6 Steps to Take to Help a Friend Who Self-Harms

You may be shocked when you learn that someone you care about is intentionally cutting or burning herself. Two questions may arise: “Why?” and “What can I do to stop this?”

In a prior article I explored some of reasons why people engage in this kind of behavior. These include a desire: to escape feeling emotions especially the fear and self-loathing, to distract themselves from unpleasant memories or to punish themselves. For more information, see my earlier article, “Trauma and Self-Harming Behavior.”

While people diagnosed with depression, anxiety, and borderline disorder are at risk of self-harm, those at most risk whom I see in my practice are those challenged by dissociative identity disorder (DID). In this article I focus on six steps you can take to help this particular population deal with the impulse to self-harm.

STEP 1: Get Professional Help

Self-harm or mutilation is a serious consequence of mental distress. As a friend, do everything you can to support the individual to make sure she is getting professional mental health care. (In this article, I refer to “friend” as “she” because nearly all of my clients diagnosed with DID are women). Self-harmful behavior, which is usually intended to not be lethal, can switch into a suicidal attempt. If your friend does not have a counselor and a psychiatrist, help them to find one.

Who to look for?

  1. A professional who accepts the diagnosis of DID.

While DID is a valid diagnosis described in the Diagnostic and Statistical Manual of Mental Disorders, many mental health professionals still refuse to recognize it. Successful treatment of self-harming in DID clients is based on an understanding of this diagnosis.

  1. Someone who has training and prior experience in working with this diagnosis.

Those who understand trauma, but not DID in particular, may ask the client prematurely to remember the abuse. This has the potential of escalating the self-harmful behavior. A good resource for potential referrals and information about this diagnosis is the International Study for Trauma and Dissociation website LINK

STEP 2: Accept Her As She Is

Help her to have “normal” experiences. Appreciate her artistic abilities, sense of humor or her ability to work hard. Invite her to do everyday kinds of things like hiking, visiting special places or eating fun foods. When things get tough and she thinks she is the bad person her abusers said she was, then she will have you and memories of these activities to tell her otherwise.

Let your friend know that you do not judge her for having a diagnosis of DID. Instead, offer compassion and understanding. She did not choose to create multiple parts or alters; it was a survival strategy that her unconscious mind created to deal with atrocities from childhood. Let her know she is not a freak.

Ask her if she is ready to introduce you to her parts or alters.  While the different parts share the same body, they may talk, think and act quite differently. The young ones may talk in a high-pitched voice and want to play with stuffed toys. The older ones may come across more manly or womanly in language and body posture. While this may take a while to get use, you may find that there are some whom you have things in common and want to hang out with. This can go a long way in helping your friend to feel better about herself.

STEP THREE: Show Caring

Being abused as a child can destroy trust in other people. Let your friend know that you will be there for her when:  she feels confused or disorganized, needs help with food or transportation or wants to self-harm. Your caringand consistent presence may make the difference between her being able to tolerate something unpleasant versus her taking out her distress by self-mutilating.

Let her know that even though you may not agree all the time, you are not going to desert her. Initially, this may be hard for her to believe. She may have a deep conviction that she either does not deserve kindness or people in her adult life are no different than her abusers.

She may try to push you away. Your persistent caring most likely over time will increase her trust of others. She may begin to replace her negative self-talk, which so often precedes the urge to cut or burn, with more positive ideas about herself.

STEP FOUR: Show Respect

One main way to show respect is to be reliable; show up when you say you will and do what you said you would do. When you treat your friend with respect, she can begin to learn that she is worthy of it.  Knowing that she is worthy of respect from others, she  can begin believe that about herself. The old messages instilled by her abusers that she is worthless no longer seem true to her. In turn she will want to act in ways that are more respectful of her body. The cutting and burning stop.

STEP FIVE: Be Understanding

Rather than using words to express themselves, your friend’s abusers used violence and force to get a message across. Your friend probably did not have someone modeling good verbal communication skills to express feelings and thoughts. As a result, she may not know how to communicate that she is frightened, offended by something you said or caring about your feelings. With patience and understanding, your gentle guidance toward effective communication can help her to see another non-violent way to express her ideas and emotions.

Likewise, if you are distressed by something she said to you, let her know this without blaming or shaming her. This creates a sense of a mutual friendship  If there is a break in your relationship, it may be you who has to make the effort to reconnect. Remember that you may be one of the best teachers she has about how to communicate with words rather than physical violence. Words replace burning and cutting.

STEP SIX: Pay Attention to Safety

If you have been able to get to know her different parts, you also may pick up on when an alter or part is contemplating doing self-harm. When this happens, discuss ways that you can help the alter to stay safe. Your friend may already have a list of ideas she can turn to that she created with her therapist. Pull this list out and review it with her.

As much as you are able, let her know that she can call on you if she were to hurt herself. At these times the person may too distracted or confused to safely drive or make good self-care decisions. Your help could be essential in getting her medical attention so the harm can be evaluated and treated appropriately.


–As a friend of someone diagnosed with dissociative identity disorder (DID) and who self-harms or self-mutilates you can take steps to help her reduce this behavior

–Supporting them in getting professional mental health help is critical

–Accepting who she is helps her to feel less like a freak and boost her self-esteem