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Call or text 988(Suicide & Crisis Lifeline), text HOME to 741741 (Crisis Text Line), or call NH Rapid Response at 833-710-6477 — any hour, free. If there is an emergency, call 911.
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Crisis & safety
Self-Harm & Safety Planning
Self-harm is one of mental health care's most misunderstood topics — often dismissed as attention-seeking or treated only as a suicide risk. This guide offers a clear, compassionate, and clinically grounded look at what self-harm is, why it happens, and how safety planning can make a real difference.
14 min read Reviewed July 2026 Plain-language summary
The short version
- Non-suicidal self-injury (NSSI) and suicidal behavior are distinct — though both require compassionate, professional attention.
- Self-harm most often serves a purpose: regulating overwhelming emotions when other coping tools feel unavailable.
- Asking someone directly about self-harm or suicidal thoughts does not plant the idea — it can be a relief.
- Safety planning is an evidence-based tool, distinct from 'no-harm contracts,' that helps people navigate their own crises.
- Effective treatments exist. DBT, CBT, and other approaches reduce self-harm significantly.
What self-harm is — and what it isn't
Non-suicidal self-injury (NSSI) refers to direct, deliberate harm to one's own body — most commonly cutting, burning, scratching, or hitting — without the intention of ending one's life. The word "non-suicidal" is important: NSSI is clinically distinct from a suicide attempt, though the two can coexist and each warrants serious attention.
NSSI affects roughly 17–35% of adolescents and 12–17% of young adults at some point in their lives. It occurs across all genders, backgrounds, and communities — though it is underreported and often hidden.
Common myths that get in the way
- "It's just for attention." Most people who self-harm go to great lengths to hide it. Even when it is partly communicative, that communication reflects a real need.
- "If they were really suicidal they'd do more." NSSI is not always suicidal, but it is a significant risk factor for later suicidal behavior and should always be assessed carefully.
- "Talking about it makes it worse." Research consistently shows that directly asking about self-harm or suicidal thoughts does not increase risk — and often provides relief.
It's also worth naming what self-harm is not in the clinical sense. Culturally sanctioned body modification (tattoos, piercings, scarification as ritual) and medically indicated procedures fall outside this definition, even if they involve pain.
Why people self-harm
Self-harm rarely occurs randomly or "for no reason." Research consistently identifies several core functions:
Emotion regulation
The most commonly reported reason. When emotional pain becomes unbearable — or when someone feels emotionally numb and disconnected — self-harm can produce rapid, temporary relief. For some, physical pain converts overwhelming internal experience into something concrete and manageable. For others, physical sensation cuts through dissociation and reconnects them to their body.
Self-punishment
Intense shame, self-blame, or feelings of worthlessness can lead people to believe they deserve pain. This is especially common in people with histories of trauma or abuse.
Communication
Some people use self-harm to express internal states that feel impossible to put into words — or to communicate distress to others in an environment where direct communication hasn't felt safe or heard.
Anti-dissociation
Dissociation (feeling detached, unreal, or cut off from one's body) is common in trauma survivors. Self-harm can interrupt dissociative states and restore a sense of presence.
Understanding the function of self-harm — what it is doing for the person — is central to effective treatment. Effective therapies don't just stop the behavior; they help people develop other ways to meet the same underlying needs.
Supporting someone who self-harms
Discovering that someone you care about is self-harming can be frightening, confusing, or even angering. Your response in the early moments matters.
Stay calm and present
Visible panic, disgust, or anger — even when understandable — can make the person feel more ashamed and less likely to seek help. Your calm presence is more useful than perfect words.
Ask directly
If you think someone may be self-harming or having thoughts of suicide, ask directly: "Are you hurting yourself?" or "Are you having thoughts of suicide?" Direct questions don't plant the idea — they open a door that may otherwise stay shut.
Listen without immediately fixing
Validate the pain driving the behavior before problem-solving. "It sounds like things have been really overwhelming" lands better than a list of coping skills before the person feels heard.
Don't bargain or demand promises to stop
"Promise me you won't do it again" puts the relationship under pressure and sets up shame if the behavior recurs. Instead, focus on connecting the person with professional support.
Get professional help involved
Self-harm is a signal that someone needs more support than a friend or family member can provide alone. Gently encourage — and help navigate — access to a therapist, school counselor, or mental health provider.
If you are supporting someone who self-harms, your own wellbeing matters too. This can be an emotionally draining role. Seek support for yourself — from a therapist, a trusted person, or a family support organization like NAMI NH (800-242-6264).
