Self-harm: understanding it and how to help
Self-harm means deliberately hurting or injuring your own body. For most people it is a way of coping with emotions that feel unbearable — distress, anger, shame or numbness — rather than attention-seeking, and not everyone who self-harms wants to die. It still signals serious distress and is linked with a higher risk of suicide, so it deserves care, not punishment. Respond calmly, get any injury treated, and help the person reach a doctor or therapist. CBT-informed therapy and, for young people with intense emotions, DBT-based therapy help.
Health writers · Aslam Clinic
is when someone deliberately hurts or injures their own body. For most people it is a way of coping with feelings that have become unbearable — anger, sadness, shame, loneliness, or a numbness that feels worse than pain. It is not usually attention-seeking, and not everyone who self-harms wants to end their life; some people describe it as the thing that keeps them going through the worst moments.
That does not make it safe or something to ignore. Self-harm is a sign of serious distress, injuries can be dangerous, and people who self-harm are at higher risk of suicide over time. The good news is that people do stop, usually once the feelings underneath are understood and they learn other ways to get through them.
Why people self-harm
The reasons are personal, and the person may not fully know them. Common ones include:
- Getting relief from emotional pain that feels impossible to bear
- Feeling something when they feel numb or disconnected ()
- Feeling in control when everything else feels out of control
- Punishing themselves out of guilt or self-hatred
- Expressing something they cannot put into words
Behind these there is often something specific: bullying, exam pressure, abuse or violence at home, a relationship ending, conflict over marriage, confusion about identity, or a condition such as , anxiety, an eating disorder or . Difficulty managing intense feelings — — is a common thread. Self-harm is most common in teenagers and young adults, but it happens at every age and in every kind of family.
Signs someone may be self-harming
- Unexplained cuts, bruises or burns, often on the wrists, arms, thighs or chest
- Wearing long sleeves or covering up even in hot weather
- Staying in the bathroom or their room for long periods
- Withdrawing from family and friends; low mood, irritability or tearfulness
- Blaming themselves, or saying they are worthless
- Unusual interest in self-harm content online
How to respond as a parent, sibling or friend
Finding out is frightening, and anger or panic are natural first reactions. How you respond in the first conversation shapes whether they come to you again.
| Helpful | Unhelpful |
|---|---|
| Staying calm and making sure any injury is looked after | Shouting, crying at them, or making it about your own shame |
| 'I can see you're going through something awful. I want to understand.' | 'Why would you do this to us? What will people say?' |
| Asking what the self-harm does for them, and what makes it worse | Calling it attention-seeking or drama |
| Letting them know you are there, and pointing out their good qualities | Threats, punishment, confiscating everything, or forcing a promise to stop |
| Helping them see a doctor or counsellor, and going with them | Keeping it secret from everyone, or telling the whole family |
| Asking directly whether they have thoughts of suicide | Assuming it is 'just a phase' |
People often cannot stop overnight, and demanding it can push the behaviour into hiding. The aim at first is honesty and safety: that they can tell you when they have hurt themselves, and that injuries get treated. Take the reasons behind it seriously — if a teenager is being bullied, or a young woman is facing violence at home, that problem needs action too.
In many Pakistani families the first instinct is to hide it — to protect the family's name or a daughter's marriage prospects — or to treat it purely as a spiritual matter. Prayer and a trusted elder's support can help, but secrecy and punishment tend to push self-harm underground. Taking away a phone or stopping a girl's studies as a response usually removes the few supports she had. What protects a young person is at least one adult at home who knows, stays calm, and helps them get proper care.
Looking after an injury
Basic first aid for a minor cut or graze is the same whoever caused it:
- Stop the bleeding with firm, steady pressure using a clean cloth or dressing.
- Once it has stopped, clean the wound gently with clean running water.
- Cover it with a sterile dressing or plaster, and keep it clean and dry.
Some people avoid hospital because they fear being judged. Health staff should treat self-injury with the same care as any other injury; if the person is anxious, go with them. Doctors can also advise later about managing scars.
Coping without self-harm
Some people find it helps to have things to try when the urge comes, to delay it or ride it out. These are not a cure, and they suit some people better than others — they work best as part of treatment and a plan made with a professional.
- Delay: set a timer for 10 or 15 minutes and do something else; urges often peak and fade
- Change your surroundings — go where other people are
- Strong physical sensations that do no harm: holding ice, a cold shower, intense exercise
- Release: shouting into a pillow, tearing paper, writing the feelings down and ripping them up
- Soothing: prayer or dhikr, slow breathing, music, holding something comforting
- Contact someone and say 'I'm having a hard time' — you do not have to explain
Treatment
The first step is usually an assessment by a doctor, or to understand the person's needs, what drives the self-harm, and whether there is an underlying condition. UK guidance advises against using checklists or scores to 'predict' risk — the point is to understand the person, not to label them.
- Talking therapy — UK guidance recommends a structured psychological therapy tailored to self-harm, informed by or problem-solving therapy, usually over 4 to 10 sessions.
- DBT-informed therapy — for young people with intense emotions and frequent self-harm, adapted for adolescents is recommended. It teaches skills for tolerating distress and managing emotions. Full DBT programmes are scarce in Pakistan, but many therapists use DBT skills.
- Treating what lies underneath — depression, anxiety, trauma or an eating disorder, which may include medicine. There is no medicine that specifically treats self-harm itself.
- Family involvement — especially for young people, so that home becomes a place where the problem can be talked about.
Self-harm and suicide
Most self-harm is not a suicide attempt, but the two are linked, and people who have self-harmed are at higher risk of suicide in the future. Always ask directly and calmly: 'Are you thinking about ending your life?' If the answer is yes, or you are unsure, see our guide to suicidal thoughts and get help the same day.
Where to get help
- Emergency: Rescue 1122, or the nearest hospital emergency department — 24 hours
- Rozan Counseling Helpline: 0800-22-444 (toll-free) or 0304-111-1741, helpline@rozan.org — free, confidential support including for self-harm, Monday–Friday, 9:30 am–5:00 pm
- Punjab Women's Helpline: 1043 — for women facing violence or abuse, 24 hours
- Child Protection & Welfare Bureau: 1121 — if a child is at risk
- Your doctor, or the psychiatry department of a district (DHQ) or teaching hospital
Common questions
Still not sure what to do?
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