Key Messages
- Self-harm means deliberately hurting oneself, for example, by cutting, burning, or overdosing
- Non-suicidal self-injury, or NSSI, means self-harm without the intention to die
- Self-harm is common in adolescence, but rates are much higher in trans young people than in cisgender peers 1 2
- Stress from stigma, bullying, dysphoria, trauma, family rejection, and poor mental health can all increase risk 1 3
- Strong support, affirmation, safety planning, and evidence-based therapy can reduce risk and help young people build other ways to cope
What is self-harm?
Self-harm means deliberately injuring yourself. This can include cutting, burning, scratching, hitting, interfering with wound healing, or taking more medication than intended. Young people often describe self-harm as a way to cope when emotions feel unbearable, confusing, or too hard to express. Non-suicidal self-injury, or NSSI, refers to self-harm without the intention to die. This is different from a suicide attempt, but the two can overlap. A young person may self-harm without wanting to die, and still be at increased risk of suicidal thoughts or later suicide attempts. For this reason, all self-harm should be taken seriously.
Self-harm can happen for many reasons. A young person might be trying to:
- Reduce overwhelming feelings
- Cope with numbness or dissociation
- Punish themselves
- Feel a sense of control
- Express pain that they don’t know how to put into words.
This does not mean the behaviour is safe or harmless. It means the young person is likely in significant distress and needs support.
How common is self-harm in young people?
Self-harm is unfortunately quite common in adolescence. Australian studies suggest that around 18 to 30% of young people have self-harmed by the mid to late teen years.4 Any self-harm is important to take seriously, especially if it is becoming more frequent, more severe, or happening alongside suicidal thoughts, substance use, or other major distress. Research suggests rates are much higher in trans and gender diverse young people. A recent systematic review and meta-analysis estimated that around 46% of trans and gender diverse young people have engaged in non-suicidal self-injury.2 While exact percentages vary depending on how studies measure self-harm and who is included, the overall pattern is clear: trans young people are at substantially higher risk.1 2
Why are trans young people at higher risk?
There is no single cause. Self-harm is usually influenced by a mix of emotional pain, stress, mental health, relationships, trauma, and access to support. Trans young people often face extra pressures that can increase risk.
- Minority stress and discrimination: Trans young people may experience bullying, harassment, rejection, misgendering, and discrimination. These experiences can build up over time and create intense distress. This is often described as minority stress. Research suggests minority stress plays a major role in the mental health difficulties and self-harm risk experienced by trans young people.1
- Gender dysphoria: Gender dysphoria can be deeply painful. Distress about one’s body, social role, or being prevented from expressing one’s gender can increase feelings of hopelessness, shame, or overwhelm. For some young people, self-harm may become a way of coping with this distress.
- Family rejection or conflict: Family support is one of the strongest protective factors for trans young people. When a young person feels rejected, invalidated, or unsafe at home, risk can increase. On the other hand, feeling accepted and affirmed by family can make a major difference to wellbeing and safety.3
- Mental health difficulties: Self-harm often occurs alongside depression, anxiety, trauma, or suicidal distress. These difficulties can reduce coping capacity and make self-harm feel like the only available release. This does not mean self-harm is inevitable. It means underlying distress needs attention and support.
- Trauma: Some trans young people have experienced trauma, including bullying, abuse, assault, family violence, or chronic invalidation. Trauma can increase shame, emotional overwhelm, dissociation, and difficulty managing distress, all of which can increase self-harm risk.
- Neurodivergence: Some trans young people are also Autistic or have ADHD. Neurodivergent young people may face extra challenges with emotional regulation, sensory overwhelm, alexithymia, impulsivity, or shutdowns. Although not all research is trans specific, broader adolescent evidence suggests that Autism and ADHD can increase self-harm risk, which means trans neurodivergent young people may need additional support.1
What helps?
Support is usually most effective when it addresses both immediate safety and the deeper reasons the young person is struggling.
- Emotion regulation support: Many young people need help learning other ways to manage intense emotions. Therapies such as Dialectical Behaviour Therapy, or DBT, can help build skills in distress tolerance, emotional regulation, mindfulness, and coping. Research suggests DBT can reduce self-harm and suicidal ideation in adolescents.5
- Safety planning: A safety plan can help a young person know what to do when urges rise. This usually includes warning signs, coping strategies, reasons to stay safe, trusted people to contact, and crisis numbers. Safety plans are often most helpful when created collaboratively with a clinician, but families can still support this process.
