dranupdhir@hotmail.com 
It's June. Delhi is already at 40+ degrees. And she's wearing a full-sleeved salwar.
You notice. Something crosses your mind. But you don't say anything because what would you even say, and what if you're wrong, and the last thing you want is to make it weird. So you look away. She looks away. The moment passes exactly the way these moments always pass — quietly, without anything being said.
That's the thing about self-injury among young women. It doesn't walk in loudly. It's there in the fabric choices, in the bracelets stacked a little too deliberately on the left wrist, in the practised story about the kitchen knife or the neighbourhood cat. Most people who are standing right next to it have genuinely no idea.
Non-suicidal self-injury, or NSSI, has no intention behind it of dying. The person cutting or scratching or burning herself is not, in that moment, trying to end her life. She might be trying to interrupt an emotional state that has become physically unbearable. Pain works neurologically. It redirects the nervous system. For someone who grew up without any real tools for handling emotional overload, it's the fastest thing available that actually does something. It's not a good solution. It's harmful and it carries real risk.
Self-harm with suicidal intent sits in a different category. The wounds might look the same. They can appear in the same places on the body. But what's happening underneath is different, the person's relationship to their own survival has shifted in a way that changes everything about how serious this is and what kind of response it actually needs.
A parent who treats her daughter's non-suicidal self-harm like an active suicide attempt, surveillance, removed objects, total panic can push the behaviour so far underground that any chance of honest conversation disappears. On the other side, someone who hears "she's just doing it for attention" and drops it there may genuinely miss something that needs urgent help. The distinction isn't academic. It determines what you do next.
About 13.5% of women will engage in self-harm behaviour at some point across their lifetime. For men the figure is 4.3%. So we're talking about roughly one in ten women — not in clinical populations, across the general population. That's not rare. That's someone at most family gatherings, in most friend groups, in most offices.
In 2024, JAMA Network Open published a meta-analysis pulling together 38 studies and data from over 266,000 participants. Across North America and Europe, NSSI showed up at twice the rate in female adolescents compared to male adolescents. A different study, focused specifically on young adults between 18 and 33, put the past-year NSSI rate at just over 14% for women versus under 8% for men.
The age window where this is most concentrated runs roughly from 16 to 30. It doesn't stay in school. It follows young women into university hostels, into their first flats, into relationships. The research does say it tends to peak somewhere around 12 to 15 and then reduces over time, but "reduces over time" still leaves a lot of women in their twenties carrying this privately, under long sleeves, through summer.
If you've seen self-harm scars on someone, they were probably on the inner surface of the left forearm. There's a practical reason and then there's something less practical.
The practical part: most people are right-handed, so the left arm is the one being held still. It's accessible, it's controllable, and it doesn't require any awkward positioning.
The less practical part is harder to pin down. The inner wrist area, close to where the pulse is visible, carries a particular psychological weight for a lot of people. Researchers have noted that injuries in visible locations: forearm, wrist — may be tied to some need for the pain to be acknowledged, for the internal experience to become externally real somehow. Contrast that with injuries on the thighs or abdomen, which are consistently linked to higher repetition rates, probably because the person is working harder to keep the whole thing hidden.
In terms of how the scars look: cutting leaves characteristic marks along the flexor surface of the forearm. Parallel lines, usually. They tend to be hypertrophic — raised above the surrounding skin — or keloidal, depending on the individual's skin type and the depth of the original injury. Over months and years of repeated behaviour, they layer up.
Full sleeves in 40-degree heat. It makes sense now.
When people encounter self-injury, almost everyone's instinct is to react to what they're seeing. Very few people stop to ask what the person was actually trying to do.
In 89% of documented female NSSI cases, the answer is emotional regulation. That phrase is clinical but the reality behind it isn't complicated. The young woman cutting her arm is trying to bring herself back from an emotional state that has overwhelmed her.