Safety planning
A safety plan is a personalized, written coping strategy that someone develops — ideally with a clinician — to use when they are approaching a crisis. It is distinct from a no-harm contract (a promise not to act), which research has not found effective and can increase shame when the behavior recurs.
The Stanley-Brown Safety Planning Intervention is the most widely validated model. It walks through six steps in order of escalating support:
Step 1 — Warning signs
Identify the thoughts, images, moods, situations, and behaviors that signal a crisis may be building. These become the trigger to consult the plan.
Step 2 — Internal coping strategies
Things you can do alone to distract or self-soothe before the urge peaks: taking a walk, listening to music, practicing breathing, holding ice. Specific is better than generic.
Step 3 — Social contacts and settings that provide distraction
People and places you can reach out to for connection (not necessarily to discuss the crisis): a coffee with a friend, visiting a familiar public space. Social connection activates calming neurobiological systems.
Step 4 — People you can ask for help
Trusted individuals who know about your struggles and can be directly told you're having a hard time — with their contact information listed in the plan.
Step 5 — Professionals and agencies you can contact in crisis
Your therapist, psychiatrist, or a crisis line (988, Crisis Text Line, NH Rapid Response). Written numbers make it easier to reach out when cognition is narrowed by distress.
Step 6 — Making the environment safer
Reducing access to the means of self-harm is one of the most effective risk-reduction strategies available. This might mean storing medications with a trusted person, removing sharp objects from easy access, or other practical steps tailored to how the person has self-harmed.
Safety planning apps
Stanley-Brown Safety Planning App (iOS and Android) is a free, evidence-based digital version of the Safety Planning Intervention — developed by the same researchers who created the clinical model. It stores your plan on your phone and makes it easy to access in a crisis.
Treatment that helps
Self-harm is treatable. Several evidence-based approaches have demonstrated significant reductions in NSSI:
Dialectical Behavior Therapy (DBT)
DBT was specifically developed for people with chronic suicidal behavior and NSSI. Its skills module — distress tolerance, emotion regulation, interpersonal effectiveness, and mindfulness — directly address the functions of self-harm. Standard DBT includes individual therapy, skills training group, phone coaching, and therapist consultation team. It has the strongest evidence base for NSSI reduction.
Cognitive Behavioral Therapy (CBT)
CBT approaches identify and restructure the automatic thoughts and beliefs that precede self-harm, and build alternative behavioral responses to emotional pain.
Mentalization-Based Treatment (MBT)
MBT builds the capacity to understand one's own and others' mental states — particularly useful when disrupted attachment and difficulty reading emotional experience drive self-harm.
Medication
No medication is FDA-approved specifically for NSSI. However, treating underlying depression, anxiety, or PTSD with appropriate medication can reduce the emotional intensity that drives self-harm, and is frequently part of a comprehensive treatment plan.
Recovery from self-harm often is not linear. Urges may persist for some time even as the behavior decreases. Progress in therapy — even slow progress — is real, and most people do significantly reduce or stop self-harming with the right support.
Find help in New Hampshire
Therapists trained in DBT, trauma-informed care, and crisis intervention serve communities across NH. If you or someone you care about is struggling with self-harm, connecting with a clinician is the most important next step.
Therapists and counselors in New HampshireSearch the Meridian directory for NH-based clinicians, CMHCs, and crisis services near you.NH crisis resources — 24/7988, NH Rapid Response (833-710-6477), and regional mobile crisis teams available any hour.References & further reading
- 1.Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6, 339–363. https://doi.org/10.1146/annurev.clinpsy.121208.131258
- 2.Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–263.
- 3.Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
- 4.Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The relationship between nonsuicidal self-injury and attempted suicide. Journal of Abnormal Psychology, 122(1), 198–208.
- 5.SAMHSA (2020). Suicide Safe Mobile App — Safety planning and evidence base. https://store.samhsa.gov/product/suicide-safe-mobile-app/PEP15-SAFEAPP1
- 6.Ougrin, D., Tranah, T., Stahl, D., Moran, P., & Asarnow, J. R. (2015). Therapeutic interventions for suicide attempts and self-harm in adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 54(2), 97–107.
- 7.Zero Suicide Institute. (2024). Safety planning intervention. https://zerosuicide.edc.org/resources/clinical-framework/safety-planning-intervention
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This page is general education, not medical advice or a diagnosis. Mental health conditions are best assessed and treated by a qualified professional. If you or someone else is in immediate danger, call or text 988(Suicide & Crisis Lifeline) or NH Rapid Response at 833-710-6477.