Understanding Deliberate Self-Harm in Adolescents
In this article:
Adolescence brings significant physical, emotional and social changes. Academic pressure, friendship and family difficulties, relationships and social media can all contribute to distress.
When feelings become overwhelming, some young people turn to self-harm as a way of coping.
Self-harm does not necessarily mean a young person wants to end their life. However, it is associated with increased suicide risk and should always be taken seriously. Parents, teachers and counsellors need to understand that self-harm is usually a sign of emotional distress, not simply attention-seeking or misbehaviour. It is a behaviour that communicates a need for help. An appropriate response involves recognising warning signs, approaching the adolescent without judgement, assessing immediate safety and facilitating timely professional intervention.
1. Understanding self-harm
Deliberate self-harm (DSH) refers to intentional behaviour in which an individual causes physical injury or harm to themselves, with or without an intention to die. It is important to understand the individual's intention and circumstances rather than assuming that all self-harm is suicidal or non-suicidal.
Non-suicidal self-injury (NSSI) refers specifically to intentional self-injury without suicidal intent. Some adolescents use self-injury to manage overwhelming emotions, reduce emotional tension or express distress they find difficult to put into words.
Even a single episode of self-harm warrants attention and appropriate assessment.
Self-harm can take different forms. Although cutting is one of the most widely recognised behaviours, it is by no means the only one.
Direct physical self-injury: Deliberately causing physical injury to one's body, such as cutting, scratching, burning, hitting or punching oneself, banging one's head against a hard surface or biting oneself.
Self-poisoning: Deliberately taking medication or another substance in a quantity that may cause harm. This may occur with or without suicidal intent. Any suspected overdose or intentional poisoning requires urgent medical assessment, regardless of the adolescent's stated intention.
Other harmful behaviours: Some adolescents engage in dangerous or reckless activities, excessive alcohol or substance use, or deliberately place themselves in unsafe situations. These behaviours do not automatically meet the clinical definition of NSSI; their motivation and circumstances need to be considered.
The key distinction between NSSI and suicidal behaviour is the intention to die. However, NSSI does not mean there is no suicide risk. An adolescent who initially self-injures without suicidal intent may later develop suicidal thoughts or behaviour.
Anyone who self-harms should be asked directly about suicidal thoughts, plans, intentions and previous attempts.
Self-harm among young people in Singapore
A local study published in March 2025, titled Prevalence and correlates of nonsuicidal self-injury among youths in Singapore: Findings from the National Youth Mental Health Study, examined 2,600 young people aged 15–35 years.
The study reported that approximately one in four participants had engaged in NSSI at least once. The median age of first self-injury was 14 years.
Although the study included young adults as well as adolescents, the median age of onset highlights the importance of recognising and addressing self-harm early.
Source: Chang et al. (2025), Child and Adolescent Psychiatry and Mental Health; National Youth Mental Health Study, Singapore.
2. Why do teenagers self-harm?
There is rarely one single reason why an adolescent self-harms. It is usually linked to a combination of emotional distress, personal vulnerabilities, environmental pressures and difficulties coping. Understanding the underlying reasons is important, as simply telling a young person to stop does not address the problem.
Emotional distress and difficulty managing feelings: Adolescents may experience overwhelming sadness, anger, anxiety, shame, guilt or loneliness. Some may feel emotionally numb or struggle to express their feelings. Self-injury may temporarily reduce emotional tension or provide a sense of relief or control, but this relief does not last.
Negative self-image and self-punishment: Some young people have very negative views of themselves. They may feel inadequate, believe they have disappointed their parents or blame themselves for family problems. Self-harm may become a way of expressing self-directed anger, guilt or shame.
Relationship, family and academic pressures: Bullying, cyberbullying, rejection, friendship or romantic difficulties, and family conflict can contribute to emotional distress. In Singapore, academic expectations may also be a significant source of pressure. Adolescents who are perfectionistic may fear failure and see mistakes as proof that they are not good enough.
Trauma and psychological difficulties: Experiences such as abuse, neglect, domestic violence, bereavement, family instability or prolonged bullying may increase vulnerability to self-harm. It may also occur alongside difficulties such as depression, anxiety or trauma-related symptoms.
Social media and peer influences: Exposure to online content that normalises self-injury, social comparison, cyberbullying and peer influences may reinforce existing vulnerabilities. However, social media should not automatically be regarded as the cause of self-harm.
