Self-harm in teens: how to recognize it and how parents should respond

Self-harm in teens: what is it, and why isn't it "attention-seeking"?

Self-harm in teens means a young person deliberately hurting their own body, most often as a way of coping with feelings stronger than they can bear: sadness, anger, fear or pressure that builds up until there seems to be no way out. It is not "just a phase" that will pass; the UK's Royal College of Psychiatrists stresses that self-harm is always a sign that something is wrong and must be taken seriously. Nor is it fair to dismiss it as "attention-seeking": as the UK's National Health Service (NHS) points out, any amount of self-harm, however small it looks, may mean someone is feeling extremely distressed. The reassuring news is that treatment helps, and your calm is the first step.

It is not rare. In its 2025 information for parents, the Royal College of Psychiatrists says research suggests that between 1 in 10 and 1 in 4 young people have self-harmed, although estimates vary between studies. Cleveland Clinic notes that it most often starts between the ages of 12 and 14, and that many people who self-harm keep doing it for years.

Why do teenagers self-harm? What is going on inside

There is no single cause. Reasons teenagers give, as gathered by the Royal College of Psychiatrists and the American Academy of Pediatrics, include:

• Stopping unbearable feelings: sadness, anger, fear or feeling overwhelmed.
• Feeling in control when life seems out of control.
• Punishing themselves because of guilt or a harsh view of themselves.
• Feeling something when they feel empty or numb.
• Expressing distress they cannot find words for.
• Copying others: after seeing friends or online content doing it.

Self-harm when angry is common too: some teenagers turn their anger on themselves instead of on other people, as Cleveland Clinic explains. The Royal College of Psychiatrists describes why it tends to repeat: feelings build up, self-harm brings temporary relief, and over time more of it is needed for the same relief, while the damage to their mental health grows.

The risk rises with bullying, isolation and rejection, with abuse or trauma, and with conditions such as depression, anxiety, eating disorders and drug use, according to Cleveland Clinic. If you notice ongoing sadness, read about signs of depression in teenagers, and if you suspect drug use, see signs that a teenager is using drugs.

Self-harm warning signs parents can notice without searching

Teenagers often hide what is happening because they are afraid of how their parents will react. Signs mentioned by the NHS and Cleveland Clinic include:

• Cuts, burns or bruises with no convincing explanation, or small "accidents" that keep happening.
• Wearing long sleeves or clothes that cover the body, even in hot weather.
• Unexplained blood stains on clothes or tissues.
• An unusual amount of bandages or first-aid supplies.
• Withdrawing from family and friends and spending more time alone.
• Signs of depression, such as ongoing sadness or harsh talk about themselves.
• Interest in self-harm content online, or new friendships with others who self-harm.

Cleveland Clinic advises looking at signs together, especially ones that are out of character for your child, rather than at a single sign.

Why searching by force doesn't help

Fear may push you to search their room or phone, or to make them show you their body. But the Royal College of Psychiatrists warns that negative reactions, such as telling them they must stop at once, can make them stop confiding in you, and that if they think they will get in trouble, they may hide it even more. Notice quietly, then ask gently about what you have seen. If you are worried about their safety right now, go to the emergency section below.

My daughter is self-harming, what do I do? Starting the first conversation

You may feel shocked, angry or guilty, and all of that is understandable. But staying calm, as the Royal College of Psychiatrists says, helps your son or daughter know they can trust you. If you find an injury that needs medical care, or you are worried about their safety right now, get medical help first, before any conversation (see the emergency section below). Here are practical steps for the first conversation:

1. Calm down first: choose a quiet time and a private place. Talking may be easier in the car, or in a written message.
2. Ask directly and gently: for example, "I've noticed cuts you haven't told me about, and I'm worried about you. Are you hurting yourself?"
3. Listen more than you talk: ask how they feel and what is weighing on them, and don't rush them to answer.
4. Accept their feelings, even if you don't understand the behavior: you might say, "It sounds like you're carrying more than you can bear, and you won't face this alone."
5. No shouting, punishment or threats: don't accuse them of attention-seeking, and don't force them to stop immediately; that pushes them to hide it.
6. Don't promise to keep it secret: you may need to involve a doctor or specialist. Say you will look for help together, and that you will only share what you know with people who need to know in order to help.
7. Agree on the next step: an appointment with a doctor or psychologist, and a simple code word they can say to you when things get too hard.

How can you make home safer and agree on a safety plan?

You can't remove every risk from the home, but simple steps make self-harm harder and buy time to reach help:

• Keep all medicines locked away, and don't keep large quantities of them at home.
• Put sharp tools and poisonous substances out of reach as far as you can, especially during stressful periods.
• Keep first-aid supplies somewhere everyone knows, and encourage your child to tell you if they have hurt themselves so they get care quickly.

Don't turn this into constant guarding or daily searches; the aim is to combine safety with trust.

