How to manage or prevent a self-harm relapse

Some people turn to self-harm* — also called nonsuicidal self-injury (NSSI) — to cope with emotions like sadness, anger, or frustration. Others might do it to regain a sense of control, numb their pain, or escape distressing thoughts. Self-harm can take many forms, like skin cutting, burning, scratching, and hitting oneself. And when someone who previously stopped self-harming returns to these behaviors, it can be called a self-harm relapse.

Relapses can happen for various reasons, including increased stress, addictive features like irresistible urges to self-harm, traumatic flashbacks, or substance use. Relapsing during the recovery process is common but doesn’t indicate failure.

If you or someone you care about is self-harming, know that you’re not alone. The first step toward healing is getting help. A therapist can support you in developing safer, more effective coping strategies.

*If you or a loved one is experiencing suicidal thoughts or thoughts about harming themself or others, please call or text 988 on any phone for the Suicide & Crisis lifeline, contact a local crisis line, or head to the emergency room immediately. Any of these resources will ensure that the person in crisis receives support right away. For more information on getting help, go to 988lifeline.org

If experiencing a life-threatening emergency or you need immediate help, please call 911. 

What is a self-harm relapse?

A self-harm relapse happens when someone returns to self-harming after a period of stopping. This can happen after days, months, or even years without self-harm. There’s no set amount of time you have to be self-harm-free before a return to self-harm is considered a relapse. Whether it happened once or several times, a relapse doesn’t erase the progress you’ve already made.

How to prevent self-harming again

If you’ve self-harmed in the past but are working toward healing, it’s important to remember that recovery isn’t always a straight line and setbacks can happen. Mental health is a lifelong journey — and relapse can be part of it. Even though it can feel discouraging, it’s not a sign of failure. And with the right support, you can get back on track.

Consider these steps:

• Reach out for support: Talk to someone you trust, like a friend, family member, or therapist. If you don’t feel comfortable talking, you can try texting a crisis line for anonymous support.

• Reevaluate your coping strategies: A relapse could mean your current coping strategies aren’t fully supporting your goals. Try exploring new approaches, like self-care, physical activity, or relaxation exercises, to better support your well-being.

• Reflect on your goals: Think back to why you wanted to stop self-harming in the first place. Maybe it was to protect your health or to find more sustainable ways to cope with negative emotions. Reflecting on this goal can re-motivate you to stop self-harming.

• Create a safety plan: The free Safety Plan app for smartphones helps people who self-harm  create a personalized safety plan they can share with loved ones. It also allows users to set personal goals, track progress, and explore different coping strategies to manage stress.

• Use distraction techniques: If you feel the urge to self-harm, distraction can help redirect your focus. Many people find that delaying the urge — even for a few minutes — can help it pass. To make distraction more effective, try matching the distraction activity to your current emotion, whether it’s anger, sadness, depression, or guilt.

• Try grounding techniques: Practice deep-breathing exercises (inhale for four seconds, hold for four, exhale for four) or practice the 5-4-3-2-1 technique (list five things you see, four you touch, three you hear, two you smell, and one you taste).

• Express emotions through journaling: If self-harm has been a way to release emotions, try putting them into words instead. Journaling can help you process feelings and recognize emotional patterns leading to self-harm.

What a self-harm relapse could mean

A self-harm relapse doesn’t always mean your mental health is getting worse. Instead, it often means that something in your life has changed or that your usual coping strategies aren’t meeting your needs right now. Understanding what may be behind a relapse can help you respond with compassion instead of self-criticism.

A self-harm relapse may be a sign of:

• Overwhelming emotions: Emotions like stress, anger, or shame may feel too intense to manage with your current coping skills.

• Returning trauma symptoms: Trauma reminders or flashbacks can increase the urge to self-harm, even after a long period without self-injury.

• Experiencing an untreated mental health condition: Anxiety, depression, or conditions like personality disorders can all make self-harm urges harder to manage.

• Going through changes in your life: A major life event like a divorce or job loss can make old coping behaviors return.

• Feeling isolated or unsupported: Losing a support system or feeling alone can make it harder to cope with difficult emotions.

What to do after a self-injury relapse

If you’ve experienced a self-harm relapse, try to respond with kindness instead of self-criticism. Recovery isn’t always a straight line, and one setback doesn't erase the progress you've already made. The goal isn’t to be perfect. It's to understand what happened and take steps toward healing.

Therapy can help you understand what led to the relapse and develop safer ways to cope. Several types of therapy are shown to help people who self-harm, including:

• Dialectical behavior therapy (DBT): DBT is one of the most effective treatments for self-harm. It’s especially helpful for those with borderline personality disorder (BPD) or who have difficulty regulating emotions. It teaches mindfulness, how to recognize triggers, and healthier coping mechanisms. DBT also helps you challenge negative thoughts and improve communication so you feel heard and understood.

• Cognitive behavioral therapy (CBT): CBT helps identify and reframe negative beliefs and behaviors, replacing them with more effective coping strategies.

• Compassion-focused therapy (CFT): This approach to therapy can help if low self-esteem, shame, or self-criticism contribute to self-harm. Through visualization and mindfulness techniques, it encourages shifting from self-judgment to self-compassion.

• Eye movement desensitization and reprocessing (EMDR): Trauma-focused therapy, like EMDR, can be effective if self-harm is in response to past trauma. This type of therapy can help process distressing memories in a safe space, reduce emotional distress, and provide tools to manage overwhelming emotions.

In addition to meeting with a therapist trained in self-harm behaviors, there are steps you can take to reduce the risk of relapse:

• Treat other mental health conditions. Managing anxiety, depression, post-traumatic stress disorder (PTSD), borderline personality disorder (BPD), eating disorders, or unhealthy substance use may reduce future relapses.

• Build a support system. Stay connected with trusted friends, family members, or support groups.

• Identify your triggers. Think about what happened before the relapse and what emotions or situations may have contributed.

• Take care of your basic needs. Prioritize sleep, nutrition, movement, and other healthy routines.

• Practice self-compassion. Recovery takes time. A relapse doesn't erase your progress.

Clinician’s take

Relapse can be a part of self-harm recovery. Understand that it’s part of your journey and doesn’t negate the work you have previously done. You are continuously adjusting and fine tuning your skills to navigate life’s emotional rollercoaster.

Ashley Ayala, LMFT

Clinical reviewer