Signs and Symptoms of Self-Harm

Pacific Grove Hospital is a nationally recognized 68-bed acute psychiatric and chemical dependency treatment center offering inpatient & outpatient services for psychiatric illnesses, addictions & co-occurring disorders.

Understanding Self-Harm

Learn about self-harm

Self-harm, or non-suicidal self-injury (NSSI), is an impulse control disorder that includes the deliberate, direct destruction of a person’s body without suicidal intention. Non-suicidal self-injury is not an attempt at suicide, rather it is an unhealthy way that some people cope with deep emotional pain, frustration, and extreme anger. Soon, the painful emotions that triggered the self-injury return, starting the vicious cycle of deliberate self-harm. Unfortunately, while self-injury may bring a sense of peace and well-being immediately after the act, this is usually followed by intense guilt and shame. As self-injury is generally considered an impulsive act, becoming upset or experiencing any strong emotion can trigger self-injury. While many people self-harm only a few times before stopping, others may find that self-injury serves a unique purpose and it becomes a long-term, repetitive behavior. Even though these behaviors are not intended as a suicidal act, self-injury can lead to serious, even fatal consequences.

Most often, people who engage in self-harm target the arms, legs, and front of the torso as these places are easily reached and hidden under clothing. People who self-injure may use one or more ways to harm themselves. There are a number of ways people engage in self-injury, including:

  • Cutting – making cuts or severe scratches on parts of the body; especially those easily covered by long sleeves or pants
  • Burning with lit matches, cigarettes, lighters, or heated sharp items, such as knives
  • Carving words or symbols into the skin
  • Breaking bones
  • Hitting or punching oneself
  • Biting oneself
  • Pulling out hair
  • Picking at and deliberately interfering with healing wounds
  • Piercing the skin with sharp objects (not as a part of a piercing)

While self-harming behaviors are an unhealthy way of coping with intense emotions, with the proper types of therapy and self-care, those who self-injure are able to recover from this behavior and lead normal, productive, self-injury free lives.


Self-harm statistics

Most individuals who engage in self-injurious behavior keep their habit a secret, which means that the statistics for self-injury are likely skewed. In the United States, each year approximately 2 million cases of self-harm are reported. Most people who cut begin to self-injure during the teen years— 90% of people who engage in this behavior begin during these years. Each year, one in five women and one in seven men engage in some form of self-injury.

Causes and Risk Factors

Causes and risk factors for self-harm

It’s thought that self-harming behaviors are not the result of one single factor, but rather a number of causes and risk factors working together. The most common causes for self-injury may include a combination of the following:

Genetic: Many mental illnesses can trigger cutting urges, such as borderline personality disorder and depression, which are thought to have genetic components. People who are born into families that have a history of mental illness are at a greater risk for developing the disorder themselves.

Physical: Many types of mental illnesses are the result of imbalances in neurotransmitters involved in emotional regulation. People who have imbalances of neurotransmitters in the brain may self-injure in order to experience emotions, or as a result of the mental illness. Additionally, physical injury results in a naturally-occurring cascade of pleasurable chemicals to the body.

Environmental: People who experienced abuse, particularly as a child, are at a greater risk for self-injurious behaviors as these people were unable to express emotions and feelings in a healthy way. Self-injury is later used as a means to covey overwhelming emotions and cope with the trauma.

Risk Factors:

  • Being female
  • Being in teens and early 20s
  • Having friends who also self-injure
  • Unstable personal identity or sexuality
  • Mental health disorders
  • Drug and alcohol abuse and addiction

Signs and Symptoms

Signs and symptoms of self-harm

As self-injury is often done in private, it can be challenging to know when a loved one or friend is engaging in self-harming behaviors. The signs and symptoms of self-injury will vary depending upon the methods a person uses when he or she engages in self-harm. Signs and symptoms of self-injury include:

Behavioral Symptoms:

  • Dressing inappropriately for the weather – long pants and long-sleeved shirts in the summer sun
  • Brushing off injuries as frequent “accidents” or being clumsy
  • Need to spend a lot of time alone
  • Challenges with friendships and romantic relationships
  • Keeping sharp objects or implements of self-injury available
  • Gradual withdrawal from once-enjoyed activities
  • Unpredictable, impulsive behaviors
  • Bloody clothing, towels, or bedding

Physical Symptoms:

  • Scars from burns or cuts
  • Fresh scratches or cuts
  • Bruises
  • Broken bones
  • Patches of missing hair

Cognitive Symptoms:

  • Ongoing questions about personal identity
  • Thoughts of helplessness, hopelessness, or worthlessness

Psychosocial Symptoms:

  • Emotional numbing
  • Emotional instability
  • Mood swings
  • Depression
  • Increased anxiety, especially when unable to self-injure
  • Guilt
  • Shame
  • Disgust


Effects of self-harm

While self-injury is not a suicidal act, the long-term effects of self-harming behaviors range from minor irritants to particularly severe injuries to unintentional death. This is why it is imperative for those who self-injure to seek professional help and learn more adaptive ways of coping with problems. Long-term self-harm effects will depend upon the ways in which a person harms him or herself. The most common long-term effects of self-injury include:

  • Broken bones
  • Social isolation
  • Worsening feelings of shame, disgust, and guilt
  • Poor self-esteem and self-image
  • Permanent scarring
  • Injured tendons, nerves, blood vessels, and muscles
  • Permanent weakness or numbness in certain areas
  • Limb or appendage loss
  • Multi-organ damage
  • Infections
  • Septicemia
  • Suicide or suicidal behaviors
  • Accidental death

Co-Occurring Disorders

Self-harm and co-occurring disorders

Self-harm is sometimes a symptom of a mental health disorder. The most common co-occurring, comorbid mental illnesses a person who self-harms struggles with include the following:

  • Obsessive-compulsive disorder (OCD)
  • Past history of trauma – especially in childhood
  • Post-traumatic stress disorder (PTSD)
  • Borderline personality disorder (BPD)
  • Personality disorders
  • Eating disorders
  • Depression and depressive disorders
  • Anxiety disorders
  • Bipolar disorder
  • Substance abuse
  • Alcoholism
  • Schizophrenia
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Everyone at Pacific Grove Hospital, from my assigned physician to the social workers were absolutely wonderful to work with. Groups were informative and useful- I learned and reinforced a lot of different coping skills.

– Brooke C.
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