While parents may suspect signs of self-injury: wearing long sleeves when it’s hot out; frequent reports of accidental injury; being sensitive, moody or getting angry very quickly; many struggle to understand it.

Self-injury typically is not meant as a suicide attempt. Instead, the act of deliberately harming one’s own body is a dangerous way to cope with emotional pain, intense anger or frustration. In most cases the person has a hard time regulating, expressing or understanding emotions. The mix of emotions that trigger self-injury is complex. For instance, there may be feelings of worthlessness, loneliness, panic, anger, guilt, rejection, self-hated or confusion about sexual or gender identity.

Self-injury often starts in the preteen or early teen years when emotions are more volatile and teens face increasing peer pressure, loneliness and conflict with parents or other authority figures. Other risk factors include having friends who self-injure, experiencing a traumatic event, having mental health issues and drug or alcohol use.

Self-injury usually occurs in private and is done in a controlled or ritualistic manner that leaves a mark on the skin, most commonly on the arms, legs and front of torso. Examples include:

• cutting
• scratching
• burning
• carving words or symbols
• self-hitting
• piercing with sharp objects
• inserting objects under the skin.

While self-injury may bring a momentary distraction, sense of control or release of tension, self-injury is usually followed by a flood of other emotions, including guilt, shame and fear. And while life-threatening injuries are usually not intended, self-injury can cause a variety of complications, including:

• worsening feelings of shame, guilt and low self-esteem
• infection
• permanent scars or disfigurement
• severe, possibly fatal injury
• worsening of underlying issues and disorders

Any form of self-injury is a sign of bigger issues that need to be addressed. If you feel your child is self-injuring themselves, be gentle. Let them know that they are not alone and that there is help. Start by consulting your pediatrician or other health care provider. While there is no one-size-fits-all approach to treatment, therapy will help get to the root of some of the emotional pain.

If you’re injuring yourself, or have thoughts of self-injury, reach out for help. Talk to someone you trust — such as a friend, trusted adult, school counselor, nurse or teacher. Or call the 988 Suicide & Crisis Lifeline  at 988 for support or advice at any time of the day or night.

This is the first step to successful treatment. If you suspect a friend is self-injuring, encourage them to seek help or offer to go with them to seek help — or be there while they call the National Suicide Prevention Lifeline.