When a teen hurts themselves on purpose: understanding self injury

This page is not medical advice. Only a trained health professional can assess your teen. Do Not Lose Hope is not a clinic or a crisis line.

What is self injury?

Self injury, also called self harm, is when a person hurts their own body on purpose. Common ways are cutting, scratching, burning the skin, hitting or punching themselves or walls, and banging their head. Injuries can be small or very serious.

Self injury is a behavior, not a diagnosis. Some teens who do it also have depression, anxiety or another condition. Some do not. It usually starts in the teen or early adult years.

If you just found out, you may feel shock, fear, anger, guilt or grief all at once. Those feelings make sense. This is not your fault, and it is not your teen's fault. It is a sign that your teen is carrying pain they do not know how to handle. That can change.

Why would my child do this?

Most often, self injury is a way to cope with feelings that are too big. Teens who self injure often say it helps them:

• Get quick relief from overwhelming feelings
• Feel something when they feel numb or empty
• Feel in control when life feels out of control
• Block upsetting memories
• Punish themselves when they feel they deserve it

The relief does not last, and the pain underneath is still there. Injuries can range from minor to very serious.

Some things raise the risk: past abuse or trauma, depression or other mental health conditions, alcohol or drug use, friends who self injure, and low self esteem. In immigrant families, fear for a parent, a family separation, or carrying adult worries can add to the weight. None of this makes it hopeless. It tells a counselor where to start.

What are the signs?

Watch for:

• Cuts, burns, bruises or scars with no clear explanation
• Frequent excuses for injuries ("the cat scratched me")
• Long sleeves or long pants in hot weather
• Keeping razors, blades, lighters or other sharp objects without a reason

Is self injury a suicide attempt?

Usually not. Most teens who self injure are not trying to die. They are trying to cope.

But it is still serious. People who self injure are at higher risk of attempting suicide if they do not get help. So you need to ask.

Ask your teen directly: "Are you thinking about killing yourself?" Asking about suicide does not put the idea in their head. Studies show it does not raise the risk. It opens the door.

Treat it as an emergency and call or text 988 now, or call 911 if a life is in danger, if your teen:

• Says they want to die, or talks about being a burden or having no reason to live
• Has a plan, or has been looking up ways to die
• Has hurt themselves more deeply or more often than before
• Seems hopeless, trapped, or in unbearable pain
• Is drinking or using drugs more
• Is giving things away or saying goodbye

If any sign is new or getting worse, get help as soon as you can. Stay with your teen. For step by step help, see What to do right now if someone is thinking of suicide and Warning signs that someone may be thinking of suicide.

What should I say to my teen?

You do not need perfect words. You need a calm voice and an open door.

1. Pick a private, quiet moment. Not in front of siblings. Not in the middle of a fight.
2. Say what you know, without blame. "I saw the cuts on your arm. I am not angry. I love you and I want to help."
3. Ask, then listen. "Can you tell me what has been going on?" Let silence happen.
4. Ask about suicide directly, as above.
5. Make a next step together. "Tomorrow we are going to call the doctor. You can be there, and you can say as much or as little as you want."
6. Check in again. One talk is rarely enough.

Try not to:

• Yell, punish, scold or lecture.
• Show disgust or say "how could you."

If your teen denies it, gets angry or shuts down, stay calm. Say "I am here when you are ready," and try again later. Do not give up after one try.

Your feelings need a place too. Talk with your spouse, a friend, your pastor or a counselor. You can also call or text 988 for support when the person you are worried about is someone else.

How do I care for a wound?

For a small cut:

1. Wash your hands.
2. Wash the cut gently with mild soap and water.
3. Press firmly with a clean cloth to stop the bleeding.
4. Put on antibiotic ointment and a clean bandage that will not stick.

Call 911 if:

• The bleeding is heavy or will not stop after 10 minutes of firm pressure
• Your teen cannot feel the area, or it does not move right
• They are seriously hurt in another way
• They swallowed pills or poison and are hard to wake or have trouble breathing

Call the doctor right away if:

• The cut is large or deep, more than a quarter inch, on the face, or reaches the bone. It may need stitches.
• It shows infection: warmth, redness, throbbing pain, swelling, a red streak, pus or fever
• Your teen has not had a tetanus shot in the last 10 years

For pills, chemicals or other poisons, call Poison Control at 1-800-222-1222, 24 hours a day, free and confidential. Call 911 if the person is unconscious or has trouble breathing.

Treat the wound calmly and kindly. How you respond in that moment teaches your teen it is safe to come to you next time.

How can I make home safer?

You cannot remove every sharp thing from a home. But you can make the most dangerous things harder to reach, especially in a crisis.

For a fuller version your teen can fill out with a counselor, see Make a safety plan for hard moments.

How is self injury treated?

There is no pill that stops self injury. Medicine can treat what may be underneath it, like depression or anxiety, which can ease the urge. The core of treatment is therapy.

