Every year in March, mental health advocates, providers, and policymakers unite to promote and participate in Adolescent Self-Injury Awareness Month to bring attention to the disturbing phenomenon of self-harm in teens.
This awareness month, supported by non-profit organizations like LifeSIGNS: Self-Injury Support Network, the National Alliance on Mental Illness (NAMI), and the Adolescent Self-Injury Foundation (ASIF), has three primary goals:
- Increase knowledge about adolescent self-injury, a.k.a. self-harm in teens, among the general public.
- Give teens and parents affected by self-harm evidence-based resources to learn about self-harm, understand the risk factors and warning signs of self-harm in teens, and help them find treatment and support for teens who self-harm.
- Ensure teens who engage in self-harm – and the families who want to help them – get this important message:
“We see you. We can help. You are not alone.”
If you’ve never heard of self-harm, we understand. It’s not something people think about unless someone close to them experiences it. To help increase overall awareness and understanding, we’ll define self-harm below, which is also known by a clinical term: non-suicidal self-injury (NSSI). We’ll also share the latest prevalence statistics, explain why teens may engage in self-harm, and share information about treatment and support for teens who self-harm.
What is Self-Harm, or Non-Suicidal Self-Injury (NSSI)?
This brief definition provided by the National Alliance on Mental Illness (NAMI) helps people new to the term and the concept:
Self-harm and/or self-injury means causing damage to/hurting yourself/body on purpose.
This clinical definition, published by the American Psychological Association (APA), goes deeper, offers a deeper, more complex view of NSSI:
“The condition – clinically known as non-suicidal self-injury or NSSI — is characterized by deliberate self-inflicted harm that isn’t intended to be suicidal. People who self-harm … engage in myriad behaviors that are intended to cause themselves pain but not end their lives.”
It’s also important to note here that among clinicians and menta health researchers, self-harm is a category that includes the following behaviors, one of which is non-suicidal self-injury:
- Risky behavior
- Disordered eating
- Misuse of alcohol and drugs
- Non-suicidal self-injury
Mental health professionals often use the phrases self-harm and self-injury to refer to NSSI, and we’ll do the same in this article. The behaviors we refer to include:
- Cutting/carving
- Scratching/scraping
- Burning
- Often with cigarettes or curling irons
- Punching/hitting
- Breaking bones
- Pinching/biting
- Picking at/preventing cuts or wounds to heal
Those are the forms that self-harm/self-injury/NSSI may take. Next, we’ll address a question that most people ask when they learn these initial facts about NSSI.
Why Do Teens Self-Harm?
If this is the first time you’ve read about self-harm or seen a list like the one above, it may be difficult to understand why a teenager might engage in these behaviors. Studies indicate teens self-harm for two primary reasons: intrapersonal and interpersonal.
Intrapersonal reasons, meaning those related to the internal self, include:
Managing Emotions
- Teens may engage in NSSI to avoid, mitigate, or minimize the impact of negative emotional states
- Teens may engage in NSSI to change negative thoughts/emotional states to positive thoughts/emotional states
Interpersonal reasons, meaning those related to others, include:
Communicating Emotional Pain/Need for Help
- Teens may engage in NSSI because they don’t understand their emotions
- Teens may engage in NSSI to signal to parents, friends, or loved ones that they’re in significant psychological distress or experiencing severe emotional pain.
- Some teens may engage in NSSI when they feel they’ve been wronged, in order to punish those they feel wronged them
Let’s be clear about something. Communicating emotional distress through NSSI is not the same as attention-seeking. The difference:
One says: Look at Me!
The other says: Help Me!
With that in mind, let’s take a look at the most recent data on the prevalence of NSSI among adolescents, or the number of teens who engage in self-harm, on average, during any given year.
Self-Harm Among Adolescents: Facts and Figures
In 2024, The Journal of the American Medical Association (JAMA) published a study called “The Global Prevalence of Nonsuicidal Self-Injury Among Adolescents” that reviewed rates of NSSI in 17 countries in North America, Australia, Europe, and Asia. Here’s what they found:
- Total: 17.7% of adolescents reported NSSI
- Males: 13.7% reported NSSI
- Females: 21.4% reported NSSI
The results of that study surprised many mental health professionals and laypeople alike. Previous assumptions around NSSI included the belief that NSSI among adolescents had greater prevalence in the U.S. and Western Europe than other world regions. However, this new study shows prevalence rates worldwide mirroring almost exactly those found in a study released by American Journal of Public Health in 2018. Here’s what that study showed:
- Total: 17% of adolescents reported NSSI
- Males: 11% reported NSSI
- Females: 24% reported NSSI
Based on the most recent population data for adolescents in the U.S., these statistics tell us that on average, in any given year, millions of teens – around 7 million females and 2 million males engage in NSSI – engage in non-suicidal self-injury.
How Do I Know if My Teen Self-Harms?
The numbers above show that NSSI is more common than most people realize. Among parents, this information begs an important question:
What are the signs of self-harm?
