What does it look like when my loved one is engaging in self-harm behaviors?

Adults and teens who self-harm may have symptoms of depression, a mood disorder, or anxiety.  They may have a formal Axis I or Axis II mental health diagnosis or they may be just regular folks who engage in behaviors that cause elevated levels of concern.  The new DSM V for the first time includes self-harm as its own diagnostic category.  Self-harm or self-mutilative behaviors range from skin rubbing to completed death by suicide.  Self-harm behavior is diagnosed according to the physical, apparent effect and/ or the functional, underlying emotional and psychological causes (Nock & Prinstein, 2004).

            Self-harm or self-mutilative behavior is typically cutting, burning, scratching, skin picking, impulsive self-poisoning, hanging, and head banging (Kortge, Meade, & Tennant, 2013).  In their examination of these behaviors, Nock and Prinstein (2004) include the disorder trichotillomania which involves the urge to systematically pull out of body hair.  Often injuries of this nature occur on the front of the body in areas that are easily hidden under clothes.  If you observe your teen or anyone with these types of injuries, please address your suspicions immediately and directly.  Competent help for you and your loved one to find and practice more effective coping strategies is available.  The Mayo Clinic (2012) has provided a list of direct and indirect self-harm symptoms.

Direct, observable symptoms include

Scars from Burns or Cuts

  • Fresh Cuts, Scratches, Bruises,      or Other Wounds
  • Broken Bones
  • Keeping Sharp Objects on Hand
  • Wearing Long Sleeves or Long Pants      in HOT weather
  • Claiming to have Frequent Accidents      or Mishaps

Indirect, often unnoticed behaviors include

  • Spending a great deal of Time Alone
  • Pervasive Difficulties in Interpersonal      Relationships
  • Persistent Questions about Personal      Identity; such as, "Who am I?" and "What am I doing      here?"
  • Behavioral and Emotional Instability
  • Impulsivity and Unpredictability
  • Statements of Helplessness, Hopelessness      or Worthlessness

Serious symptoms requiring immediate intervention include:

  • Burning (with lit      matches, cigarettes or hot sharp objects like knives)
  • Carving Words or Symbols      on the Skin
  • Breaking Bones
  • Hitting or Punching
  • Piercing the Skin with Sharp      Objects
  • Head Banging
  • Biting
  • Pulling out Hair
  • Persistently Picking at      or Interfering with Wound Healing


Kortge, R., Meade, T., & Tennant, A. (2013). Interpersonal and intrapersonal functions of deliberate self-harm (DSH): A psychometric examination of the inventory of statements about self-injury (ISAS) scale. Behaviour Change, 30(1), 24-35.

Mayo Clinic Staff. (2012). Self injury/ cutting: Symptoms. Retrieved from http://www.mayoclinic.com/health/self-injury/DS00775/DSECTION=symptoms

Nock, M. K. & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72(5), 885-890.


Check back for parts III through V! 

III. Why Do Some Adults and Teens Choose to Self-Harm?

            How can I understand self-harm behavior?

IV. What Can I Do when My Loved One Engages in Self-Harm Behavior?

            What professional help is available for those who self-harm and those who love them?

            How can I find an intensive outpatient treatment program for self-harm?

V. Coping with Self-Harm Behavior and Moving On

            How can I find hope and healing?


By Matt Bulkley