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Because self-injury is often kept secret, it may be difficult to spot signs and symptoms. Self-injury symptoms may include:

• Scars, such as from burns or cuts
• Fresh cuts, scratches, bruises or other wounds
• Broken bones
• Keeping sharp objects on hand
• Spending a great deal of time alone
• Relationship troubles
• Wearing long sleeves or long pants, even in hot weather
• Claiming to have frequent accidents or mishaps

Forms of self-injury
One of the most common forms of self-injury is cutting, which involves making cuts or scratches on your body with a sharp object. Forms of self-harm, include:

• Severe scratching
• Cutting
• Burning
• Poisoning
• Carving words or symbols on the skin
• Breaking bones
• Hitting or punching
• Piercing the skin with sharp objects
• Head banging
• Biting
• Pulling out hair
• Interfering with wound healing

People who self-injure may use more than one method of harming themselves. Self-injury is often an impulsive act. You may become upset, or triggered, and develop an urge to hurt yourself.

Many people only self-injure a few times and then stop. However, for others, self-injury can become a repetitive behavior, occurring multiple times, rather than just once or twice. Most frequently, the arms, legs and front of the torso are the targets of self-injury because these areas can be easily reached and easily hidden under clothing. But any area of the body may be used for self-injury.

When to see a doctor
Emergency situations
If you have injured yourself severely or believe your injury may be life-threatening, call 911 or your local emergency services provider. If a loved one has injured himself or herself severely, take him or her to the hospital or call for emergency help. If possible, take away any instruments used for self-injury.

If you're hurting yourself
If you are injuring yourself, even in a minor way, or if you have thoughts of harming yourself, reach out for help. Any form of self-injury is a sign of bigger issues that need to be addressed. Self-injury poses the risk of serious injury, infection or disfigurement, or even death. And self-injury has some addictive qualities, making it hard to overcome on your own.

While you may feel ashamed and embarrassed about your behavior, you can find supportive, caring and nonjudgmental help. Getting appropriate treatment can help you learn healthier ways to cope — ways that won't leave your body permanently scarred. Try to work up the courage to talk to someone you trust, whether it's a friend, loved one, health care provider or a school official. Someone you trust can help you take the first steps to successful treatment.

When a friend or loved one self-injures
If you have a friend or loved one who's self-injuring, you may not know what to do. You may be shocked and scared. Learning more about self-injury can help you understand why it occurs and help you develop a compassionate but firm approach to helping your loved one stop this harmful behavior.

If your loved one is an adult, gently encourage him or her to seek medical treatment. If it's your child, you can start by consulting your pediatrician or family doctor, who can provide an initial evaluation or a referral to a mental health specialist. Don't yell at your child or make threats or accusations — doing so may increase the risk that your child will self-injure.

If you discover that your teenaged friend is self-injuring, let him or her know that you care and let your friend know that he or she has options. Suggest that your friend talk to his or her parents, a teacher, a school counselor or another trusted adult. If your friend doesn't seek help, you may need to let someone know what's going on. Although you might feel that you'd be betraying your friend, self-injury is too big a problem for your friend to deal with alone. Ask your parent, a teacher or your school counselor for help.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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There's no one single or simple cause that leads someone to self-injure. The mix of emotions that triggers self-injury is complex. In general, self-injury is usually the result of an inability to cope in healthy ways with deep psychological pain. For instance, you may have a hard time regulating, expressing or understanding your emotions. Physical injury distracts you from these painful emotions or helps you feel a sense of control over an otherwise uncontrollable situation.

When you feel emotionally empty, self-injury is a way to feel something, anything, even if it's physical pain. It also offers an external way to express internal feelings. You may also turn to self-injury as a way to punish yourself for perceived faults. Sometimes self-injury may be an attempt to seek attention or to manipulate others.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Certain factors may increase the risk of self-injury, including:

• Age. Most people who self-injure are teenagers. Self-injury often starts in the early teen years, when emotions are more volatile and children face increasing peer pressure, loneliness, and conflicts with parents or other authority figures.
• Having friends who self-injure. People who have friends who intentionally harm themselves are more likely to begin self-injuring.
• Life issues. Some people who injure themselves were sexually, physically or emotionally abused as children or adults. They may also have experienced neglect in childhood.
• Mental health issues. Among those at highest risk are people who experience many negative emotions and are highly self-critical. People who self-injure are more likely to be impulsive and to have poor problem-solving skills. In addition, self-injury is commonly associated with certain mental illnesses, including borderline personality disorder, depression, anxiety disorders, substance abuse disorders, post-traumatic stress disorder and eating disorders.
• Alcohol or substance use. People who harm themselves often do so while under the influence of alcohol or illegal drugs.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Self-injury can cause a variety of complications, including:

• Worsening feelings of shame, guilt and low self-esteem.
• Infection, either from your wounds or from sharing implements.
• Life-threatening problems, such as blood loss if major blood vessels or arteries are cut.
• Accidental or deliberate suicide. You may unintentionally injure yourself fatally, especially if you injure yourself while under the influence of alcohol or illegal drugs. You're also at higher risk of deliberately taking your own life.
• Permanent scars or disfigurement.

In addition, people who self-injure are also more likely to get into car accidents.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Your first appointment to start treating your self-injury may be with a school nurse or counselor, your family doctor, or a general practitioner. But because self-injury often requires specialized mental health care, you may be referred to a mental health provider for evaluation and treatment.