- Reducing access to means: It can help to make the environment safer by locking away or reducing access to items that might be used for self-harm, such as blades or large amounts of medication. This should be framed as care and safety, not punishment.
- Supportive connection: Young people are less alone when they feel understood, accepted, and connected. Supportive family relationships, affirming peers, and connection to the LGBTIQA+ community can all reduce risk. Being respected in their gender identity matters here too.
- Gender affirmation: Affirmation is not a minor issue. It can be a protective factor. Using a young person’s name and pronouns, supporting gender expression, and helping them access gender-affirming care where appropriate may improve wellbeing and reduce distress.3
- Addressing underlying issues: Self-harm support should not focus only on stopping the behaviour. It is also important to address what is underneath it, such as depression, trauma, bullying, dysphoria, family conflict, neurodivergent overwhelm, or substance use.
What parents and carers can do
You don’t need to fix everything at once. Small, steady supports matter.
- Stay calm and take it seriously: Try not to respond with anger, panic, or punishment. Self-harm is serious, but calm support is usually more helpful than shock or blame.
- Focus on safety first: If possible, reduce access to tools or substances that could be used to self-harm. Do this gently and explain that it is about care and safety.
- Keep communication open: Let your child know you want to understand, not judge. Young people are more likely to talk when they feel safe.
- Validate the distress underneath the behaviour: You don’t need to agree with the self-harm to recognise that your child is in pain.
- Support regulation and routine: Regular meals, sleep, sensory supports, reduced overwhelm, and predictable routines can all help create a sense of stability.
- Seek affirming professional help: A GP, psychologist, psychiatrist, CAMHS service, or headspace may be able to help. It is especially important to find support that is trans affirming.
- Build a support network: If possible, help your child stay connected to safe people, affirming peers, or LGBTIQA+ supports so they are not carrying this alone.
How to talk about self-harm
How you respond can shape whether your child feels safe enough to open up.
- Stay calm and gentle: Try to choose a private, calm moment. You might say something like, “I’ve noticed you seem really overwhelmed, and I’m worried about you. I’m not angry. I want to understand.
- Avoid shame or blame: Try not to say things like “Why would you do that?” or “You’re just doing it for attention.” These responses can increase shame and secrecy.
- Listen more than you speak: If your child talks, try to listen without interrupting. You don’t need to rush to fix everything straight away. Feeling heard is often an important first step.
- Validate the pain: You might say, “It sounds like things have felt really unbearable,” or “You must be carrying a lot.” This helps communicate that you see the distress underneath the behaviour.
- Keep the conversation open: If your child does not want to talk much, let them know you are still there. Ongoing gentle support is often more effective than a single big conversation.
References
- Bird, K., Arcelus, J., Matsagoura, L., O’Shea, B. A., & Townsend, E. (2024). Risk and protective factors for self-harm thoughts and behaviours in transgender and gender diverse people: A systematic review. Heliyon, 10(5), e26074. https://doi.org/10.1016/j.heliyon.2024.e26074
- McArthur, B. A., Pesigan, K. L., Berg, L., Sin, G., Singh, S., & McClurg, C. (2026). Suicidality and nonsuicidal self-injury in transgender and gender diverse youth: A systematic review and meta-analysis. JAMA Pediatrics, 180(2), 144. https://doi.org/10.1001/jamapediatrics.2025.5274
- Call, D. C., Challa, M., & Telingator, C. J. (2021). Providing affirmative care to transgender and gender diverse youth: Disparities, interventions, and outcomes. Current Psychiatry Reports, 23(6), 33. https://doi.org/10.1007/s11920-021-01245-9
- Terhaag, S., & Rioseco, P. (2021). Self-injury among adolescents (Growing Up in Australia Snapshot Series, Issue 4). Australian Institute of Family Studies. https://aifs.gov.au/growing-australia/all-research/research-snapshots/self-injury-among-adolescents
- Kothgassner, O. D., Goreis, A., Robinson, K., Huscsava, M. M., Schmahl, C., & Plener, P. L. (2021). Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: A systematic review and meta-analysis. Psychological Medicine, 51(7), 1057–1067. https://doi.org/10.1017/S0033291721001355