If someone you love is hurting themselves through self-harm, you may feel at a loss. Maybe they haven’t told you, but you’ve noticed it on your own, so you’re wondering if you should confront them—and how. Or maybe they have opened up to you, but you’re still unsure of the right way to help.
Self-harm is typically best understood as an unhealthy coping mechanism for emotional suffering, according to the National Alliance on Mental Health (NAMI). Often, people self-harm to release intense feelings they don’t have the tools to express any other way, NAMI says. Other possible reasons for self-harm include trying to break through emotional numbness, avoiding distressing memories, signaling a need for help, punishing themselves, or needing to exert a sense of control, according to the U.S. National Library of Medicine.
Given that every self-harm scenario (and friendship) is a little different, it’s hard to issue one-size-fits-all advice. A lot of how you handle this will depend on the specific situation. Mental health experts do still have some suggestions for how you may and may not want to approach this conversation.
Before you say anything, choose a good time for both of you.
“You want to strike while the iron is cold,” Elaina Zendegui, Psy.D., assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai, tells SELF. That means not jumping on your friend right after they walk in the door from their exhausting job or on a day when they’re clearly in a bad mood.
You also want to be aware of where you’re at so you can be as supportive as possible. “Make sure you actually are in a space to talk about it in a calm way, because it can be really upsetting,” Zendegui says.
While your first instinct may be to respond to your friend’s self-harm confirmation or details with shock, horror, or sadness, do your best to remain nonjudgmental and nonreactive (or at least, not over-reactive), psychologist Joan Freeman, M.A., founder of suicide and self-harm intervention nonprofit centers Pieta House in Ireland and Solace House in New York City, tells SELF.
Here are suggestions for what to say:
1. “I noticed some marks on your arm, and I’m worried because I care about you. Are you hurting yourself?”
If your friend has not told you that they are self-harming but you have reason to believe they are, open with something simple and straightforward. “Describe what you've noticed and what makes you think there's a problem, express your concern, and ask them directly,” Zendegui says.
You may be nervous to ask specifically if they’re hurting themselves. You can try a more open-ended question to see if they volunteer the information, like “What’s going on?”
While it’s possible that your friend will lie or evade the question, giving someone the space to talk about their self-harm can be the first step in their recovery, Pamela Cantor, M.D., a developmental and clinical psychologist in private practice in Massachusetts and former president of the American Association of Suicidology, tells SELF. “It may release what may have been a frightening secret,” Dr. Cantor says.
Meghan S., 29, who self-harmed for about two years while she was in college, tells SELF that “it was actually kind of a relief” when a close friend asked if she was hurting herself. “I think part of me wanted someone to ask if I was OK,” she says.
2. “I can see that you’re in a lot of pain. Do you want to tell me what’s been going on?”
“You can validate that the pain they’re feeling is real without validating the [self-harm] itself,” Zendegui says. As an alternative, you can try something like, “I don’t know what you’re going through, but I can tell you're having a really hard time right now.”
Then, invite them to talk about what’s causing their pain, Dr. Cantor says. Listen until they’re done sharing—don’t jump in to offer advice or try to relate it to your own experiences.
3. “What gives you the urge to self-harm?”
If your friend has signaled that they’re open to talking, it’s OK to ask more questions to try to better understand what they’re going through, Zendegui says.
Focus your questions on the emotional triggers preceding the self-harm and the effects following it. “You want to identify the feelings happening around the action, not judge the action itself,” Freeman says.
Questions like, “Have you noticed what kind of feelings lead to the impulse to hurt yourself?”, “How do you feel afterward?”, and “How long does the relief last?” are generally appropriate, Dr. Cantor says. Not only are you learning more about your friend’s experience, but you’re also giving them a chance to talk through the process in a way they may have not before.
4. “I will do anything I can, but I can’t help you alone. Can we get you some support?”
You can also try something like, “Have you thought about talking to someone?”
Self-harm is a complex issue that often comes with other behavioral and mental health problems like dangerous substance use and depression, according to NAMI. Stopping the behavior and learning new coping mechanisms usually requires the help of a mental health professional, so your priority should be to guide your friend to a clinician.