What you can do
Being an active participant in your care can help your recovery efforts. One way to do this is by preparing for your first appointment. Think about what your needs and goals for treatment are. Also, write down a list of questions to ask. These may include:

• Why can't I get better on my own?
• How do you treat self-injury?
• Are there medications that might help?
• How often will we meet?
• What should I do if I have an urge to self-injure between therapy sessions?
• How long will treatment take?
• What can I do to help myself?

What to expect from your doctor
Your doctor is likely to ask you a number of questions about your self-injury and emotional state. Your doctor may ask such questions as:

• When did you first begin harming yourself?
• How frequently do you injure yourself?
• What methods do you use to harm yourself?
• What feelings and thoughts do you have before, during and after self-injury?
• What triggers you to harm yourself?
• What makes you feel better or worse?

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Unless you're ready to stop self-injuring and you tell someone about your behavior, it can be difficult for a doctor or therapist to diagnose self-injury. Sometimes self-injury is discovered accidentally. For instance, a doctor doing a routine medical examination may notice signs, such as scars or fresh injuries.

In any case, there's no specific diagnostic test for self-injury. Diagnosis is based on a physical and mental evaluation. During an initial evaluation for self-injury, a health care provider may ask you such questions as:

• When your self-injury began
• How often you cut or injure yourself in other ways
• What types of self-injury you use
• What seems to trigger your self-injury
• What emotional issues you face
• What social networks or relationships you have
• What previous treatment, if any, you've had
• Your feelings about the future
• Whether you have thoughts of suicide

A definitive diagnosis may require evaluation by a mental health provider with experience in treating self-injury. A mental health provider may also evaluate you for other mental illnesses that may accompany self-injury, such as depression or personality disorders.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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There's no one best way to treat self-injury. Treatment is tailored to your specific issues and any related mental health conditions you might have, such as depression. Treating self-injury can take time, hard work and your own desire to recover. Because self-injury can become such a major part of your life and it's often accompanied by serious mental disorders, treatment with a mental health professional experienced in self-injury issues may be necessary.

Treatment options for self-injury include:

Psychotherapy
Also known as talk therapy, counseling or behavior therapy, psychotherapy can help you identify and manage underlying issues that trigger self-injury. Therapy can also help you learn skills to better tolerate stress, regulate your emotions, boost your self-image, better your relationships and improve your problem-solving skills.

Several types of psychotherapy in particular may be helpful, including:

• Cognitive behavioral therapy
• Dialectical behavior therapy
• Psychodynamic psychotherapy

In addition to individual therapy sessions, family therapy or group therapy also may be recommended.

Medications
There are no medications that specifically treat self-injury. However, your doctor may recommend treatment with antidepressants or other psychiatric medications that can help improve depression, anxiety or other mental disorders commonly associated with self-injury. An improvement in these symptoms may help you feel less compelled to hurt yourself.

Psychiatric hospitalization
If you injure yourself severely or repeatedly, your doctor may recommend admission for psychiatric hospitalization. Hospitalization can provide a safe environment and more intensive treatment until you get through a crisis. Day treatment programs also may be an option.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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While you generally shouldn't try to treat self-injury on your own, you can do some things for yourself that will build on your treatment plan. In addition to professional treatment, follow these self-care tips for self-injury:

• Stick to your treatment plan, including attending psychotherapy appointments and taking prescribed medications as directed.
• Fully disclose incidents of self-injury to your doctor.
• Care properly for your wounds when you do injure yourself, such as seeking medical treatment when necessary and following appropriate first-aid guidelines.
• Don't share instruments used for self-injury, which raises the risk of infectious disease.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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If you or a loved one is suicidal or in emotional distress, you can call the National Suicide Prevention Lifeline 24-hour crisis line at 800-273-TALK (800-273-8255).

Coping tips if you self-injure

• Try to find ways to cope other than injuring yourself, such as reaching out to a friend, practicing relaxation techniques, contacting a support group or getting in touch with your doctor.
• Resolve not to underestimate the ability to change your life in positive ways.
• Avoid alcohol and illegal drugs; they affect your ability to make good decisions and can put you at risk of self-injuring.
• Shun Internet sites that support or glamorize self-injury. Instead, seek out sites that are supportive of your recovery efforts.

Coping tips if your loved one self-injures

• Try not to judge or criticize. Criticism may increase the risk of self-harming behavior.
• Let your child know you love him or her no matter what.
• Take care of yourself, too. Take some time to do the things you enjoy doing, and get adequate rest. You may also find it helpful to talk to other people who've gone through the same thing you're going through now. Ask your child's or loved one's doctor or therapist if there are any local support groups for parents or other loved ones of people who self-injure.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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There is no sure way to prevent self-injury. Prevention strategies may need to involve both individuals and communities, including parents, schools, medical professionals and coaches, for instance.

Ways to reduce the risk of self-injury may include:

• Identifying people most at risk and offering help. For instance, those at risk can be taught resilience and healthy coping skills that they can then draw on during periods of distress.
• Expanding social networks. Many people who self-injure feel lonely and disconnected. Forming connections to people who don't self-injure can improve relationship and communication skills.
• Raising awareness. Adults, especially those who work with children, should be educated about the warning signs of self-injury, and what to do when they suspect self-injury.
• Promoting programs encouraging peers to seek help. Peers tend to be loyal to friends even when they know a friend is in crisis. Programs that encourage youths to reach out to adults may chip away at social norms supporting secrecy.
• Offering education about media influence. News media, music and other highly visible outlets that feature self-injury may nudge vulnerable children and young adults to experiment. Teaching children critical thinking skills about the influences around them might reduce the harmful impact.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.