Ask a therapist: Understanding self-harm

This video and article discuss self-harm. If you feel like you or someone you know is at risk of serious harm, call 000. A number of other crisis support services are also there for you – visit our urgent help page.

Self-harm is a complex and deeply personal experience. Whether you’re going through it yourself or supporting someone who is, learning more about why it happens, how to manage it and where to find help can make a big difference.

We asked clinical psychologist Nasalifya Namwinga to answer common questions about self-harm, and to share her expert advice and suggested coping strategies.

Video transcript.

What is self-harm?

Self-harm is when someone intentionally physically hurts themselves but without wanting to end their life. For most young people, it's a way to cope with painful feelings and emotions. 

Some people find it distressing to read about self-harm methods, or find that it can trigger an urge to self-harm. If you think it may be unhelpful to read this section, consider skipping it.

Why do people self-harm?

There is no one reason why people self-harm – it’s different for everyone. As Nasalifya explains, it’s often a way to cope with or to express overwhelming feelings and emotions such as guilt, sadness, anger, shame or self-hatred. 

People might also self-harm as a way to:

• communicate that they need support

• gain a sense of relief (even if it’s only temporary)

• regain a sense of control when life feels really chaotic

• prove to themselves that they are not invisible

• punish themselves for feelings of guilt or shame

• feel something during times of emotional numbness.

A common myth is that self-harm always means someone wants to end their life. While some people who self-harm may also have thoughts of suicide, self-harm isn’t the same as a suicide attempt. But it can still cause serious harm, which is one of the reasons why it’s important to get support.

Is self-harm attention seeking?

Another common myth is that people self-harm just to get attention, but that’s not true. As Nasalifya explains, self-harm is often a deeply personal coping mechanism.

Even if someone hopes that others will notice, self-harm is usually a sign that they are in distress and need support, rather than that they are just seeking attention. They might not know how else to ask for help, or they may feel like their emotions aren’t valid unless someone sees them struggling.

What are the signs of self-harm?

It can be tricky to recognise that someone is self-harming, as people often try to keep it hidden. However, there are physical, emotional and behavioural signs that might suggest someone is struggling.

Physical and emotional signs of self-harm

• Having unexplained (and frequent) cuts, burns, scratches or bruises

• Feeling constantly sick or unwell

• Feeling sad, angry or irritable

• Feeling guilty or ashamed

• Being less energetic

• Putting less effort into hygiene or appearance

• Seeming anxious or depressed

Behavioural signs of self-harm

• Wearing long-sleeved clothing, even in hot weather

• Avoiding activities where their skin might be exposed (e.g. swimming)

• Being less socially active or interested in hobbies

• Creating strange excuses for injuries

• Withdrawing from friends and family

• Taking unnecessary risks

How can I help a friend who might be self-harming?

It’s normal to feel worried about a friend’s wellbeing if you think they might be self-harming, but supporting them can be really tough. Nasalifya suggests four key ways you can help them.

Video transcript.

1. Lead with care, not judgement 

Approach your friend with kindness and let them know you’re there for them. Remember: you can’t force them to stop self-harming – that’s a decision they need to make for themselves. Try starting the conversation gently with something like, ‘Hey, I’ve noticed you seem really down lately and I just want to check in. How are you going?’

2. Encourage them to seek professional help

If they open up, gently encourage them to reach out for professional support. You could say something like, ‘It might be helpful to chat with someone who knows a bit more about this’, or ‘What do you think about checking in with a doctor or a counsellor?’ If you’re comfortable with the idea, you could offer to go with them if they feel nervous about taking that first step. 

3. Take care of yourself, too

Supporting a friend who is self-harming can be emotionally draining, so it’s important to take care of yourself as well. Do things that help to recharge you – like exercising, pursuing hobbies or chatting with friends. This will support your own wellbeing, so you’ll be in a better place to support your friend. 

4. Bring in extra support if needed

There is no shame in seeking extra support. Especially if you’re really worried about your friend or need help yourself. As Nasalifya points out, it’s not about betraying your friend’s trust – it’s about helping to keep them (and you) safe.

What are some strategies for managing self-harm urges?

Nasalifya suggests a few strategies you can try on your own to manage self-harm urges.

Use a distraction box

Fill a box with things that make you feel calm and safe, like a colouring book, stress ball, soothing scents, or photos of people that make you smile. The idea is that this box can distract you by offering an alternative activity when you’re feeling the urge to self-harm. Read this young person’s story of using a distraction box to manage self-harm urges.

Do your go-to activities

What activities bring you joy or a sense of peace? Whether it’s gaming, watching funny films, listening to music or just chatting with friends, your go-to activities can shift your focus when urges come up and keep you occupied until they pass.

Take time to reflect

It can be helpful to think about what might be triggering your urges. Keep a journal to reflect on feelings, situations or people that may trigger your urges. This can help you to avoid them, or at least feel prepared for them when they come up.

Learn more about self-help strategies for self-harm. And remember: while self-help strategies can be useful, seeking professional support can also be a big step towards stopping self-harming behaviours. 

How can I seek further support? 

Changing self-harming behaviours can be hard, but there are many ways to get the support you need. Here’s what Nasalifya suggests.

Chat to someone you trust

Opening up to someone you trust can be a big relief. It could be a friend, family member, teacher, coach or community member. They can listen to you, remind you that you aren’t alone, and help you to find healthier ways to cope.

See a GP or mental health professional

A GP can check your overall health, talk through your options with you and, if needed, refer you to a mental health professional such as a psychologist or counsellor. These professionals can help you to uncover what might be driving your feelings and to explore therapy approaches for managing strong urges and emotions.

Use online and phone services

Not up to talking to someone face-to-face? Try calling a helpline or using an online chat support service. These services are free and confidential, and have trained people on the other end who are ready to support you:

• Lifeline – call 13 11 14, text 0477 13 11 14 or use the Lifeline online chat.

• Kids Helpline – call 1800 55 1800 or use the Kids Helpline online chat.

• 13YARN (for Aboriginal and Torres Strait Islander people) – call 13 92 76 or visit the 13Yarn website.

• ReachOut PeerChat – a free online chat service for people aged 16–25, with trained peer workers.

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Need to talk? Try PeerChat, a safe and secure space to talk to a trained peer worker about what’s going on for you.

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How can I tell someone I’m self-harming?

It can feel scary to open up about it if you’re self-harming. You might worry about being judged or misunderstood. It can help to think about what you want to say to someone and how you will respond to their questions.

They will likely want to know why and how you are self-harming and to discuss ways to support you. Before the conversation, have a think about what kind of help you would like and how they can best support you.

You could kick things off by saying something like, ‘I need to talk about something hard, and I just want you to listen.’ Let them know you're feeling nervous about opening up, but that you’re coming to them for support.

You can also share these self-harm resources for parents and carers, which may help them to understand your feelings. If you're struggling with your mental health, this could be a good time to ask for help with finding professional help.

Remember, like Nasalifya says: ‘Progress is not a straight line. Setbacks do happen, but they're not a sign of failure. Learning new ways to manage self-harm can take time, but even the small steps really matter.’