When Teens Turn to Self-Harm: Signs, Support, and Hope

Why Teens Hurt Themselves—and What Drives It

Studies show that adolescents who engage in nonsuicidal self-injury frequently feel emotions more intensely than their peers and are often self-critical. However, according to expert Michael R. Hollander, PhD, these traits alone do not distinguish who will self-harm.

“Those who self-harm may not have the necessary skills to manage their emotions in conjunction with their high degree of self-criticalness,” he explains.

Given the severity of self-harm behaviors, it might seem that the practice would be easy to detect—but it often isn’t. Most teenagers who engage in self-injury hide their wounds, cutting or burning areas such as their shoulders, ankles, abdomen, or thighs—places usually covered by clothing. This behavior typically occurs in private, often at home and alone, which makes it especially difficult for parents and teachers to detect.

“This is because the majority of teens are not looking for attention when they self-harm,” Hollander says. “Instead, the act of self-injury gives the teenager relief from emotional distress.”

Motivations can vary, but managing overwhelming emotions is the primary driver for most teens who self-harm.

Different Motivations Behind Self-Injury

Other reasons teens may self-harm include:

• Feeling something: Counteracts emotional numbness or emptiness
• Distraction: Shifts focus from overwhelming feelings or problems
• Self-punishment: Expresses self-loathing or a sense of being undeserving
• Communication: As Hollander notes, “Words may be ignored, but self-harm triggers responses.”
• Social influence: Exposure to the behavior of peers or online

In some cases, teens with suicidal thoughts may use self-injury, rather than attempting suicide, to temporarily ease their distress.

While self-injury in itself is not a mental health diagnosis, it is often associated with several conditions, including borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD), among others. However, teens who do not meet the criteria for these or other mental health conditions may still engage in self-harm.

Types of Self-Harm

Self-harm can take different forms, some more visible than others.

The single largest category for nonsuicidal self-injury is cutting. Adolescents cut themselves with razors, knives, shards of glass, or other sharp objects.

The next most common form of self-injury is burning. Other less common self-injury behaviors include skin picking, punching, or even breaking bones.

The wounds are typically superficial, but a small number of adolescents hurt themselves more severely.

Self-Harm Is Different Than Being Suicidal

Another widespread misconception is that self-harm and suicidal behavior are the same.

While these behaviors are related, there are important differences. Suicide attempts involve the intent to end one’s life, whereas self-harm typically serves an emotional function rather than a desire to die.

While there is no single reason why people engage in nonsuicidal self-injury, teens may be more likely to use self-harm to cope with family conflict, academic stress, identity-related distress, or social pressure.

It’s important to note that while most people who self-harm do not intend to die, untreated self-injury can increase the risk of suicide.

Self-injury and suicidal thoughts and behaviors share the same common risk factors, such as high emotional sensitivity, isolation, limited coping skills, and a history of substance misuse.

Research shows that among teenagers who engage in nonsuicidal self-injury, 70% have made at least one suicide attempt, and more than half have made multiple attempts.

Self-injury can be treated, but it’s important that teens who self-harm receive help as soon as possible. Most teens who receive appropriate treatment find healthier ways to manage their emotions.

Seeing the Signs of Self-Harm

Parents and teachers are usually the first people to notice self-harm in young people. Signs to watch for include:

• Wearing long-sleeved clothing in warmer months or being defensive about clothing choices
• Frequently wearing wristbands or bandages, or avoiding activities where skin is exposed
• Unexplained cuts, burns, or bruises
• Bloody tissues or sharp objects found in a teen’s environment

A teen’s routine doctor’s visit can sometimes reveal the issue, as clinicians may notice injuries during a physical exam. Peers might also raise concerns if they observe changes in the teen’s behavior.

While it is important to be aware of the signs of self-harm, closely monitoring a teen’s body for evidence can be counterproductive and intrusive.

A balanced approach—remaining observant while prioritizing open communication—is often more effective.

Helping Teens Who Self-Harm

When helping someone who is in emotional distress, it’s important to distinguish between self-harm and suicidal behaviors. While many teens who self-harm do not intend to end their lives, the two can overlap, and risk can change over time.

If you believe a teen is in imminent danger of taking their own life, seek emergency support immediately. Call or text 988, call 911, or take them to the nearest emergency department. The 988 Suicide and Crisis Lifeline also supports parents and others helping someone through a mental health crisis.

If you are unsure whether someone is struggling with suicidal or self-harm behaviors, ask directly and compassionately: “Are you thinking of taking your own life?” Asking does not introduce the idea—it creates an opportunity for support.

Clinicians should assess for suicidal ideation, intent, plan, and access to means at every encounter—risk level can shift quickly. For parents and educators, asking directly, while difficult, helps create space for honesty and support.

How To Start the Conversation

If it is clear that your child is not in immediate danger but is engaging in self-harm, seek professional guidance before initiating the conversation. A therapist, school counselor, or other trusted professional can help you prepare.

When you are ready to talk, regulate your own emotions and approach the situation with curiosity rather than alarm. Open-ended questions such as, “You seem like you have a lot on your mind—what’s going on?” can help open the conversation.

In clinical settings, using a trauma-informed, open approach encourages honest communication while carefully assessing risk.

Whether at home or in a clinical setting, a calm, nonjudgmental tone builds trust and makes it more likely they’ll share what they’re experiencing.

