The Hidden Reality of Self-Harm in Boys and Young Men: A Psychotherapeutic Perspective

Self-harm among boys and young men is often overlooked, hidden beneath the surface of aggression, “accidents,” or risk-taking behaviours. Yet behind these actions lies deep emotional distress. In this post, we’ll explore what self-harm is, how it’s assessed in the NHS, the types of self-harm boys and men in Britain engage in, and why it’s so often unseen.

The Reality of Self‑Harm Among Boys and Men in the UK

Self‑harm is often thought of as something that mostly affects young women — but the reality is that many boys and men are also struggling, often in silence. The data tells a sobering story:

• Boys aged 13–17: Around 10–11% report self‑harming in a given year.
• Young men aged 16–24: Roughly 1 in 10 have self‑harmed at some point, with 15% reporting it in their lifetime.
• Adult men aged 16–74: Around 8.5% have self‑harmed at some stage in life.
• LGB+ men: Rates are more than double those of heterosexual men, with bisexual men at particularly high risk.

These numbers may actually be an underestimate. Many men express emotional distress through behaviours that don’t always get recognised as self‑harm — things like punching walls, dangerous drinking, over‑exercise, or reckless behaviour.

Why does this matter? Because while women’s rates are higher overall, the gender gap narrows significantly during late adolescence and early adulthood. Men are also less likely to seek help, increasing the risk that self‑harm will go unnoticed until it escalates into a crisis.

What is Self-Harm?

Self-harm refers to deliberate behaviour that causes harm to oneself, usually as a way of coping with overwhelming emotions, distress, or mental pain. This can happen with or without suicidal intent.

While self-harm is often associated with cutting, the reality is much broader. For boys and men, it can take forms that society may not easily recognise as self-harm—such as punching walls or engaging in extreme risk-taking.

How the NHS Assesses Self-Harm

When someone presents with suspected self-harm, a GP or emergency clinician will typically:

• Explore what triggered the behaviour and the emotions surrounding it.
• Discuss home life, relationships, and support systems.
• Assess for suicidal thoughts or intent.
• Review any history of self-harm or previous attempts.
• Look at substance use, alcohol, and medication.
• Offer treatment options or referral to mental health services.

For under-18s, referrals are usually made to Children & Young People’s Mental Health Services (CYPMHS). Adults may be referred to their local Community Mental Health Team (CMHT).

Quickly Why Boys and Men Self-Harm

From a psychotherapeutic perspective, self-harm often acts as an emotional release or coping mechanism. For boys and men, gender expectations can make it difficult to openly express vulnerability. Society often tells them to “man up” or hide their pain—leading to behaviours that mask emotional suffering as anger, recklessness, or “acting out.”

Common underlying factors include:

• Depression or anxiety
• Past trauma or abuse
• Bullying or social isolation
• Low self-esteem or identity struggles
• Feeling emotionally unsupported

Types of Self-Harm in Boys and Men

Self-harm is not just physical—it can also be emotional or behavioural.

Physical Self-Harm (often hidden or misinterpreted)

• Punching or hitting objects or self – common in boys, often explained away as aggression.
• Cutting or scratching – usually on arms, thighs, or torso, often concealed under clothing.
• Burning skin – using cigarettes or lighters.
• Self-poisoning or overdosing – with painkillers like paracetamol or ibuprofen.
• Risk-taking behaviours – dangerous stunts, extreme exercise, or self-starvation.

Emotional or Behavioural Self-Harm

• Self-criticism – harsh inner dialogue, constant self-blame.
• Emotional withdrawal – isolating from friends and loved ones.
• Digital self-harm – posting fake insults about oneself online to invite negative responses.

Patterns and Gender Differences

Research in the UK shows that while more girls report cutting or overdose, the gender gap narrows by late adolescence. Boys tend to engage more in physical self-injury, such as punching walls, and in self-poisoning. These are often under-recognised as forms of self-harm.