“Once you listen and offer support and caring, the best way to help is to get your friend to a responsible professional,” Dr. Cantor says. Doing this can also help set boundaries between you and your friend, which can be important if you’re feeling overwhelmed, Zendegui says.
Let’s say your friend seems resistant to therapy, though. Try mentioning people in your life or your friend’s life who have gone to therapy (as long as those people are open about it so that you’re not invading their privacy). You can say something like, “I know therapy was really helpful for so-and-so when they were having a hard time,” Zendegui says.
Since the idea of indefinite therapy can be intimidating, you can also try what Zendegui calls the “foot-in-the-door” technique and propose that your friend just calls somebody to see what they can offer or tries an initial consult. They don’t need to commit for life, just to that first step.
If your friend seems daunted at the prospect of finding an affordable therapist they can trust, you can help them with these tips. Just don’t ignore your own mental and emotional capacity in the process.
5. “It’s OK if you don’t want to talk about it now. I’m here whenever.”
Your friend might not be ready to jump into a lengthy conversation or agree to get help off the bat. Respect that, Zendegui says, and extend an open invitation to talk anytime. You can always gently bring it up again later. It might take weeks or months and multiple tries, Zendegui says. It’s also possible that your friend will never be ready to open up to you about this, she adds. While that may be frustrating and upsetting, you can’t force it.
In Meghan’s case, she appreciated her friend’s standing offer to revisit the subject at a later date. “I actually don’t think we ever really talked about it again,” she says. “But it was a relief telling someone and probably good for me to have to say [it] out loud.”
The only exception to this let-your-friend-be advice is if you think their self-harm is a sign that they want to end their life. While self-harm usually is not a suicide attempt, the habit does increase a person’s risk of attempting suicide if they don’t get help, according to the U.S. National Library of Medicine.
If you’re scared for your friend’s life, call the 24/7 National Suicide Prevention Hotline at 1-800-273-8255 or use the 24/7 Crisis Text Line at 741-741. You may also want to take your friend to the emergency room or call their family, depending on the circumstances. Here’s more information about what to do if you think a friend is having suicidal thoughts.
Here are some things not to say:
1. “Can I see?”
Avoid voyeurism, Freeman says. While you might be curious to hear the details, they’re not relevant in getting your friend help. You also run the risk of reacting negatively to what your friend shows you, which can be stigmatizing.
Meghan had this experience with a different friend who asked to see her injuries after learning what was going on but then was visibly upset when she obliged. “I didn’t blame her for her reaction, but it definitely hurt my feelings a little,” Meghan says. “You’re already pretty ashamed and judging yourself.”
2. “Things aren’t that bad.”
Don’t attempt to convince your friend that their feelings aren’t justified or that their behavior isn’t “rational.” Glass-half-full isn’t going to work here.
Your friend is likely in tremendous pain, and the last thing you want to do is invalidate that, Zendegui says. “That can really minimize their experience and make them feel worse,” she explains, “and even damage your relationship with them.”
3. “If you don’t stop, I can’t be your friend anymore.”
Do not give your friend any kind of ultimatum, Zendegui says. Quitting self-harm requires much more than willpower, NAMI explains. There is a decent chance that issuing an ultimatum will actually make things worse.
The prospect of losing your friendship (or other consequences) may only make your friend feel more isolated, trapped, misunderstood, and powerless. What’s more, the threat of losing the only coping mechanism your friend may currently have—as unhealthy as it is—could potentially put them in a more precarious mental health position.
Remember, there are limits to how much you can do.
No matter what, your friend may dismiss or reject what you say, Dr. Cantor says. You may feel like you have failed or that the situation is hopeless, but that doesn’t mean that your words have no effect. These changes are often cumulative and take time. “[They] may not immediately change [their] behavior, but you have planted the seeds,” Dr. Cantor says.
Meghan, for example, continued to self-harm for at least six months after her friend first brought it up to her, she says. She eventually stopped with the help of her mom and a therapist. But her friend talking to her “was kind of like a baby, baby step [toward] stopping,” she explains.
It’s reasonable to be nervous about having this conversation. Try rehearsing what you’re going to say beforehand, Zendegui says. It’s also a good idea to be prepared to use supportive nonverbal communication, she adds: “You can be ready with eye contact and mirror some of their body language—their expression, their stance—to kind of meet them where they're at.”