When my clients first tell me about their self-injury, it’s usually with a mix of emotions—often fear, sometimes shame, and almost always tremendous relief. And it’s usually the first thing we talk about because it’s usually the reason they’ve come to see me.

I’ve spent over a decade of working with individuals who engage in self-injury and I don’t usually get referrals for much else. But conversations during those intakes quickly shift from histories of self-injury to stories of family and friendships, interests and hobbies, love, pain, music, loss, sports, school, identity—all of the things that make my clients uniquely them and so much more than the struggles that brought them to therapy. By the end of the intake, we acknowledge that self-injury is a way of coping with difficult emotions and no one should be defined by a single behavior. We are all so much more complex than any one thing that we do.

March 1 is Self-Injury Awareness Day, a grassroots awareness event that was created to acknowledge the strength and resilience of individuals who often suffer in silence. Despite stigmatizing beliefs that individuals who engage in self-injury are “crazy” or just seeking attention, self-injury—also known as nonsuicidal self-injury or self-harm—is most likely to be used by individuals as a way to cope with overwhelming distress or feelings of numbness.

Although rates of self-injury vary between studies, anywhere from 12 percent to 32 percent of teens and 9 percent to 38 percent of young adults engage in self-injury. This includes individuals struggling with depression and anxiety or those who have experienced trauma, but also includes many who are not struggling with mental health difficulties. Learning to cope with difficult emotions is a normal part of adolescence and emerging adulthood; however, individuals may end up using unhealthy coping mechanisms like self-injury when they become overwhelmed by these difficult emotions.

Considering the stigma associated with self-injury, experiencing connection, validation and acceptance are important parts of overcoming self-injury. Here are three things you can do if you learn that a loved one is hurting themselves:

1. Don’t freak out. Respond with emotional neutrality and respectful curiosity. Learning that a loved one is hurting themselves can be a scary or overwhelming experience. Take a moment to breathe and then be there for their feelings first.
2. Find the function. Each individual has different reasons for engaging in self-injury, but common functions include regulating emotions, relieving feelings of numbness, distracting from distressing thoughts (including suicidal thoughts) and believing that they deserve to hurt themselves. Help them understand their reasons for hurting themselves. This will make it easier to find healthy alternatives that fulfill those same functions.
3. Reflect, validate and then problem-solve. It’s easy to get caught up in advice-giving or problem-solving when we’re concerned about people close to us. Taking a moment to first reflect back what a loved one is saying and validating their feelings will open up the possibility of more effective problem-solving.

To learn more about self-injury, visit online resources such as the Cornell Self-Injury and Recovery Research and Resources or the National Suicide Prevention Lifeline. If you are concerned about a loved one or struggling yourself, download the SafeUT smartphone app.

If you or someone you know between the ages of 12 and 24 struggles with self-injury or has a history of self-injury, consider participating in my Interrupting Self-Harm (ISH) Study. I hope to build upon existing knowledge about what works to treat self-injury—and most importantly, I hope to gain a greater understanding of what teens and young adults believe needs to be done to address self-injury.