Self-Harm: Recognising Signs, Offering Support, and Finding Professional Help
[TRIGGER WARNING: The following article mentions self-harming behaviours. Reader discretion is advised.]
What is Self-Harm?
Self-harm refers to the act of intentionally hurting oneself. It is an extremely unfortunate response that can emerge when someone is facing overwhelming emotional pain, stress, numbness, or difficulties with their mental wellbeing. For some, self-harm is used to release intense emotions; for others, it temporarily interrupts feelings of emptiness or dissociation. While it may feel like a short-term relief, it is a maladaptive coping strategy that often increases distress over time, undermines self-worth, and can create medical risks.
Importantly, self-harm is not a sign of weakness or attention-seeking. It is a signal that someone is in pain and needs compassionate support. In severe cases, self-harm may occur alongside thoughts of suicide or act as a precursor to suicidal behaviour, which makes early recognition and intervention essential. If you or someone you know is in immediate danger, prioritise safety and seek urgent help.
Why People Self-Harm: Functions and Myths
Understanding the functions of self-harm helps friends, families, and professionals respond with empathy rather than judgment. Common (but not exhaustive) functions include emotional regulation (turning emotional pain into physical sensation that feels more manageable), relief from numbness or dissociation (feeling anything when emotions feel “switched off”), self-punishment (responding to guilt or shame), communication (signalling distress when words feel inaccessible), and grounding (momentarily interrupting racing thoughts or flashbacks). None of these functions mean self-harm is “effective” or safe, only that it can feel compelling in the moment.
Myths persist that self-harm is “just for attention,” “a phase,” or “manipulative.” In reality, many people conceal their injuries and feel intense shame. Labelling the behaviour as attention-seeking closes the door to help; seeing it as a distress signal opens the door to care. Another myth is that talking about self-harm “puts ideas into someone’s head.” Evidence and clinical experience indicate that asking directly and calmly can reduce risk by making space for honest conversation and safety planning.
Methods of Self-Harm
Self-harm can take many forms and may not always be visible. Recognising patterns without providing graphic detail is important to avoid triggering. Some forms include:
- Cutting oneself
- Burning oneself
- Hitting oneself or banging against objects
- Overdosing on medication or toxins
- Starving oneself or binge eating (e.g., anorexia, bulimia nervosa)
- Excessive exercising to the point of injury
- Alcohol and drug abuse as self-destructive coping
Each presentation has unique drivers and risks, but the shared theme is an attempt to cope with unbearable internal states. Regardless of the method, the person deserves care, privacy, and access to appropriate help.
Warning Signs
It is crucial to recognise signs of self-harm. Early, non-judgmental intervention can reduce risk and open pathways to safer coping. Warning Signs may be:
- Physical: Unexplained cuts, bruises, burns; frequent “accidents”; wearing long sleeves or pants even in hot weather; sudden changes in weight.
- Emotional: Depressed mood, irritability, shame, self-loathing, expressions of hopelessness or feeling like a burden.
- Behavioural: Social withdrawal, giving away belongings, increased secrecy, spending long periods alone in bathrooms/bedrooms, hiding sharp objects.
- Cognitive: Rigid, all-or-nothing thinking; frequent self-criticism; intrusive memories or flashbacks; thoughts of self-punishment.
- Digital: Searching for graphic content; engaging with online communities that normalise self-injury; private message drafts describing self-harm.
Risk Factors
Self-harm risk arises from a combination of individual, social, and environmental factors. These may include a history of trauma (including bullying, abuse, or neglect), persistent stressors (family conflict, academic or work pressures), mental health conditions (depression, anxiety, post-traumatic stress, eating disorders), traits such as high self-criticism or perfectionism, and difficulties with emotion regulation. Substance use can increase impulsivity and reduce inhibition. Social isolation and limited access to supportive relationships elevate risk, while compassionate connection and professional care reduce it.
Self-Harm vs. Suicidal Ideation
Self-harm and suicidal ideation can co-occur but are not identical. Some people self-harm without wanting to die; others experience both self-harm and suicidal thoughts. Because risk can shift quickly, it is essential to ask directly and often: “Are you thinking about ending your life?” If the answer is yes—or if you are unsure—prioritise safety and seek urgent help. Even if the answer is no, any pattern of self-injury warrants professional assessment and support.
How to Help Someone Who Self-Harms
Supporting a loved one requires calm, empathy, and patience. The goal is not to control the person’s behaviour but to help them feel safer and less alone while connecting them with effective care.
- Stay calm: Express concern without panic or anger. “I’m glad you told me. I’m here with you.”
- Validate: Acknowledge their pain. “What you’re feeling sounds really hard.” Avoid minimising or debating their emotions.
- Ask directly and kindly: “Have you harmed yourself?” “Are you thinking about harming yourself now?” “Are you thinking about ending your life?” Clear questions save lives.
- Listen more than you speak: Use open-ended questions: “What made today tough?” “What helps even a little?” Avoid “why” questions that can feel accusatory.
- Co-create a Safety Plan: Identify triggers, warning signs, reasons for living, coping strategies, supportive contacts, and steps to make the environment safer (e.g., secure medications, lock sharps).
- Encourage Professional Help: Offer to help find a clinician, book an appointment, or accompany them. Normalise therapy as a skill-building process.
- Respect autonomy and confidentiality: Unless there is imminent risk, collaborate rather than command. If safety is at risk, seek urgent help.
- Follow up: Send a brief message the next day. Consistent care combats isolation.
