Cutting and Self-Harm: Why It Happens, What Causes It, and What to Do
Self-harm is sometimes hidden under long sleeves on the hottest days of summer. Sometimes it's hidden in the corner of a bathroom that only one person knows about. Whether you're the one going through it or someone who has quietly noticed something is wrong, it can be hard to know what to do next.
This article covers:
What is self-harm?
What causes self-harm?
How is self-harm classified?
Do I or does someone I know have a tendency toward self-harm?
What is the key difference between self-harm and suicidal intent?
What should you do when you find out a friend or family member is self-harming?
What to do when you're feeling low and want to hurt yourself
What Is Cutting and Self-Harm?
Self-harm, formally known as Non-Suicidal Self-Injury Disorder (NSSID), refers to the deliberate act of causing physical pain to oneself. It is a way of coping with emotional distress that feels overwhelming or impossible to bear. While cutting is one of the most common forms, the definition also includes burning, scratching, and hitting or banging one's head.
One important fact to note is that self-harm is often highly concealed. Scars and wounds are frequently located on the upper thighs, upper arms, chest, or abdomen. These areas are easy to cover, which is why the behavior often goes unnoticed by others.
Why Do People Cut or Self-Harm?
The reasons behind self-harm vary from person to person, but they often stem from a few common psychological mechanisms.
Redirecting pain. Physical pain is concrete and locatable. Emotional pain, by contrast, is often vague and difficult to put into words. When internal distress builds to an unbearable level, physical pain can provide a tangible release.
Feeling real. For people in a prolonged state of numbness or dissociation, physical pain serves as confirmation that they still exist. Feeling something, even pain, proves they are still real.
Physiological relief. Oxford Health has noted that injury triggers the release of endorphins in the brain, producing a brief sense of calm and numbness. This explains why self-harm can be so difficult to stop. It provides genuine, short-term relief at a physiological level.
Developmental background. For those who grew up in environments without stable caregiving or faced chronic neglect, self-inflicted wounds can be an unspoken test to see if anyone will notice or care. A history of physical or emotional abuse can also lead to an internalized belief that pain is associated with being loved or seen.
Co-occurring mental health conditions. Self-harm is commonly seen in Borderline Personality Disorder and frequently co-occurs with depression, anxiety disorders, PTSD, and anorexia nervosa. Some individuals with ADHD or bipolar disorder may also self-harm during episodes of emotional dysregulation.
How Is Self-Harm Classified?
Clinically, self-harm is understood through several lenses:
- Whether suicidal intent is present
- Whether the behavior provides a brief break from overwhelming emotion
- Whether it functions as a cry for help directed at others
Whether the person is in a dissociative or altered state at the time
Some people self-harm in a relatively conscious state, aware they are using physical pain to manage an emotion. Others harm themselves in a dissociative, disconnected state, remembering only fragments afterward and sometimes unsure how the wound appeared. The latter is more common in people with trauma histories or those under severe, prolonged stress.
These distinctions matter because they shape the type of support that is actually helpful. The first scenario generally calls for an emotion regulation approach. The second requires addressing the underlying trauma simultaneously, as focusing on the behavior alone is usually not enough.
It is also worth noting that self-harm in adolescents deserves particular attention. When it occurs repeatedly, it can become a habitual pattern or take on a compulsive quality, and the severity of the harm may escalate over time.
Do I Have a Tendency Toward Self-Harm?
Have you ever experienced any of the following? Rate yourself or your loved one based on actual experience:
Never / Almost never: 0 points
Yes, but not often: 1 point
Yes, and it happens frequently or affects daily life: 2 points
- Have you repeatedly cut, burned, or scratched your own skin?
- Before self-harming, did you feel an urgent sense of emotional pressure or anger that felt impossible to release any other way?
- After self-harming, did you feel a sense of numbness or temporary calm?
- Do you go out of your way to hide scars because you are afraid of being found out?
- Do you feel that, aside from hurting yourself, you have no other way of dealing with your emotions?
Results
0–3 points: Your situation is relatively stable, but it is still worth paying attention to your emotional state.
4–6 points: There are signs here that deserve to be taken seriously. Consider talking to a professional. You don't need to wait until things get worse.
