“When I first told my mom about hurting myself, I was hoping that she would help me. Instead, she totally flipped out. I didn’t even think about how she would react. I only thought about how tough it was for me to tell her.” (From The Scarred Soul by T. Alderman)

Finding out that someone you care about is intentionally hurting themselves can be a scary, confusing, and shocking experience. It can be hard to understand why a person would seek out physical pain, particularly if you have not noticed any concerning signs otherwise. Although behaviors like cutting, scratching, embedding objects in the skin, burning, and other forms of self-injury are done without suicidal intent, you may be afraid to talk about it for fear of causing or escalating thoughts of death. The majority of self-inflicted wounds are not life threatening and sometimes the behavior is used to prevent suicidal thoughts or actions. People generally self-injure because it helps them cope with upsetting situations or painful feelings.

Self-injurers are aware that their reasons for harming themselves are difficult for others to understand, and often fear angry, shaming, or even indifferent responses. Most people who self-injure actively try to hide it and consider it a shameful secret they do not want discovered. Self-harming behaviors serve a purpose for some people by temporarily alleviating emotional pain and they may not have learned other healthy ways to deal with this distress. It is important to focus on what he or she needs from you and what they are trying to communicate.

What can I do to help?

• Do not ignore the self-injuring behavior. It will not make it go away and may increase feelings of guilt, isolation, and secrecy about the behavior.
• Try to calm down before starting the conversation if you are mad that they have hid this from you. Angry responses may reinforce feelings of shame and shut down the discussion.
• Know that there are no “perfect words” to use. It is okay if you are not sure what to say, but acknowledging the issue and being open to talking about it is important. Ask how you can help.
• Be supportive and honest. You can share your concern about the person and his or her well-being. Let them know you will do your best to listen and be open to what they have to say.
• Ask how they are feeling. Recognize that they may be afraid, embarrassed, angry, or even relieved to discuss it with you.
• Acknowledge the intensity and severity of their distress. They may feel unable to stop the self-injury even if they want to, or may have tried unsuccessfully in the past to control the behavior.
• Do not demand details about how they self-harm or ask to see the wounds. Let him or her control the amount of information that is shared.
• Do not punish, threaten, or give ultimatums about stopping the self-injuring. The behavior will likely continue, but they will go to greater lengths to hide it from you.
• Respect his or her privacy. Broadcasting the issue to everyone in their life will damage your relationship and communication, and increase feelings of shame and alienation.
• Be a good role model by calming yourself when you get upset, putting your feelings into words, and being active in problem-solving.
• Encourage the person to find help through talking to others, connecting with a therapist, or joining a support group. Offer assistance in looking for resources, but remember that you are not responsible for ending the self-injury. Facilitating a referral to a mental health professional is the best way to be helpful.

Friends and loved ones of people who self-injure may experience their own distress, so finding your own support is also very important. Consult with a mental health professional if you are feeling overwhelmed by the person’s behavior. A therapist can be very helpful in determining ways to support the person while also attending to your own needs.