The Power of Validation in Addressing Self-Harm

Responding to a teen’s experience with validation is an important first step before trying to solve problems. Validation means expressing, in a tentative way, that you understand or are trying to understand their feelings.

Approaching the teen in an affirming, supportive manner helps open a pathway to communication. It’s natural to have strong reactions to self-harm, but reactive statements such as “I can’t believe this!” or “What did you do?!” can increase tension and make the teen shut down or feel overwhelmed.

As you listen, try to stay regulated. Avoid pressing for reasons behind self-harming behavior. Teens may feel put on the spot, defensive, or simply unable to articulate the “why.”

Instead, focus on validating statements like, “I hear how much pain you’ve been in.” This kind of language reduces shame, conveys support, and reinforces that help is available.

Validation is key in therapy for self-harm and can be just as effective at home, fostering honesty and a sense of safety.

Whenever possible, connect the teen with a therapist experienced in treating self-harm.

Why It’s Important To Find Help

Approaching a teen about self-harm can be incredibly challenging. It’s important to consider not only the teen’s well-being but also your own mental health.

Self-harm can sometimes reflect environmental or relational stressors, and supporting a teen through it can feel frustrating, particularly when the behavior continues despite your efforts.

What matters most is communicating that getting help is important, that a therapist experienced in self-harm will be involved, and that you are there to support them throughout the process.

Treatment Targeting Self-Harming Behaviors

Connecting a teen to therapy is the essential first step. Effective treatment addresses underlying stressors, builds emotional coping skills, and involves the family.

The right approach depends on the function of the self-harming behavior, any co-occurring conditions, and the level of family and environmental support available.

Several evidence-based therapies can treat self-harm in teens; familiarity with each can help clinicians, school counselors, and parents make informed referral decisions.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is typically the first-line treatment for teens who self-harm. It combines individual therapy, group skills training, and between-session coaching to help patients manage emotions and develop healthier coping strategies.

DBT for adolescents (DBT-A) adapts the standard model for this age group and includes a meaningful family component. Parents attend skills group alongside their teen or participate in their own individual therapy, creating a shared framework and language.

DBT focuses on four core skills:

• Mindfulness: Staying present without being overwhelmed by thoughts about the past or future
• Distress tolerance: Moving through difficult situations without turning to harmful behaviors
• Emotion regulation: Identifying and managing intense emotions
• Interpersonal effectiveness: Communicating needs while being mindful of others

As teens learn to observe and label their emotions, they can better manage triggers and respond without self-injury. When families learn these skills together, communication often improves and relationships become more supportive, which can be protective.

Mentalization-Based Treatment

Mentalization-based treatment (MBT) helps patients understand their own thoughts and feelings, as well as others’ perspectives. MBT for adolescents (MBT-A) helps teens develop interpersonal skills while reducing self-destructive behaviors.

MBT-A begins by stabilizing emotional expression and limiting impulsive behaviors associated with self-harm. The therapeutic relationship helps teens apply these skills in everyday relationships.

Family sessions focus on improving communication, increasing mutual understanding, and changing unhealthy patterns.

Transference-Focused Psychotherapy

Transference-focused psychotherapy (TFP) focuses on strengthening a patient’s sense of identity.

While MBT-A focuses on understanding thoughts and feelings to improve relationships, TFP focuses on exploring identity and relationship patterns through the therapist-teen relationship itself.

Over time, patients build trust, improve self-reflection, and learn to express emotions more openly, reducing the urge to self-harm.

General Psychiatric Management

General psychiatric management (GPM) is a generalist approach that can be used by a range of health care providers to treat borderline personality disorder and self-harm.

GPM therapists view self-harm as rooted in a patient’s experiences of connection and disconnection from others. They focus on self-care, improving communication, and helping patients build more supportive relationships.

Traditional Psychotherapy

When specialized treatments aren’t accessible, standard talk therapy remains effective. Most approaches draw on cognitive behavior therapy (CBT) and mindfulness strategies to help teens identify and challenge negative beliefs, build coping skills, and strengthen peer and family relationships.

A therapist’s trained, objective stance is especially valuable when family dynamics are contributing to the behavior. They can navigate situations that are understandably harder for parents to manage.

Family Therapy

Self-harm does not occur in isolation, and family dynamics can contribute to or help maintain the behavior. Family involvement can take the form of parent training, multi-family groups, or family sessions. This creates space for parents and siblings to express concerns, build coping and communication skills, and better understand how to support the teen’s recovery.

Parents are also encouraged to seek their own individual therapy to process the stress of the situation and model help-seeking behavior for their child.

You Don’t Have To Navigate This Alone

It can be frightening to learn that a teen is engaging in nonsuicidal self-injury. Knowing that self-harm is a response to real emotional pain, and that it is treatable, can help you respond with clarity rather than fear.

It’s important for parents and professionals alike to tend to their own well-being. Reach out to trusted friends, colleagues, or loved ones, and practice self-compassion. Even when family dynamics or environmental factors play a role, the teen’s behavior is not your fault—and their actions are largely outside anyone else’s control.

Whether you are a parent, teacher, or clinician, maintaining a steady, empathetic approach encourages communication, reduces shame, and strengthens the teen’s connection to care.

For professionals, consultation with colleagues and access to supervision are equally important. This work is demanding, and no one should carry it without support.