7 points or above: Professional support is genuinely needed. Please reach out to a school counselor, psychologist, or psychiatrist as soon as possible.
Please note: If you are currently experiencing strong thoughts of death, have made a plan to harm yourself, or have clear suicidal intent, do not rely on this screening tool alone. Seek emergency resources immediately by calling your local emergency line or a crisis hotline. You don't have to go through this alone.
What are the Differences Between Self-Harm and Suicidal Intent?
This is one of the hardest distinctions for outsiders to make. While both involve physical injury, the psychological motivations are fundamentally different.
Suicide is oriented toward ending pain. The person believes that ending their life is the only way out.
Self-harm is oriented toward staying alive. It is a way of surviving. It uses physical pain to suppress emotional collapse so the person can continue to function in a difficult reality.
This does not mean that people who self-harm are not at risk for suicide. Over time, chronic self-harm can evolve into suicidal behavior, and that risk warrants professional assessment. Understanding this distinction early on helps avoid both overreaction and under-response.
What to Do When a Friend or Family Member Is Self-Harming?
The first reaction is usually shock, and it is often followed by anger or blame. That is a very human response. However, from a clinical standpoint, your reaction in that first moment directly affects whether the person feels safe enough to keep talking.
The following principles can help you offer a genuinely supportive response:
Stay calm and neutral. If you show fear or disgust, the person will likely withdraw out of shame. Learning to talk about self-harm without visible distress is a skill support people need to develop.
Lead with specific concern instead of interrogation. Avoid asking "Why would you do this to yourself?" Instead, try an observational approach: “I can see that you're hurt, and I'm worried about you. Do you want to talk?”
Help clean the wound. Assisting with basic medical care is a form of support. It sends a message that their pain is seen and they don't have to carry it alone.
What to do if you find someone in the act of self-harming?
First, assess whether the injury requires immediate medical attention. If the wound is deep or bleeding heavily, medical care is the priority. Once the physical situation is stable, focus on helping the person feel emotionally grounded. Avoid blame or pressing for explanations. When they are calmer, gently help them consider connecting with a mental health professional.
What to do when feeling Low and Wanting to Hurt Yourself?
If you are in a place of intense pain right now, consider this: self-harm may be the only method you currently know for managing that pain, but it only provides temporary relief. It does not resolve the emotional root of what you are going through.
If you are open to it, here are some directions to consider:
Try other ways to ride out the urge. Snapping a rubber band on your wrist when the urge hits is less likely to leave scars. Crying loudly, tearing up paper, or yelling into a pillow can also give emotions a concrete outlet.
Put your feelings into words. Try writing down what you are experiencing or talking to someone you trust.
Seek a psychiatric evaluation. If you have been feeling down, detached, or have lost interest in life for a while, it is time to reach out for support.
One more important note: If you have strong thoughts of death, have planned how to hurt yourself, or have a wound that requires stitches or medical attention, please do not wait. Call emergency services or seek out a psychiatrist right away.
Closing Thoughts
Self-harm scars carry complicated meanings. Some see them as marks of shame, while others view them as evidence of surviving a difficult period. Clinically, the scars themselves are not the most urgent issue. What matters more is whether those underlying emotions are still present and if they have found a different outlet.
Self-harm is not a character flaw, nor is it simply attention-seeking behavior. It reflects how a person used the limited resources available to them to try and keep themselves alive.
Author: Psychologist Zeng Yang Yuan
Further Reading
- Do I Need Counseling? Does Counseling Really Work? Pricing, Free Resources, and Recommended Online Platforms at a Glance
- Generalized Anxiety Disorder: Symptoms, Causes, Types, GAD-7 Test, and Treatment Options
- How to Support Someone with Depression: What to Say, What to Avoid, and How to Help
References
- Steven Levenkron, Cutting: Understanding and Overcoming Self-Mutilation.
- Oxfordshire Adolescent Self Harm Forum. (2016). Self harm guidelines for staff within school and residential settings in Oxfordshire (4th rev.). Oxfordshire Safeguarding Children Board. https://www.oxfordhealth.nhs.uk/wp-content/uploads/2018/03/self-harm-guidelines-for-school-staff.pdf
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