We created the list below from reliable, reputable sources here, here, and here. If you suspect your teen engages in self-harming behavior, pay attention t these signs:
- Inappropriate clothes for weather/season, such as wearing long pants or long-sleeved shirts during the summer, or on hot days.
- Unexplained injuries such as burns, bruises, cuts, or scratches
- Spending time with friends who self-harm
- Absence of hair: pulling out hair, removing eyelashes/eyebrows
- Presence of unnecessary sharp objects – e.g. knives or razor blades – among personal possessions
- Withdrawal to bedroom and locking the door after an emotional or distressing event
- Injuries brought to your attention by teachers, coaches, or a physician
- Presence of blood on sharp objects among personal possessions
In addition, a peer-reviewed meta-analysis published in 2024 called “Risk and Protective Factors of Self-harm and Suicidality in Adolescents: An Umbrella Review” identifies a range of factors that increase the likelihood a teen may self-harm, called risk factors. Self-harm risk factors for teens include:
- Presence of clinical behavioral disorders/mental health disorders
- Previous instances of NSSI/self-harm
- Previous suicidality: ideation, planning, or attempts
- Adverse childhood experiences/significant trauma during childhood
- Presence of clinical behavioral disorders/mental health disorders in family
- Previous suicide in family
- Experiencing bullying online or in person
In addition, research we cite above shows people in the following groups are at increased risk of NSSI:
- Female teens
- LGBTQIA+ teens
- Female gender
- Teens with contact with peers who engage in NSSI
- Teens exposed to social media content/online content related to NSSI
Therefore, if your teen identifies as a member of one those groups, has a history of the conditions/circumstances we list, and/or displays any of the warning signs identified by experts on NSSI, we encourage you to arrange a full psychiatric evaluation administered by a licensed, qualified mental health professional.
While NSSI is a scary phenomenon, it’s important for parents to understand that there are specific therapeutic approaches that can help teens who engage in NSSI.
NSSI: What Types of Treatment are Effective?
Mental health experts confirm that professional treatment and support can help teens who self-harm and reduce the likelihood of ongoing or subsequent instances of self-harm. Studies indicate three types of therapy can help teens who self-harm:
Cognitive behavioral therapy (CBT):
- CBT helps teens recognize distorted thinking, and teaches them how those thoughts can impact feelings and behavior. By identifying and resolving these cognitive distortions, teens can reassess the thoughts, feeling, and decisions associated with self-harm, and replace them with productive, life-affirming thoughts and behaviors.
Dialectical behavioral therapy (DBT):
- DBT is a subtype of CBT designed for people who are highly emotionally reactive and have problems managing emotion-based impulses. DBT focuses on building practical skills that are immediately useful and effective. This makes it ideal for teens who engage in NSSI and other self-harming behaviors.
Mentalization-based treatment for adolescents (MBT-A):
- MBT-A can help adolescents better understand their thoughts and feelings – and those of others – during times of high emotional distress. This helps them modulate their reactions to others’ behavior and their own emotions, which can reduce impulsivity associated with self-harm.
Among those three approaches – all of which can significantly reduce self-harming behavior in teens – recent research shows that DBT may help teens the most. Compared to standard treatment for NSSI after an instance of NSSI, teens who engaged in DBT showed:
- Less time in inpatient psychiatric hospitalization
- Less time under constant surveillance for self-harm
- Fewer suicide attempts
- Fewer subsequent instances of self-harm
We encourage parents of teens who show signs of self-harm to understand that mental health treatment is important not only because it can reduce subsequent instances of self-harm, but also because it can identify/begin the healing process for any underlying mental health issues that may contribute to self-harm. The most common mental health disorders related to self-harm include, but are not limited to:
- Depression
- Alcohol/drug misuse
- Anxiety
- Bipolar disorder
- Schizophrenia
- ADHD
- Personality disorder
The association of these disorders with self-harm among teens means that if your teen engages in self-harm, learning the root cause is essential: treating the underlying disorder – if one is present – can increase the likelihood of treatment success.
The earlier a teen who needs mental health treatment gets the help they need, the better the outcome. Therefore, if your teen shows warning signs of self-harm, the best choice is to seek professional support as soon as possible. With an evidence-based treatment plan and skilled therapist, your teen can start their healing journey, and your family can work to restore harmony and balance in the home.
Self-Harm Hotlines
- For Teens seeking support:
- The National Mental Health Help Line (24/7/365): 988
- The Trevor Project (Telephone 24/7/365): 1-866-488-7386
- The Trevor Project (Direct message 7 days/wk, 6am-am ET, 3am-10pm PT): Text START to 678678
- The Trevor Project (online chat): CLICK HERE
How to Find Support: Online Resources for Families
- The American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Their treatment finder is convenient and easy to use.
- The National Institute of Mental Health (NIMH) maintains a page for youth, adolescent, and family mental health
- The National Alliance on Mental Illness maintains excellent resources for families
