Under the sleeve: Adolescent self-harm
In the summer of 2025, I was riding the subway home when I noticed a teenage girl standing in front of me in the semicrowded car. She held an overhead strap, steadying herself as the train swayed. As her long sleeve slipped back, a row of thin, unmistakable razor cuts appeared on her forearm. She quickly lowered her arm. I returned my eyes to my phone, deliberately avoiding eye contact so as not to embarrass her. Moments later, she got off and faded into the flow of commuters. Left behind, my mind reeled with unease, and I thought of my sister, a school counselor, who has often spoken of the magnitude of self-harm among students and how carefully it is hidden.
Self-harm refers to the deliberate infliction of physical injury on one’s own body in the absence of suicidal intent. Such behaviors are emerging at younger ages, with some studies indicating onset as early as the fourth grade. Recent data indicates that 27.4 percent of Korean adolescents have engaged in self-harm, a rate higher than what’s reported in other countries, including the United States. The gravity of the situation is likely even greater than statistics suggest, given that self-harming behaviors are frequently concealed and underreported due to stigma.
Despite its prevalence, adolescent self-harm is widely misunderstood. Many believe that cutting is the primary form of self-injury, but self-injury also encompasses behaviors such as burning, scratching, biting, hitting or banging body parts, and embedding objects under the skin. Another misunderstanding is that self-harm occurs predominantly among female adolescents. Although many studies in Korea report that female adolescents engage in self-harm nearly twice as often as male adolescents, international research presents mixed findings. Research also reveals a gendered pattern, with females more likely to engage in cutting and males more likely to hit body parts. Taken together, the evidence indicates that self-harm affects adolescents across genders.
Misinterpretation also extends to motivations for self-harm. Adolescents often report engaging in self-harm as a means of coping with overwhelming emotions — such as relieving stress, regaining a sense of control or counteracting emotional numbness — rather than attempting to seek attention. A self-inflicted injury can trigger the release of endorphins and other pain-relieving chemicals in the brain that temporarily alleviate emotional distress. This physiological response helps explain why such behaviors are self-reinforcing.
Although some adolescents discontinue self-harming behaviors as they enter adulthood, self-harm should not be dismissed as transient or harmless. Self-harm is a known risk factor for suicidal ideation and attempts. In Korea, suicide has consistently ranked as the leading cause of death among youth. According to the Korea Disease Control and Prevention Agency, in 2024, adolescents constituted 16.9 percent of emergency room admissions related to self-harm and suicide attempts.
Adolescent self-harming behavior is influenced by multiple factors, including strained family relationships, academic pressure and stress from peers. Digital environments further amplify the risk. Certain websites and social media platforms expose adolescents to self-harm-related content, including detailed descriptions of methods, peer discussions that normalize or reinforce self-injury and graphic images. Repeated exposure to such content can lower psychological barriers and increase the risk of self-harm among vulnerable youth through contagion effects facilitated by social modeling.
Public discussion of adolescent self-harm has increased, yet many fail to receive timely and sufficient support. One powerful and often overlooked factor is adultism, which upholds adult authority while discounting young people’s voices, autonomy and experiences.
Adolescent distress is frequently dismissed as exaggeration, immaturity, or “just a phase.” It is interpreted as misbehavior requiring discipline or is met with callousness. Although such responses are often unintentional, their effects can be pernicious, silencing adolescents and discouraging help-seeking. When suffering is consistently minimized or invalidated, vulnerable youth become less likely to disclose their struggles and more likely to turn to self-harm as one of the few outlets they can control.
To address current situations, school districts across Korea must bolster prevention and intervention efforts for adolescents. These can include teaching effective coping skills, increasing extracurricular activities and providing peer support programs alongside accessible parent education. Too often, prevention education focuses only on risk factors and warning signs. Instead, emphasizing protective factors — things that help students feel supported, confident and connected — is more likely to foster resilience. Equally important, adults must critically examine their attitudes and assumptions that inadvertently discourage adolescents from seeking help.
The health of adolescents is crucial to the future of society. When self-harm is minimized or overlooked, we fail not only young individuals today but future generations as well. Acknowledging the seriousness of the issue is essential to constructing frameworks that safeguard, support and value young lives.
Ma Kyung-hee holds a Ph.D. from the University of South Carolina and works in Seoul as an editor and researcher focusing on psychological well-being and community care.