Self-harm, also known as non-suicidal self-injury (NSSI), is the act of harming oneself on purpose. This can include cutting, burning, or hitting oneself. Self-harm is often used as a way to cope with difficult emotions or experiences. It is believed that the act of self-harm releases pent-up emotions in the short term; however, these feelings tend to get worse in the long term. People who self-harm may have a history of trauma, such as physical, sexual, or verbal abuse. Self-harming behaviors can also be indicative of mental health issues, such as anxiety, depression, or borderline personality disorder.
A study of more than 60,000 U.S. high school students published in the American Journal of Public Health found that self-harm rates ranged from about 6% to 15% among boys and 18% to 31% among girls, depending on the state. While self-harm is common among teens, adults can self-harm too.
If you are thinking about suicide, have seriously injured yourself, or are concerned that you may not be able to keep yourself safe, seek immediate help.
Call or text 988 to reach the 988 Suicide & Crisis Lifeline. Trained crisis counselors are available 24 hours a day, seven days a week.
If you have a serious injury or are in immediate danger, call 911 or go to the nearest emergency department.
If you are self-harming but are not in immediate danger, you deserve support. A mental health professional can help assess what is happening, evaluate your safety, and recommend treatment options.
This is often one of the hardest things for parents and loved ones to understand.
From the outside, intentionally causing pain seems like it should make distress worse. But for many people who engage in self-harm, the behavior develops as a way to cope with emotions that feel too intense, confusing, or difficult to manage. This is sometimes described as difficulty with emotion regulation. Emotion regulation is the ability to recognize what you are feeling, tolerate strong emotions, and respond to them in ways that help rather than create additional problems.
People engage in self-harm for different reasons, but many of those reasons involve difficulty managing or responding to overwhelming emotions. Someone may use self-harm to:
Emotional dysregulation treatment focuses on helping someone recognize what they are feeling, understand what tends to make emotions more difficult to manage, and develop safer ways to respond when distress becomes intense. Rather than simply taking away self-harm as a coping strategy, treatment helps build other ways to manage the experiences that were driving the behavior.
Dialectical Behavior Therapy (DBT) is particularly helpful for self-harm because it does more than ask someone to stop the behavior. It teaches specific skills for getting through the moments when the urge to engage in self-injury is strongest.
DBT skills are organized into four main areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Together, these skills help people become more aware of what they are experiencing, manage difficult moments, respond more effectively to emotions, and navigate relationships in healthy ways.
Distress tolerance skills help someone manage an immediate emotional crisis without making the situation worse. When distress feels unbearable and self-harm has become a fast way to change how someone feels, these skills provide other ways to safely make it through the most difficult moments.
Emotion regulation skills focus on a broader goal: helping someone better understand their emotions, recognize what makes them more vulnerable to becoming overwhelmed, and respond to strong emotions more effectively. With practice, the goal is not simply to resist an urge each time it occurs, but to reduce how often emotions escalate to the point where self-harm feels necessary.
DBT also teaches mindfulness and interpersonal effectiveness skills, which can help someone notice emotions and urges earlier, communicate what they need, and navigate relationship stress more effectively.
Over time, treatment can help build a larger set of responses to distress so that self-harm is no longer the primary coping strategy available.
For someone seeking self-harm therapy in Arizona or in Texas, the appropriate level of care may range from individual therapy to more intensive treatment such as an Intensive Outpatient Program (IOP) or Partial Hospitalization Program (PHP).
Self-harm can happen at different degrees of frequency and severity, so there is no single level of treatment that is right for everyone. A professional assessment can help determine how much support someone needs based on factors like how often self-harm behavior is occurring, the intensity of urges, other mental health symptoms, how well the person is functioning in daily life, and their current safety.
Individual therapy may be appropriate when someone infrequently engages in self-injury and can remain safe between appointments. Treatment can focus on understanding what leads to self-harm, building skills for managing emotions and distress, addressing other concerns such as depression or anxiety, and developing alternatives to self-harm.
Intensive Outpatient Programs (IOP) provide more frequent treatment when weekly therapy is not enough. IOP may be appropriate when self-harm is more frequent, symptoms are significantly interfering with everyday life, or someone needs more opportunities to learn and practice coping skills. Because participants attend treatment multiple times each week, they can practice new skills, return to discuss what worked or did not work, and continue building on them with support.
