Why does self-harm happen and how can you support someone? Learn what function the behaviour serves, its warning signs and the role loved ones can play.
If you do not feel safe right now, if a serious injury has occurred, or if you are having thoughts of ending your life, please call 112 (emergency services) immediately or go to the nearest emergency department.
Self-harm is a behaviour that often happens in secret and is widely misunderstood. People who self-harm usually feel intense shame and find it hard to tell anyone. Those who discover that someone close to them is hurting themselves may swing between fear, shock, anger and helplessness. The behaviour is often dismissed as "attention-seeking" or "exaggeration", yet beneath it there are usually emotions that are extremely hard to cope with. In this article we explain what self-harm is, why it happens, which signs deserve attention, and what both the person who self-harms and their loved ones can do. Our aim is not to judge but to understand, and to show ways of offering support.
What Is Self-Harm?
Self-harm is when a person deliberately causes physical harm to their own body. In most cases it is a way of trying to cope with intense, overwhelming emotions. In the clinical literature, this kind of behaviour carried out without any intention to die is called "non-suicidal self-injury".
Although it can occur at any age, it most often begins in adolescence and young adulthood. People of every gender, every socioeconomic level and every culture can struggle with it.
Is This the Same as Suicide?
This behaviour usually does not aim to end life; on the contrary, many people say they do it "in order to keep going". That does not mean it is unimportant, however. Self-harm is recognised as a significant risk factor for later suicidal thoughts and attempts. In some people, both can also be present at the same time. For that reason it should always be taken seriously and assessed by a professional. For more detailed information about suicidal thoughts, you can read our article on suicidal thoughts.
Why Does Self-Harm Happen? The Function of the Behaviour
The most important step in understanding this behaviour is to ask what function it serves for the person. Often the behaviour is not the problem itself but an attempt at a "solution" to another problem: one that seems to work in the short term but deepens the pain in the long term.
Regulating Unbearable Emotions
The most commonly reported reason is to reduce intense emotional pain, anger, anxiety or tension. A person may describe emotional pain becoming more "manageable" once it is turned into physical pain. This brief relief is registered in the brain like a reward and makes the behaviour more likely to be repeated.
Breaking Out of Numbness
Some people experience the opposite: being unable to feel anything for a long time, emptiness, or a sense of being a stranger to themselves. In this case, hurting the body can be used to "feel something" and to return to reality.
Punishing Oneself
Thoughts such as "I deserve this" or "I am a bad person" can lead to behaviour aimed at punishing oneself. These thoughts are often fed by deep shame and feelings of worthlessness.
Expressing Pain That Cannot Be Put into Words
For some people, self-harm is the expression of a pain that cannot be put into words. It is usually not about "seeking attention" but about the need to be understood, and that need is profoundly human.
Risk Factors
- Depression, anxiety and difficulties with emotion regulation
- Abuse, neglect or trauma in childhood
- Peer bullying and cyberbullying
- Conflict within the family and a lack of emotional support
- Loneliness and exclusion
- Alcohol and substance use
- Perfectionism and intense self-criticism
Warning Signs of Self-Harm
This behaviour is mostly carried out in secret. However, some signs can offer clues to an attentive eye:
- Wounds, bruises and marks that are unexplained or explained inconsistently
- Wearing long sleeves even in hot weather, trying to hide the body
- Avoiding situations in which the body would be seen, such as swimming, sport or medical examinations
- Spending long periods shut in the bathroom or bedroom
- Hiding sharp objects
- Marked changes in mood, withdrawal, irritability
- Statements such as "I hate myself" or "I am worthless"
- A decline in school or work performance, drifting away from friends
None of these signs is conclusive proof on its own; but when several appear together, it is important to talk to the person calmly and compassionately. That the behaviour goes unnoticed from the outside does not mean the person is fine; many people carry intense pain inside for a long time while appearing highly successful and well adjusted at school or work.
Digital Life and Young People Today
In the digital age, young people often express their emotional difficulties through social media and connect with others who have similar experiences. These connections can sometimes reduce loneliness; but content that normalises, glamorises or turns self-harm into a competition carries serious risks. Comparison on social media, body image pressure and cyberbullying can also add to young people's emotional burden.
In Turkey, the pressure created by high-stakes exams such as LGS and YKS (Turkey's national high-school and university entrance exams), the difficulty of talking about feelings within the family, and the continuing stigma around mental health difficulties can lead many young people to hide their pain. The stress that the rising cost of living places on families can also affect the time and emotional capacity parents have for their children. The losses and displacement that followed the 6 February 2023 earthquakes may also have increased difficult emotions in some children and young people. For more detail on this subject in teenagers, you can read our article on self-harm in teenagers.
Tips for Coping with the Urge to Self-Harm
This section is written for people who are experiencing the urge to hurt themselves. These suggestions are not a substitute for professional support, but they can open up some space for you in difficult moments.
1. Delay the Urge
When the urge comes, say to yourself, "Not now, I will wait fifteen minutes." Urges are like waves; they rise, reach a peak and then subside. Try to lengthen the waiting time gradually. Every delay is a small but important gain against the urge.