Note the distinction between empathy and sympathy: empathy means “feeling with” the person; sympathy often creates distance or pity. Empathy fosters connection and safety.
What To Avoid
Well-intended but unhelpful responses can increase shame and secrecy:
- Avoid threats (“If you do this again, I’ll…”) or ultimatums.
- Avoid moralising (“You’re hurting everyone by doing this”).
- Avoid graphic discussions or demanding to see injuries.
- Avoid promises you cannot keep (“I’ll keep this secret no matter what”). Safety sometimes requires involving others.
Safer Alternatives and Skills for Distress
While professional treatment is key, practical skills can help manage urges in the moment. The aim is to reduce intensity, ride out the urge, and reach support:
- Grounding: 5-4-3-2-1 (name five things you see, four you feel, three you hear, two you smell, one you taste) to anchor in the present.
- Breathing: Paced breathing (inhale 4, exhale 6) or box breathing (4-4-4-4) to calm the nervous system.
- Temperature shift: Splash cold water on your face or hold a cool compress to activate a calming reflex.
- Movement: Brisk walk, gentle stretches, or shaking out limbs to discharge adrenaline.
- Sensory strategies: Hold an ice cube; use textured objects; wrap in a blanket; cuddle a pet.
- Expression: Journal, draw, or write unsent letters to give emotions a safe outlet.
- Connection: Text or call a trusted person; use crisis lines or peer support platforms.
- Delay and distract: Set a 10–15 minute timer and try a list of distractions (music, puzzles, shower). Urges often peak and pass.
Create a personalised “coping box” (grounding items, affirmation cards, photos, crisis numbers) for moments of high distress. Over time, these skills reduce reliance on harmful behaviours.
Professional Help and Evidence-Based Treatments
Professional Help is crucial for sustained recovery. Evidence-based therapies teach emotion regulation, reduce shame, and address underlying causes:
- Dialectical Behaviour Therapy (DBT): A comprehensive approach with skills modules in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT emphasises building a life worth living and has strong evidence for reducing self-harm.
- Cognitive Behavioural Therapy (CBT): Targets unhelpful thoughts and avoidance, builds problem-solving skills, and increases behavioural activation to improve mood and coping.
- Mentalisation-Based Therapy (MBT): Improves understanding of one’s own and others’ mental states, helpful when intense emotions and relationship difficulties drive self-harm.
- Trauma-Focused Therapies: For those with trauma histories, therapies such as EMDR or trauma-focused CBT can reduce triggers and re-experiencing that fuel self-harm.
- Family- or Systems-Based Approaches: Particularly helpful for adolescents—improves communication and support within the family.
Medication may be considered for co-occurring conditions (e.g., depression, anxiety, sleep disorders). Medication does not “cure” self-harm but can reduce symptom intensity so therapy skills work better. Any medication plan should be overseen by a qualified prescriber.
Creating a Safety Plan
A practical Safety Plan is a living document tailored to the individual. Include:
- Warning Signs: Thoughts, feelings, or situations that signal risk is rising.
- Internal Coping Strategies: Skills to try alone (breathing, grounding, movement, music).
- People and Places: Safe contacts and locations that provide distraction or comfort.
- Support Network: Friends/family you can call or text, plus clinicians and crisis lines.
- Professional and Crisis Services: Appointment details, clinic numbers, urgent care and crisis hotlines.
- Means Safety: Steps to limit access to common tools used for harm (secure medications, sharps).
- Reasons for Living: Personal values, goals, and commitments that matter during tough moments.
Keep the plan accessible (wallet card, phone notes). Share it with trusted supporters so they know how to help.
Supporting Teens and Young Adults
Parents and caregivers often feel fear or guilt when a young person self-harms. Helpful approaches include staying curious (ask, don’t assume), setting collaborative boundaries (agree on safety steps and check-ins), and modelling regulation (your calm helps their calm). In schools, coordinate with counsellors for support plans, discreet access to breaks, and crisis procedures that protect the student’s dignity.
Workplace and Community Responses
Managers and colleagues can foster safety by promoting mental health literacy, offering flexible adjustments during treatment, and signposting to employee assistance services. Community leaders can reduce stigma through accurate education and compassionate language. Small acts—using non-judgmental words, avoiding sensationalism—make spaces safer for disclosure.
Recovery, Relapse, and Hope
Recovery is rarely linear. Urges may spike during life transitions or stress. Relapse is not failure; it is information. Debrief non-judgmentally: What triggered the urge? Which skill helped even a little? What will I try next time? Track progress by actions (used grounding; reached out; kept appointment), not by perfection. Many people move from daily urges to occasional flickers—and build rich, meaningful lives beyond self-harm.
What To Do If You Have Already Self-Harmed
If you have self-harmed and are safe but distressed, reach out to someone you trust or a helpline. If there are injuries requiring medical attention, seek care as soon as possible. If you feel at risk of harming yourself again or have thoughts of ending your life, prioritise safety and seek urgent help now.
Where Can I Receive Help?
If you self-harm or have a loved one who self-harms and want to receive anonymous support in Singapore, consider the following helplines:
- Samaritans of Singapore: 1800 221 4444 (24-hour hotline) / WhatsApp Text Messenger
- TOUCHline: 1800 377 2252
- Singapore Association for Mental Health: 1800 783 7019
If there is an immediate safety concern, contact local emergency services.
We recommend This Video to those who wants to learn more about Self-Harm Awareness and Support.
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