Boys are also less likely to seek medical attention, meaning their self-harm often goes unnoticed by professionals and family alike.

Real-World Examples

• A 17-year-old repeatedly punching a wall until his knuckles swell—explained to teachers as “just messing around.”
• A man secretly burning his arm with a cigarette to “feel something” during periods of numbness.
• A teenager taking frequent low-dose painkillers to “numb” emotional pain—never enough to be hospitalised, but enough to cause long-term harm.
• A young man pushing himself through extreme workouts as punishment for perceived personal failings.

Why We Need to Talk About This

Boys and men often hide their distress in plain sight. Recognising the different forms of self-harm they use is the first step to offering help. By opening the conversation—at home, in schools, in therapy—we can break down the stigma and create safer spaces for men and boys to be honest about their struggles.

Why Some Boys and Men in Britain Self-Harm: Understanding from Different Psychological Perspectives

Firstly Self-harm isn’t just about “wanting attention” or “being weak.” For many boys and men, it’s about dealing with feelings they don’t know how to put into words. When you’ve been taught all your life to “tough it out,” emotions can get trapped inside. Self-harm can become a way of letting that pressure out.

Different branches of psychology explain why this happens in different ways. Here’s how they fit together—especially for men growing up in Britain, where culture, race, class, and family background all shape the story.

1. CBT (Cognitive Behavioural Therapy) Perspective

CBT looks at how your thoughts, feelings, and behaviours feed each other.

• For many men: You might think “I can’t show weakness” or “No one cares about how I feel.”
• Those thoughts create feelings of shame, anger, or hopelessness.
• Self-harm then becomes a behaviour that either relieves the feeling temporarily or punishes yourself for having it.

Example: You fail an exam or lose your job → you think “I’m useless” → you feel hopeless and angry → you punch a wall to release the feeling.

2. Psychodynamic Perspective

Psychodynamic therapy looks at unconscious emotions and early life experiences.

• If you grew up with a dad who told you to “man up” or a family where emotions weren’t talked about, you may have learned to push feelings deep down.
• Those feelings don’t disappear—they come out in other ways: anger, withdrawal, or harming yourself.

From a male perspective, psychodynamic theory says self-harm might be a way of expressing hidden grief, loneliness, or rejection without having to say the words out loud.

3. Humanistic Perspective

Humanistic therapy focuses on self-worth, meaning, and being true to yourself.

• If you feel your life is controlled by expectations—being the strong one, the provider, the protector—you might feel trapped.
• Self-harm can be a signal that something inside you is screaming for freedom or for someone to notice that you’re struggling.

Humanistic thinkers say the goal isn’t to “fix” you but to help you reconnect with who you are—beyond other people’s labels of what a “real man” should be.

4. Transactional Analysis (TA)

TA says we all have three “ego states”: Parent, Adult, Child.

• In men who self-harm, the Critical Parent voice might say: “You’re pathetic, you should be stronger.”
• The Hurt Child feels sadness, fear, or loneliness but doesn’t know how to express it.
• The self-harm becomes a way for the Child to get relief or punish themselves because the Parent voice says they deserve it.

If you grew up in Britain where stoicism and “banter” hide deeper feelings, your Adult voice might not even get the chance to say: “I’m hurting—how do I deal with this in a healthier way?”

5. Freud’s Perspective

Freud believed our behaviour is driven by unconscious drives and early relationships.

• For men, self-harm can be linked to suppressed anger towards parents or authority figures.
• Instead of directing anger outward (which might feel unsafe or shameful), you turn it inward—hurting yourself instead.

Freud might say this is a way of controlling emotional pain when you can’t control what’s going on around you.

6. Jung’s Perspective

Jung talked about the shadow—the parts of ourselves we hide from others and sometimes even from ourselves.

• For many men, the shadow contains vulnerability, fear, and sadness—emotions they’ve been told are “weak.”
• Self-harm might be the shadow’s way of breaking through the mask you wear every day.