2. Name the Feeling
Ask yourself: "What exactly am I feeling right now? Anger, shame, loneliness, emptiness?" Giving the feeling a name can reduce its intensity a little and helps you understand what you need.
3. Calm Your Body Safely
Intense emotions are also experienced in the body. Harmless approaches such as washing your hands and face with cold water, going for a brisk walk, slowing your breathing (breathing in for four seconds and out for six), or punching a pillow can help bring the emotional intensity down.
4. Reach Out
Call someone you trust or go to them. You do not have to explain in detail what you are going through; saying "I'm having a hard moment right now, could you talk with me for a while?" is enough.
5. Make Your Environment Safe
Moving items you could use to hurt yourself out of the place you are in, or giving them to someone you trust, puts some distance in the way at the most intense moment of the urge.
6. Show Yourself Compassion
If you have hurt yourself once again, blaming yourself harshly can strengthen the cycle. Instead, remember: "I was trying to cope with a very difficult feeling. I can learn better ways, and I can get support to do so." If your injury needs medical care, do not hesitate to go to a healthcare facility; for a serious injury, call 112 (emergency services).
Self-harm can be the language of pain; there are always people who can hear that pain and look for other ways forward together with you.
How Can You Support a Loved One Who Is Self-Harming?
Finding out that someone close to you, especially your child, is hurting themselves is deeply shocking. Your reaction at this moment can directly affect their willingness to seek help.
Try to Stay Calm
It is entirely natural to feel fear, anger or shock. However, shouting, punishing or panicking can cause the person to hide even more. If necessary, take a breath and leave the conversation for a moment when you are calmer; but do not ignore the subject.
Listen Without Judging
The question "Why did you do something like this?" can sound accusing. Instead, use sentences that open a door, such as "You must be going through some really hard things; would you like to tell me about them?" Show that you take the person's pain seriously, without approving of the behaviour.
Avoid Asking for Promises
Saying "Promise me you won't do it again" can cause the person to hide it next time. Instead, tell them that you will look for support together.
Guide Them Towards Professional Support
Help the person reach a specialist. With children and teenagers, involving the family in the process is very important. Adolescent counselling focuses on supporting both the young person and the family through this process.
Find Support for Yourself Too
While supporting a loved one, you may become tired, anxious or feel guilty. Getting support for your own feelings helps you stand more firmly beside them.
When Should You Seek Professional Support?
Self-harm always calls for professional support. That the behaviour looks "mild" should never be a reason to postpone getting help.
Call 112 (emergency services) immediately or go to the nearest emergency department:
- If a serious injury has occurred,
- If the person talks about thoughts or a plan of ending their life,
- If you think the person is not safe right now.
See a specialist as soon as possible:
- If the behaviour has been seen even once,
- If the urges are becoming more frequent or more intense,
- If the behaviour is accompanied by depression, intense anxiety, eating difficulties or substance use.
An assessment by a psychiatrist can also play an important part in this process. For adults, individual therapy offers a safe space to build emotion regulation skills and address underlying difficulties.
How Is This Behaviour Addressed in Therapy?
In therapy, the first priority is always the person's safety. The behaviour is talked about openly and compassionately, without judgement.
A Safety Plan
The therapist and client together prepare a personal safety plan covering what to do when urges become intense. The plan includes warning signs, ways of coping, people who can be reached, and 112 (emergency services) in an emergency.
Understanding the Function of the Behaviour
The situations in which the self-harm occurs, the emotions it is linked to and what it gives the person are explored together. This analysis is the basis for identifying healthier ways to replace the behaviour.
Emotion Regulation Skills
Cognitive Behavioural Therapy (CBT) and other approaches that focus on emotion regulation help develop skills for coping with intense emotions, tolerating distress and expressing one's needs in relationships. Dialectical behaviour therapy is also one of the frequently used approaches developed in this field.
Underlying Difficulties and Schemas
Deep-rooted beliefs such as "I am worthless", "I am a bad person" or "My feelings are dangerous" can be worked on from a schema-focused perspective. If there is trauma, loss or difficulty within the family, these also become a focus of therapy. When working with children and teenagers, collaborating with the family is an important part of the process.
Frequently Asked Questions
Do people who self-harm want attention?
No. The behaviour is mostly carried out in secret, and the person puts great effort into hiding it. It is usually an attempt to cope with emotions that are hard to bear. When the person does let it be noticed, it is often an expression of a need to be understood and helped.
Does this behaviour pass with time?
Yes, with appropriate support many people are able to stop this behaviour and learn to cope with their feelings in healthier ways. The process can take time and setbacks may occur from time to time; this is not failure but part of recovery.
I have seen marks on my child's arms. What should I do?
First, try to stay calm and talk to your child without judgement. Show that you are trying to understand the difficulties they are going through rather than punishing them. Seek support from a child and adolescent specialist as soon as possible; if there is a serious injury or any thought of ending their life, call 112 (emergency services) immediately.
Is this behaviour a mental disorder?
Self-harm is not a diagnosis in itself but a behaviour. It can occur alongside different conditions such as depression, anxiety, post-traumatic stress or difficulties with emotion regulation. For this reason, a comprehensive assessment by a specialist is important.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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