’s relationships, communication, or school performance can be a sign that the child is experiencing emotional difficulties. Concerned parents can look out for small, parallel, linear cuts on a forearm, upper arm, or leg. Unexplained cuts or scratches might also be a concern, especially if they appear regularly. Those who are self-injuring often try to hide the signs by wearing long-sleeve clothing, so parents should be aware of that.
Talk with your child. It can be difficult to figure out where to begin if your child is displaying self-injury behaviors. Be careful when you begin this conversation. Remain calm and focus on the fact that you love your child and are concerned about their well-being. Emphasize that you are trying to understand where your child is coming from and are not judging them.
Connect with your child’s primary care provider or therapist. Your child’s primary care provider may be able to help your family develop an action plan. A mental health professional can help your child to talk through what they are experiencing and develop healthy coping skills. For example, dialectical behavior therapy (DBT) has been shown to help those who self-injure to stop harming themselves.6 DBT is a type of therapy that teaches how to manage difficult and overwhelming emotions without hurting oneself. One of the skills taught in DBT is called mindfulness, because it encourages people to be aware of their feelings without being overwhelmed by them. DBT can help your child express and manage the emotional pain that can cause self-injury behavior.
To find a therapist, you can search Psychology Today, use the U.S. government’s Substance Abuse and Mental Health Services Administration’s (SAMHSA) Behavioral Health Treatment Services Locator, or call SAMHSA’s National Helpline (1-800-622-4357). Remember: If the situation is potentially life-threatening, call 911 or go to a hospital emergency room immediately.
Take household safety seriously. Parents should be aware of the medications, matches, knives, and other sharp objects that are easily accessible in the home. Consider whether some of these objects should be stored in a secure place.
Use available support and resources. There are many free education and support resources available. Here are some resources for you to explore:
- Information for parents: What you need to know about self-injury (Cornell Research Program on Self-injury and Recovery)
- Talk about Mental Health: For Parents and Caregivers (U.S. Department of Health and Human Services)
- Alternatives to Self-injury (Kelty Mental Health Resource Center)
Self-injury is more common among teens than among adults.6 However, do not assume that your teen’s self-injuring behavior or mental health problems will go away on their own over time without help. Research has shown that those who self-injured as teens are more likely to have mental health problems in adulthood.14 If you are concerned that your child might be self-injuring, talk with a professional to get your child the help that they need.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.
- Olfson M, Wall M, Wang S, Crystal S, Gerhard T, Blanco C. Suicide following deliberate self-harm. American Journal of Psychiatry. 2017; 174(8):765-74.
- Ohlis A, Bjureberg J, Lichtenstein P, D’Onofrio BM, Fruzzetti AE, Cederlöf M, Hellner C. Comparison of suicide risk and other outcomes among boys and girls who self-harm. European Child & Adolescent Psychiatry. 2020 Feb 13:1-6.
- Monto MA, McRee N, Deryck FS. Nonsuicidal self-injury among a representative sample of US adolescents, 2015. American Journal of Public Health. 2018; 108(8):1042-8.
- Klemera E, Brooks FM, Chester KL, Magnusson J, Spencer N. Self-harm in adolescence: protective health assets in the family, school and community. International Journal of Public Health. 2017; 62(6):631-8.
- Mercado MC, Holland K, Leemis RW, Stone DM, Wang J. Trends in emergency department visits for nonfatal self-inflicted injuries among youth aged 10 to 24 years in the United States, 2001-2015. JAMA. 2017; 318(19):1931-3.
- Lockwood J, Daley D, Townsend E, Sayal K. Impulsivity and self-harm in adolescence: a systematic review. European Child & Adolescent Psychiatry. 2017; 26(4):387-402.
- Edmondson AJ, Brennan CA, House AO. Non-suicidal reasons for self-harm: A systematic review of self-reported accounts. Journal of Affective Disorders. 2016; 191:109-17.
- Twenge JM, Cooper AB, Joiner TE, Duffy ME, Binau SG. Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005–2017. Journal of Abnormal Psychology. 2019; 128(3):185.
- Zubrick SR, Hafekost J, Johnson SE, Sawyer MG, Patton G, Lawrence D. The continuity and duration of depression and its relationship to non-suicidal self-harm and suicidal ideation and behavior in adolescents 12–17. Journal of Affective Disorders. 2017; 220:49-56.
- Kelly Y, Zilanawala A, Booker C, Sacker A. Social media use and adolescent mental health: Findings from the UK Millennium Cohort Study. EClinicalMedicine. 2018; 6:59-68.
- Pew Research Center. Teens, Social Media & Technology 2018. Pewresearch.org. https://www.pewresearch.org/internet/2018/05/31/teens-social-media-technology-2018/. May 2018.
- Seldin M, Yanez C. Student Reports of Bullying: Results from the 2017 School Crime Supplement to the National Crime Victimization Survey. Web Tables. NCES 2019-054. National Center for Education Statistics. 2019 Jul. https://nces.ed.gov/pubs2019/2019054.pdf
- John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K. Self-harm, suicidal behaviours, and cyberbullying in children and young people: Systematic review. Journal of medical internet research. 2018;20(4):e129.
- Borschmann R, Becker D, Coffey C, Spry E, Moreno-Betancur M, Moran P, Patton GC. 20-year outcomes in adolescents who self-harm: a population-based cohort study. The Lancet Child & Adolescent Health. 2017; 1(3):195-202.