3. Red flags: How can parents, teachers and counsellors recognise self-harm?
Some potential signs or accompanying features of self-harm may include the following:
Frequent use of long-sleeved clothing despite hot weather.
Avoidance of swimming, sports or activities requiring exposed skin.
Reluctance to change clothes in front of others.
Unexplained bald patches or evidence of hair-pulling.
Frequent visits to the toilet or bathroom to be alone.
Carrying out unexplained activities in isolation.
Difficulty managing frustration.
Statements suggesting that others would be better off without them.
Exposure to self-harm content online.
Sudden changes in friendship groups.
Withdrawal from previously supportive relationships.
The absence of visible injuries does not exclude self-harm. Some forms of self-injury leave little obvious evidence, and adolescents may be highly skilled at concealing their behaviour. Equally, an adolescent who appears cheerful, sociable and academically successful may still be struggling with significant psychological distress.
4. Talking to a teenager you suspect is self-harming
This can be one of the most challenging situations for parents, teachers and counsellors. Adults may feel anxious, shocked, angry or frightened when they discover that an adolescent may be self-harming. However, approaching the conversation calmly and sensitively can help the adolescent feel safe enough to share what is happening.
A. Choose the right time and environment
Find a quiet, private place where the adolescent feels comfortable. Avoid starting the conversation during an argument, after a disciplinary incident or in front of others. Allow enough time and avoid rushing.
B. Begin with observations rather than accusations
Describe what you have noticed without immediately asking whether the adolescent is self-harming. This helps communicate concern without making them feel interrogated.
Possible opening statements include:
"I have noticed that you have been wearing long sleeves quite often, even when it is hot. I also noticed that you seem a little withdrawn. Is everything okay?"
"You seem to have been having a difficult time lately. Is there anything bothering you?"
"I have noticed that you haven't been spending as much time with your friends."
"I want you to know that you can talk to me about anything, even things that may be difficult to discuss."
C. Ask directly about self-harm
If you remain concerned, ask directly but calmly. Asking about self-harm or suicide does not implant the idea; it gives the adolescent an opportunity to talk about something they may have found difficult to disclose.
For example:
"Sometimes, when young people feel overwhelmed, they may hurt themselves physically to cope with difficult feelings. Have you ever done anything like that?"
"Have you ever deliberately hurt yourself when you were feeling upset, angry or overwhelmed?"
D. If the adolescent admits to self-harm, remain calm
Avoid becoming angry, scolding, threatening punishment or accusing them of seeking attention. Do not demand immediate explanations or make them feel guilty. Instead, acknowledge their courage in sharing something difficult.
Helpful responses include:
"Thank you for trusting me enough to tell me."
"I am sorry that things have been so difficult for you."
"I may not fully understand what you are going through, but I want to understand."
"I am not angry with you. I am concerned about your safety, and I want to help."
E. Understand the function of the self-harm
When the adolescent feels comfortable, gently explore what may have led to the behaviour and what they experience before and afterwards. Do not insist on detailed descriptions of injuries or ask them to demonstrate how they hurt themselves.
Questions may include:
"Can you tell me what was happening when you first started hurting yourself?"
"What do you usually feel before it happens?"
"What do you experience afterwards?"
"Does it help you feel less overwhelmed?"
"Are there particular situations that make the urge stronger?"
"How often has this been happening?"
"Have you told anyone else about it?"
F. Gently explore any suicidal thoughts and immediate safety
Never assume that an adolescent who describes their self-harm as non-suicidal has no suicide risk. Ask clearly and directly about suicidal thoughts and their immediate safety.
Questions may include:
"Have you ever felt that you did not want to be alive?"
"Have you thought about ending your life?"
"Have you thought about how you might do that?"
"Have you made any plans to hurt yourself or end your life?"
"Have you ever tried to end your life before?"
"Do you feel safe at the moment?"
If there is current suicidal intent, a plan, access to means or an inability to remain safe, arrange urgent emergency assessment. Do not leave the adolescent alone while immediate danger is being addressed.
What should adults avoid saying?
Certain responses may unintentionally increase shame, isolation and reluctance to seek help. Instead of criticising or dismissing the adolescent's feelings, try responding with understanding and reassurance.
Avoid: "Why would you do something so stupid?"
Try saying: "Can you help me understand what you were feeling?"
Avoid: "You're just doing this for attention."
Try saying: "I can see you're struggling, and I want to help."
Avoid: "You have nothing to be upset about."