Jung would say healing comes from integrating those hidden parts—accepting that being a man includes having feelings, needing connection, and sometimes asking for help.

7. Intersectionality and Cultural Differences

Not all men’s experiences are the same. Your background changes how you carry and express emotional pain.

• Race: As a Black or Asian man in Britain, you might face racism, stereotyping, or microaggressions that make you feel you always have to be strong. Showing pain might feel dangerous.
• Culture: Some cultures value family honour or reputation so highly that admitting emotional struggles feels like letting everyone down.
• Class: Working-class boys may be taught to “just get on with it” and may have fewer mental health resources available.
• Sexuality: If you’re LGBTQ+, you may have had to hide parts of yourself, leading to shame or self-punishment.

Intersectionality says you don’t just carry the weight of being male—you carry the weight of your race, class, sexuality, and culture all at once.

Bringing It Together

Self-harm in men and boys isn’t just about “cutting” or “acting out.” It’s often about:

• Trying to manage pain you’ve been told you’re not allowed to feel.
• Finding control when life feels uncontrollable.
• Punishing yourself for not living up to a picture of masculinity that was never realistic in the first place.

Different therapies give us different tools:

• CBT: Spot the thoughts and break the cycle.
• Psychodynamic: Understand where the pain began.
• Humanistic: Reconnect with your real self.
• TA: Learn to quiet the critical voice and listen to your adult self.
• Freud & Jung: Accept and integrate the hidden, unspoken parts of you.

If you’re reading this and some of it sounds like you—know that your pain is real, even if you can’t explain it in words. And there are ways to get help that don’t involve hurting yourself.

A Walk Through the Process: From First Signs to Getting Help

1. Spotting the Symptoms in Yourself

Self‑harm doesn’t always look like dramatic cuts or burns. For many men, it can be more hidden. You might notice:

• You’ve been punching walls or hitting yourself when angry or frustrated.
• You’ve been scratching, burning, or cutting yourself in secret.
• You’ve been drinking too much or pushing your body through extreme exercise to punish yourself.
• You’ve been taking more painkillers than you should, even if it’s “just” over‑the‑counter tablets.
• You feel numb, hopeless, or like you have no way to get your feelings out.

If you notice one or more of these, and it’s becoming a habit—or you’re worried it’s getting worse—it’s time to take it seriously.

2. Deciding to Call Your GP

• You don’t have to have the right words.
• You can say something as simple as:

“I’ve been hurting myself and I’m worried about my mental health.”
or
“I’ve been feeling low and have been doing things to hurt myself.”

• You can also write it down if it’s easier to read it out when you’re on the phone.

When you call, the receptionist might ask why you need the appointment. You can simply say:

“It’s about my mental health.”

They don’t need the full detail—just enough to make sure you’re booked in with the right person quickly.

3. The GP Appointment: What to Expect

When you see your GP, they will:

• Ask what’s been happening and how long it’s been going on.
• Ask how you’ve been hurting yourself and how often.
• Ask if you’ve had any thoughts about ending your life.
• Ask about your daily life—work, family, relationships.
• Ask about past mental health issues or trauma.

They may also:

• Check your physical health (especially if you’ve injured yourself or taken tablets).
• Ask about alcohol or drug use.

You do not have to sugar‑coat it. This is the time to be as honest as possible. The GP’s role is not to judge but to understand so they can help.

4. What Happens After the GP Appointment

Depending on what you’ve told them, your GP may:

• Refer you to talking therapies—like CBT, counselling, or a local mental health service.
• Offer crisis support numbers in case you feel unsafe.
• Give you information about organisations such as CALM, Mind, or Samaritans.
• Check your injuries and arrange medical treatment if needed.
• Refer you to a psychiatrist or specialist mental health team if your self‑harm is severe or linked to suicidal thoughts.

If you’re under 18, they’ll likely refer you to Children and Young People’s Mental Health Services (CYPMHS).