Partial Hospitalization Programs (PHP) provide a higher level of structure and support while still allowing someone to return home each evening. PHP may be appropriate when symptoms or self-harm are more severe and the person needs more support than outpatient therapy or IOP can provide but does not require inpatient hospitalization. This type of care can help people learn coping skills because of the increased opportunities to practice them as part of a supportive group. At Transitions, PHP is currently offered for teens at select locations through our Teen Partial Hospitalization Program, and teens who need less structure can attend our Teen Intensive Outpatient Program.
The appropriate level of care can also change over time. Someone may need more intensive treatment during a particularly difficult period and transition to less frequent care as symptoms improve and they are better able to manage self-harm urges safely.
Self-harm can occur at any age, but treatment may look somewhat different for teens and adults. For teens, self-harm can emerge during a developmental period that includes stronger emotions, increasing independence, changing relationships, academic pressures, and new social challenges.
For teens seeking self-harm help, treatment can help them build skills for managing emotions, tolerating distress, communicating their needs, solving problems, and navigating relationships more effectively.
Parents or caregivers can also play an important role in treatment for teens. They may help support safety, reinforce new skills at home, and learn how to respond effectively when their teen is struggling. At the same time, teens need opportunities to develop greater independence in managing difficult emotions and situations.
For adults, treatment generally places greater emphasis on helping the individual recognize their own patterns and develop strategies they can use independently in daily life. Therapy may also address depression, anxiety, trauma, relationship difficulties, or other concerns contributing to self-harm.
At any age, treatment should be individualized to understand what is driving self-harm and what support will help them respond differently.
In many cases, self-harming behaviors are done in private and kept secret, so it can be hard to detect. Frequent injuries such as cuts, scratches, bruises, bald spots, bite marks, and burns can indicate potential self-harm. In some cases, someone who self-harms may also seem prone to accidents or may engage in extremely risky and dangerous behaviors. They may also make comments about feeling worthless or try to hide marks made by self-harming behaviors. If you are self-harming or suspect that a loved one is self-harming, schedule an appointment with our team at Transitions Counseling in Glendale, North Phoenix, South Mountain, or Chandler. Our team is also available for telehealth appointments.
At Transitions Counseling, Dr. Krauss and our team diagnose self-harm by identifying the underlying cause through a comprehensive professional assessment. During this evaluation, you will be asked about your symptoms, medical history, and other factors that could affect your mental health.
Treatment for self-harm focuses on understanding what is driving the behavior and helping someone develop safer, more effective ways to respond to distress. At Transitions Counseling and Consulting, Dialectical Behavior Therapy (DBT) skills are an important part of treatment for many people who struggle with self-harm.
DBT teaches practical skills in four areas: distress tolerance, emotion regulation, mindfulness, and interpersonal effectiveness. These skills can help someone get through intense moments without self-harming, better understand and manage strong emotions, notice urges before acting on them, and communicate more effectively when they need support.
Treatment may also incorporate Cognitive Behavioral Therapy (CBT) strategies to address patterns of thinking and behavior that contribute to distress. Depending on the person’s age and needs, treatment may include individual counseling, family involvement, psychiatric care, or a more intensive level of support, such as an Intensive Outpatient Program (IOP) or Partial Hospitalization Program (PHP).
The goal is not simply to stop self-harm. Treatment helps someone understand the patterns that lead to self-harm and build skills they can use to manage difficult emotions and situations differently over time.
Non-suicidal self-injury therapy should be matched to the reasons someone is self-harming and the other symptoms or difficulties they are experiencing.
Dialectical Behavior Therapy (DBT) is one of the most commonly used evidence-based treatments for people who engage in self-harm, particularly when self-harm occurs alongside intense emotions, difficulty tolerating distress, or suicidal thoughts or behaviors. DBT teaches practical skills for managing emotions, getting through periods of intense distress, recognizing urges without immediately acting on them, and communicating needs more effectively.
Other approaches, including Cognitive Behavioral Therapy (CBT), may also be helpful. The most appropriate treatment depends on the person’s age, what is contributing to the self-harm, other mental health symptoms, current safety, and how much support they need.
An Intensive Outpatient Program (IOP) may be appropriate when self-harm is recurring, symptoms are significantly affecting everyday functioning, or weekly outpatient therapy and medication are not providing enough support or improvement. IOP provides several hours of treatment multiple days each week, giving participants more frequent opportunities to learn, practice, and troubleshoot skills for managing distress, regulating emotions, and responding differently to self-harm urges.
If you are self-harming or suspect that a loved one is self-harming, Dr. Krauss and our team at Transitions Counseling would love to help you get back on your feet with an integrative treatment program that addresses the whole person. Give us a call for more information!