Self-harm, also known as non-suicidal self-injury (NSSI), is the act of deliberately harming your own body. It is not a suicide attempt, but a response to overwhelming feelings of sadness, anger, stress, or numbness. Engaging in self-harm can bring a brief, misleading sense of calm or release. These feelings are often followed by guilt and the return of the original distress, but there are effective ways to learn healthier methods of coping.
The Purpose Behind Self-Harm
Self-harm is a complex behavior that serves as a coping mechanism when an individual lacks the skills to manage intense emotions. For some, it is a way to release unbearable emotional pressure by transforming an internal, invisible pain into an external, physical one. This physical pain can provide a distraction from distressing thoughts.
In other instances, self-harm can be a way to feel something tangible when experiencing emotional numbness or a sense of unreality. The physical sensation can momentarily ground a person in the present moment, breaking through a fog of dissociation. Some individuals may also use it to punish themselves for perceived faults or to express internal feelings externally.
Immediate Management Techniques
When the urge to self-harm arises, having immediate, practical alternatives is helpful. These techniques are designed to manage the acute distress of the moment. Delaying the urge, even for just 15 minutes, can sometimes be enough for it to fade. Finding a technique that matches the intensity of the emotion can increase its effectiveness.
Distraction techniques engage the mind and redirect focus away from the urge. This could involve watching a movie, solving a puzzle, reading a book, or cleaning a room. Calling a friend to talk about something completely unrelated can also shift your mental state.
Sensory grounding techniques use the five senses to reconnect with the present, which is helpful for feelings of numbness. Holding a piece of ice in your hand, taking a cold shower, or smelling a strong scent like peppermint oil can create a sharp physical sensation. Listening to loud music also serves this purpose.
Finding a safe outlet for intense emotions is another effective strategy. Instead of turning anger or frustration inward, these feelings can be expressed physically without causing harm. Screaming into a pillow, ripping up paper, or engaging in intense exercise like running can help release pent-up emotional energy.
Professional Therapeutic Treatments
While immediate coping skills manage crises, professional therapy addresses the underlying issues that lead to self-harm. Several evidence-based treatments have proven effective and are conducted by a mental health professional to build long-term skills.
Dialectical Behavior Therapy (DBT) is a psychotherapy developed to help individuals who struggle with intense emotions. DBT is built on four core skill modules:
- Mindfulness (staying present and non-judgmental)
- Distress tolerance (getting through crises without making things worse)
- Emotion regulation (understanding and managing feelings)
- Interpersonal effectiveness (navigating relationships and advocating for one’s needs)
By learning these skills, individuals can develop healthier ways to respond to emotional pain.
Cognitive Behavioral Therapy (CBT) helps individuals identify and change the negative thought patterns that contribute to self-harm urges. A therapist works with the person to recognize distorted thinking, challenge those thoughts, and reframe them constructively. Medication for co-occurring conditions like depression or anxiety may be used alongside therapy.
Creating a Personal Safety Plan
A personal safety plan is a proactive, written tool designed to help you navigate moments of crisis. It is a personalized guide that you create, often with a therapist, to have ready before distress escalates. The first step is to identify your personal triggers, such as specific situations, thoughts, or feelings that precede the urge to self-harm.
Next, the plan should include a list of the specific coping strategies and distraction techniques that you find most effective. It is also helpful to list the names and phone numbers of supportive people you can contact, such as trusted friends, family members, or a therapist.
Including contact information for crisis hotlines, like the 988 Suicide and Crisis Lifeline, provides an immediate resource. A final component involves making your environment safer by removing or securing objects that could be used for self-harm. Having this plan accessible provides a clear path to follow when thinking is difficult.
How to Support Someone Who Self-Harms
Discovering that a friend or loved one is self-harming can be distressing, but your support can make a significant difference. The first step is to stay calm and approach the person with care and concern, not anger or panic. Focus on their feelings by asking open, non-judgmental questions like, “I’m worried about you, how are you feeling?”.
Listen without judgment and validate their pain, even if you do not understand the behavior itself. You do not need to have all the answers; often, the person just needs to feel heard and cared for. Offer to help them find professional support, perhaps by assisting them in finding a therapist. Do not issue ultimatums or demand that they stop, as this can increase feelings of shame.
While offering support, it is also necessary to set healthy boundaries to protect your own mental well-being. You cannot be solely responsible for another person’s safety. Encourage them to build a wider support network and know your own limits. If you believe they are in immediate danger of serious harm, reach out to a crisis line or emergency services for guidance.