5. Attending Mental Health Services

If you’re referred, you might:

• Get an assessment with a mental health nurse, psychologist, or therapist.
• Be asked about your history, triggers, and coping habits.
• Work together to create a care plan—this might involve weekly therapy, group sessions, or practical coping tools.

6. Moving Forward

Getting help doesn’t mean everything changes overnight. But:

• You’ll have someone checking in with you regularly.
• You’ll learn healthier coping strategies to replace self‑harm.
• You’ll start to understand the root of what’s going on—not just treat the symptoms.

Key Reassurance for Men and Boys

• Your GP has heard this before—you won’t shock them.
• Asking for help is a sign of strength, not weakness.
• You can choose not to share details with certain people—your privacy is respected.
• The earlier you speak up, the quicker you can start to feel some relief.

“What Happens When I Finally Decide to Get Help” – A Man’s Story

1. Something’s Not Right

I don’t even know when it started. At first, it was just me hitting the gym harder than usual, skipping meals, pushing myself until my body ached. Then came the nights when I’d get angry and punch the wall. I’d tell myself it was just frustration. But lately… it’s been more. I’ve scratched at my skin until it bled. Taken a few too many painkillers—just enough to feel something different.
No one knows. I hide it well.

2. Should I Call the GP?

Part of me says, Don’t make a fuss. Man up. Another part whispers, You can’t keep doing this. I sit there staring at my phone. I don’t even know what to say. My chest feels tight. I finally type the number and hit call. The receptionist answers. “Um… I need an appointment… It’s about my mental health.” That’s all I manage. She doesn’t sound shocked. Just books me in for tomorrow.

3. Walking into the GP Surgery

It’s weird. My heart’s racing like I’m about to confess to a crime. The GP looks up and smiles. “What’s been going on?” The words feel heavy in my throat. I mumble, “I’ve been… hurting myself. Not all the time… but enough.” He doesn’t look disgusted. Doesn’t tell me to man up. He just nods. “Tell me more about what’s been happening.”
I explain—punching walls, scratching, sometimes taking painkillers. I tell him about the days I feel numb and the nights I feel like my head’s going to explode.

4. The Questions

He asks:

• How long has this been going on?
• What sets it off?
• Have you thought about ending your life?

I freeze for a second. I admit, “Yeah… sometimes it crosses my mind.” He writes a few notes. Then checks my hand where the bruises are. He tells me I’ve probably sprained a knuckle.

5. What He Says Next

“I want to get you some proper support,” he says. He talks about therapy—CBT, counselling, people I can actually speak to about all this. Gives me a crisis number in case I need it. Says if it gets bad, I can come back anytime. I nod, not sure what to say.
He’s already sending a referral to the local mental health team.

6. Waiting for the Call

A week later, I get a call from a mental health nurse.
She says, “We’ll do an assessment first. Just to understand what’s going on for you.”
I want to hang up. But I don’t.

7. Sitting in the Assessment

The nurse asks about my childhood, my friends, my family. She asks what I do when I feel low. I tell her about the gym, about hurting myself, about feeling like I have to keep it all together for everyone else. She doesn’t judge me. She says there’s a name for what I’m going through. And that there are ways to cope without hurting myself.

8. Moving Forward

It’s not magic. I don’t suddenly feel amazing. But I’ve got someone checking in with me every week. I’m learning to spot when I’m spiralling before I get to the point of hurting myself. I still have bad days. But at least now I know there’s a way through them that doesn’t leave scars.

If You’re Reading This

It’s not weak to make that call. It’s not overreacting. You don’t have to have the perfect words—just say, “I need help.” And you don’t have to do this alone.

Getting Support

If you or someone you know is self-harming:

• Speak to a GP—they can arrange assessment and referral.
• Contact Mind (0300 123 3393) or CALM (0800 58 58 58) for free, confidential support.
• For under-18s, Childline (0800 1111) offers confidential listening.
• Contact me at Male Minds Counselling

Cassim