Try saying: "Your feelings matter, even if I don't fully understand them."
Avoid: "Just stop doing it."
Try saying: "Let's work together to find safer ways to cope."
Avoid: "Promise me you will never do it again."
Try saying: "Let's develop a plan for what you can do when the urge returns."
Avoid: "Other people have worse problems."
Try saying: "I am interested in understanding what this feels like for you."
The guiding principle is to respond with curiosity, compassion and concern rather than judgement, criticism or punishment.
5. What should parents, teachers and counsellors do after self-harm is identified?
Recognising self-harm is only the first step. A coordinated response helps ensure that the adolescent receives appropriate support. Parents and teachers should seek professional help and not attempt to manage significant self-harm independently or assume responsibility for providing specialist psychological treatment. The REACH (Response, Early intervention and Assessment in Community mental Health) programme works with schools to support students with emotional and behavioural difficulties.
Recommended approaches include:
Maintain a calm and supportive home environment.
Listen without immediately offering solutions or criticism.
Avoid excessive monitoring that makes the adolescent feel punished or distrusted.
Reduce access to medications, sharp objects and other potentially dangerous items.
Developing a safety plan is vital. This should include:
Warning signs: What thoughts, emotions or situations suggest that distress is increasing?
Internal coping strategies: What safe activities help the adolescent manage difficult emotions?
Supportive contacts: Which trusted adults, friends or family members can they approach?
Professional contacts: Which counsellor, psychologist, psychiatrist or crisis service can they contact?
Environmental safety: How can access to potentially dangerous items and substances be restricted?
Emergency arrangements: What should happen if suicidal thoughts intensify or the adolescent cannot remain safe?
The plan should be practical, accessible and regularly reviewed. It does not replace emergency assessment when there is imminent danger.
6. Where can parents, teachers and adolescents seek help in Singapore?
There are several avenues for support in Singapore, ranging from school-based assistance to specialist psychiatric services and 24-hour crisis support. The appropriate service depends on the adolescent's age, symptoms and immediate safety.
A. Emergency services
If an adolescent has sustained a serious injury, taken an overdose, has current suicidal intent or cannot be kept safe:
Call 995 for an ambulance in a medical emergency or go to the nearest hospital Accident and Emergency Department.
Do not leave the adolescent alone if there is an immediate risk of suicide.
Remove access to potentially dangerous items if this can be done safely.
B. Crisis hotlines and mental health support
Institute of Mental Health (IMH) operates a 24-hour emergency psychiatric service.
General enquiries: 6389 2000
Samaritans of Singapore (SOS) supports people experiencing suicidal thoughts or emotional distress.
National Mindline provides mental health support and access to resources.
Singapore Association for Mental Health (SAMH)
Helpline: 1800 283 7019
C. Services specifically for young people
Child Guidance Clinic (CGC), Institute of Mental Health (IMH)
Provides assessment and support for children and adolescents under 18 experiencing emotional or behavioural difficulties.
There are two clinic locations:
IMH: 10 Buangkok View, Block 3, Basement 1
Health Promotion Board: 3 Second Hospital Avenue, #03-01
Appointment line: 6389 2200
For more services, see the Ministry of Health mental health services directory.
Families do not need to wait until self-harm becomes frequent or severe before seeking help.
7. What can adolescents do when they experience the urge to self-harm?
Although professional treatment is important, adolescents can also learn healthier ways to manage emotional distress. Parents, teachers and counsellors can encourage alternative coping strategies as part of an individualised treatment plan.
Adolescents should be encouraged to identify activities that are safe, accessible and personally meaningful. These strategies should not involve replacing one harmful behaviour with another potentially harmful practice.
Examples of alternative coping strategies include:
Journalling: Helps adolescents identify and express difficult emotions.
Talking to a trusted adult: Helps reduce feelings of isolation.
Physical activity: Helps reduce stress and improve mood.
Mindfulness exercises: Improves awareness of emotions without immediately reacting to them.
Breathing and relaxation techniques: Helps manage anxiety and physiological arousal.
Creative activities: Provides alternative outlets for emotional expression.
Grounding exercises: Helps manage emotional overwhelm and dissociation.
Structured daily routines: Provides predictability and stability.
Perhaps the most important thing adults can communicate to a struggling adolescent is:
“You do not have to hurt yourself to show us how much you are hurting. We may not fully understand what you are going through, but we are here to listen, support you and help you find a safer way forward.”