A good therapist helps a teen:

• Understand what triggers the urge
• Learn safer ways to handle big feelings
• Solve problems and build relationships
• Build self worth

One therapy with strong evidence for teens who self injure is dialectical behavior therapy (DBT). In an NIMH funded trial of teens 12 to 18 with repeated self harm, those in DBT were much less likely to self harm in the first six months than those in a comparison therapy. DBT often includes skills groups for teens and parents together. For a teen in serious danger, a doctor may suggest a day program or a hospital stay.

Recovery takes time. A slip is not a failure. Keep going back.

Where can my teen get help?

• Call the doctor first for a body check and a referral. Bring the printable above.
• Use Medi-Cal. Children and teens up to age 18 can get full Medi-Cal in California no matter their immigration status, and mental health care is covered. From January 1, 2027, many move to Medi-Cal Fee for Service, which changes how you find a doctor, not whether your teen is covered; county specialty mental health care continues (DHCS). See Where your child can get mental health help in California.
• Call your county line. For San Mateo County residents, ACCESS at (800) 686-0101; for Santa Clara County residents, (800) 704-0900, press 1. Other California counties are on the DHCS county list. Outside California, ask your teen's doctor or call 988 for local options.
• Ask the school counselor. In California, what a student 12 or older tells a school counselor is generally kept private, but counselors can share when there is a clear and present danger.
• Teens can start on their own. A teen 12 or older who is mature enough can agree to outpatient counseling in California without a parent's consent. The counselor will usually involve parents unless that would be harmful.

Will they ask about immigration status? In California, if a clinic learns your immigration status, the law treats it as private medical information. See Will my therapist share my information with immigration?

If you are the one hurting yourself

If you are a teen reading this for yourself: you are not crazy, and you are not alone. What you feel is real, and so is the way out.

• Tell one person you trust. A parent, aunt, coach, teacher, school counselor or pastor. You can say, "I have been hurting myself and I need help."
• Notice what comes right before the urge. A fight, a message, a memory, being alone at night.
• Have a plan for the urge. Text someone you trust, or go be near other people. A counselor can teach you skills that work for you.
• Reach out tonight if you need to. Teen Line has teens to talk to: call (800) 852-8336 from 6 to 10 p.m. Pacific, or text TEEN to 839863 from 6 to 9 p.m. You can also text HOME or HOLA to 741741 any time.

If you are thinking about dying, call or text 988 now. If you are in danger, call 911.

Questions people ask

Is my child doing this for attention? Many teens hide it, with long sleeves and excuses. Even if your teen wants you to notice, that is a cry for help, and it deserves a loving answer.

Should I take away their phone or lock their door? Experts advise against punishment. Focus on safety and connection, and ask the therapist about house rules that make sense.

Will my child have to go to the hospital? Not usually. Counseling is the core of care. More intensive care, like a day program or a hospital stay, is for serious cases or real danger.

Is this a spiritual problem? Self injury is a sign of deep pain, not of weak faith or a bad heart. Prayer and your church can walk beside care, not take its place. See When to talk to your pastor and when to see a counselor.

Who can help

These are public programs, clinics and free lines. Contact them to confirm hours, languages and openings. Being listed here is not a referral or a promise of service.

• 988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org. Free and confidential, available 24/7/365. 988lifeline.org
• For San Mateo County residents: County Crisis Line (StarVista): (650) 579-0350, 24 hours. You can call about someone else. smchealth.org
• For San Mateo County residents: BHRS ACCESS Call Center, for people with Medi-Cal or no insurance. (800) 686-0101, 24 hours, TTY 711. smchealth.org
• For Santa Clara County residents: youth crisis and call center: (800) 704-0900, then press 1, 24 hours, ages 4 to 20. bhsd.santaclaracounty.gov
• For East Palo Alto and East Menlo Park families: CHC Ravenswood Initiative, bilingual therapy for children and families in East Palo Alto and East Menlo Park, including DBT skills groups. 1765 E Bayshore Rd. 650-702-2487. chconline.org
• For East Palo Alto and nearby: Ravenswood Family Health Center, counseling for children and adults. 1885 Bay Road, East Palo Alto. (650) 330-7400. ravenswoodfhn.org
• Other California counties: your county's mental health line is on the DHCS county list.
• allcove, for young people near San Mateo or Palo Alto: youth centers for ages 12 to 25, free or low cost. San Mateo (650) 226-7030; Palo Alto (650) 798-6330. allcove.org
• Teen Line: up to age 19. (800) 852-8336, 6 to 10 p.m. Pacific; text TEEN to 839863, 6 to 9 p.m. English only. didihirsch.org/teenline
• Crisis Text Line: text HOME or HOLA to 741741, free, 24/7. crisistextline.org
• Poison Control: 1-800-222-1222, 24/7, free. calpoison.org

Your teen's pain is real, and so is their way through it. With your love and the right help, many teens stop hurting themselves and find new ways to cope. We are holding hope for you both.