There is no single reason why people self-harm. For some, it can become a way of coping with intense distress, expressing something difficult to put into words, regaining a sense of control or responding to other painful experiences.
Looking at self-harm only from the outside can make the behaviour difficult to understand.
The injury may be visible, but the reason behind it often is not. Two people may self-harm for very different reasons, and the same person's reasons may change over time.
Understanding self-harm therefore means looking beyond the behaviour itself and considering what may be happening for the person.
People sometimes ask what causes someone to self-harm. There may be experiences or circumstances that contribute to distress, but there is rarely one simple cause that explains the behaviour.
Difficult relationships, loss, bullying, trauma, pressure at work or school, financial worries, low self-esteem and mental health difficulties can all be part of somebody's wider circumstances. For another person, the picture may be quite different.
It can be more useful to ask what function self-harm is serving. In other words, what does the behaviour seem to do for this person at this point in time?
That does not make self-harm harmless or inevitable. It helps explain why telling somebody to "just stop" can miss what is happening underneath.
These are examples rather than categories that everyone will fit into. More than one may be relevant at the same time.
Self-harm may provide a temporary release from distress, tension or emotions that feel difficult to manage in another way.
For some people, self-harm can communicate distress or give physical form to feelings they are struggling to explain in words.
When circumstances, emotions or other parts of life feel outside someone's control, self-harm may create a temporary sense of agency or control over what happens to their body.
Self-harm can sometimes be connected with guilt, shame, low self-worth or a feeling that the person deserves to be punished.
Someone who feels numb, disconnected or detached from themselves may use self-harm as a way of feeling something or becoming more present in the moment.
Self-harm can also become habitual or feel compulsive.
If somebody has discovered that self-harm brings short-term relief from intense distress, the behaviour may become something they return to when similar feelings arise. That can make the pattern difficult to move away from even when the person dislikes the consequences or wants things to change.
This is another reason why understanding what happens before, during and after self-harm can matter. The behaviour may be meeting a need in the short term while creating other difficulties or risks.
There is no fixed explanation that applies every time somebody self-harms.
NICE guidance specifically recognises that each person has their own reasons and that those reasons may differ from one episode to another. Someone may understand very clearly why they self-harmed on one occasion and feel much less certain about another.
The meaning can also change as circumstances change. What begins as a response to one particular situation may later become a more established way of dealing with distress.
This is why assumptions based on someone's age, diagnosis, background or previous behaviour are unlikely to tell the whole story.
Self-harm is sometimes dismissed as attention-seeking. That description can obscure more than it explains.
Some people hide self-harm because they fear judgement or do not want anyone else to know. Others may be trying to communicate distress because they have not found another way to make what they are experiencing understood.
If somebody's behaviour is communicating that they are struggling, the useful question is not whether they "want attention". It is what they may be trying to express, what they need and how somebody can respond without adding shame or judgement.
Knowing that people self-harm for different reasons changes the way we approach a conversation.
Rather than deciding in advance what the behaviour means, we can listen to the person and allow their explanation to guide our understanding. We can take safety seriously without reducing them to the self-harm itself, and recognise when professional or specialist support may be appropriate.
For mental health awareness training, this is an important shift. The aim is not to work out somebody's reason from the outside. It is to understand that there may be a reason worth listening for.
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