The safety plan: one page, written with a professional

Guidance from the UK's National Institute for Health and Care Excellence (NICE), published in 2022, recommends considering a safety plan developed in partnership with the person who has self-harmed, with their family involved where appropriate. It usually includes:

• The situations and feelings that come before the urge to self-harm, and early warning signs.
• Personal ways of coping with distress that the teenager has tried and found helpful.
• Places and people that help them change their surroundings, and family members they can turn to.
• Contact numbers for the treatment team and emergency numbers.
• Agreed steps to make the home safer.

The Royal College of Psychiatrists advises writing the plan once the teenager is calmer, and reviewing it regularly. It is best to put it together with the doctor or therapist, not on your own.

Is self-harm a suicide attempt? When should you go to the emergency department?

Not all self-harm is a suicide attempt; most teenagers who self-harm are looking for an escape from emotional pain, not trying to die, as the American Academy of Pediatrics explains. But for some, self-harm can be a sign of wanting to die, and it can sometimes lead to death even when the teenager did not intend it, as the Royal College of Psychiatrists warns. Cleveland Clinic adds that although non-suicidal self-injury is not meant to end a life, the risk of suicide attempts is much higher in people who self-harm. That is why all self-harm is taken seriously.

Go to the nearest emergency department or call an ambulance straight away if your child:

• Has taken an overdose of any medicine or substance, even if they seem fine; the Royal College of Psychiatrists warns that many medicines can do serious damage to the body that does not show at first.
• Has a wound that won't stop bleeding, or an injury you fear is serious and can't be treated at home. If you are in doubt, the safest choice is to go to the emergency department.
• Says they can't keep themselves safe.
• Talks about wanting to die or about a plan to end their life.

Warning signs listed by the US National Institute of Mental Health (NIMH) include talking about being a burden to others, feeling hopeless, withdrawing, and saying goodbye to people or giving away important belongings. If you see them, ask directly: "Are you thinking about suicide?" NIMH says asking this does not increase suicidal thoughts. Listen without judgment, stay close, and help them reach help.

Self-harm treatment for teenagers: what actually helps?

Treatment starts with an assessment by a doctor or psychologist: any injury is treated first, then the reasons behind the self-harm are explored, and conditions that often come with it, such as depression or anxiety, are looked for. Treatments supported by evidence or recommended in guidelines include:

• Dialectical behavior therapy for adolescents (DBT-A): it teaches teenagers skills for managing emotions and tolerating distress, and parents take part. NICE's 2022 guidance recommends considering it for young people who self-harm frequently and have significant difficulty managing their emotions.
• Family involvement: family sessions in which the teenager and parents learn new ways to cope with distress and to talk to each other with understanding.
• Cognitive behavioral therapy (CBT) and other talking therapies, given individually, in a group or with the family.
• Treating conditions that come with it, such as depression and anxiety; a doctor may decide on medication for these after an assessment, and a medicine is only started or stopped on the doctor's decision. For self-harm itself, NICE does not recommend any medicine as a specific treatment to reduce it; psychological therapy is the mainstay. If the doctor prescribes an antidepressant, read about its side effects and the signs that mean you should contact the doctor quickly.

In a randomized trial published in 2018 in JAMA Psychiatry, involving 173 high-risk adolescents aged 12 to 18 who had previously attempted suicide and repeatedly self-harmed, six months of DBT, with parents taking part in skills groups, did better than a comparison supportive therapy at reducing suicide attempts and self-harm by the end of treatment, although the difference in these outcomes was no longer statistically clear over the following six months. In a Norwegian trial published in 2014 with 77 adolescents who repeatedly self-harmed, a shortened form of DBT outperformed enhanced usual care in reducing self-harm, suicidal thoughts and depression.

At Oxygen Center, teenagers aged 15 and over can start with an appointment with a psychiatrist, followed by psychotherapy sessions as part of a plan that involves the family, with a parent or guardian's consent for anyone under 18. Appointments and sessions are open to both males and females, while inpatient stays are for males only. The center does not provide services for children under 15; if your child is younger, see a child psychiatrist.

When should you get help, and where can you find it now?

Don't wait for it to happen again or get worse. Ask for a specialist assessment soon if:

• You discover any self-harm, even if it looks minor or your child says they have stopped.
• It keeps happening, or it comes with ongoing sadness, withdrawal or falling behind at school.
• There are signs of drug or alcohol use.
• You feel it is more than you can handle.

If your child refuses to go, parents can come to Oxygen Center on their own first. Contact us at any time to book an appointment or ask about the first step.

• In urgent danger: call an ambulance on 123, or go to the nearest emergency department.
• The Ministry of Health and Population's mental-health line, 24/7: 16328.
• Oxygen Center's emergencies line, 24/7: +20 100 006 6752; for bookings and questions: +20 101 687 0711 (phone and WhatsApp).
• Outside Egypt: your local emergency number.

Self-harm is a message of pain, not the end of the road. With calm support from the family and the right treatment, teenagers learn other ways to cope with their feelings.