The reason this shows up more in women has a lot to do with how girls are raised. There's a specific combination of being expected to feel deeply, being socialised to absorb other people's emotions, and being simultaneously trained not to express distress in any way that inconveniences anyone. That combination, sustained over years, produces someone with an enormous amount of emotional experience and very few ways to actually process it.
There's also a fairly significant overlap with eating disorders — present in around 55% of people who self-injure. That connection makes sense when you think about it. Both involve using the body as a site where internal pain gets managed. Both involve a kind of disconnection from the body as something that belongs to the person rather than something that gets acted upon.
The relief figure is striking too. Around 82% of girls who self-injure report feeling real relief after doing it. That number explains why people don't just stop when they want to. The brain has learned a pattern. It doesn't evaluate the pattern for safety. It just knows the pattern reduces the feeling.
This doesn't come from nowhere. There's almost always a history.
The most consistent background factors are trauma, childhood abuse especially and years of emotional invalidation. Being told that feelings are too big, too sensitive, exaggerated, attention-seeking. Reasons can be romantic loss, isolation, relentless pressure of academic or social performance.
NSSI and suicidal self-harm aren't the same thing, but pretending they're completely separate isn't honest either.
NSSI shows up as a predictor of suicide attempts in the research. It doesn't mean most people who self-injure will attempt suicide, most won't. But it's a signal. The level of psychological pain and emotional dysregulation involved is real, and writing it off as "just NSSI" because the intent isn't suicidal is a clinical error that can have bad outcomes.
Suicidal self-harm has a different character to it. The hopelessness tends to be more settled, not just a bad week, but a genuine absence of belief that things will get better. It often comes alongside withdrawal from people, giving belongings away; things said that sound like goodbyes. The physical injuries are usually more severe, placed more deliberately near vessels or vital structures. There's a quality to the intent that's different even when the surface presentation looks similar.
Between 16 and 22 is where escalation risk tends to be highest. Emotions are at full volume. The skills to handle those emotions are still underdeveloped. Family, academic, and social pressures are landing at the same time. NSSI that's been ignored or dismissed in that environment has a way of not staying non-suicidal.
The responses that reliably make things worse: panicking visibly, issuing ultimatums, removing sharp objects without offering any emotional support, telling her she's doing it for attention, crying in front of her about how worried you are, making the conversation about your own feelings. Every one of those increases shame, and shame is the main fuel. More shame means more hiding, more behaviour, less help.
Dialectical Behaviour Therapy (DBT) has the strongest evidence base for treating NSSI. It was developed specifically for people who feel emotions at an intensity that overwhelms their ability to cope, and who never learned the skills to regulate those emotions. The therapy is practical. It teaches specific techniques: tolerating distress without acting on it, identifying what's happening emotionally, making different choices in the moment of crisis. It takes time. It genuinely works.
Trauma-focused therapy is often needed alongside or after DBT. A lot of women who self-injure have experiences sitting underneath the surface that never got processed. Improving someone's coping skills doesn't dissolve the original material. Addressing both changes outcomes.
What stays, even after everything else has changed, are the marks on the left forearm.
The scars remain after the behaviour has stopped, after the therapy has worked, after the person has moved into a completely different chapter of her life.
They show up every morning when she gets dressed. They show up at the beach and in the changing room and in the job interview when the interviewer's eyes drop to her arms for half a second.
Addressing the scars, for women who are genuinely past the acute phase of their recovery, isn't about erasing history. It's about not being required to carry a visible record of the worst period of your life into every room you enter for the rest of it.
Laser resurfacing works on surface irregularities, pigmentation differences, and skin texture. Corticosteroid injections are effective for flattening raised hypertrophic tissue. Surgical revision is an option when scarring is more extensive or complex. For cases where the tissue quality has been compromised at a deeper level, ADRC-enriched fat grafting can address the structural problem rather than just the appearance of the scar.
What a patient actually wants matters enormously here. Some women want the maximum correction available. Others are looking for something more modest, scars that are softened enough that they stop being the first thing visible, the thing that requires a story. Both goals are legitimate. Both are achievable with the right approach and plastic surgeon.
Dr. Anup Dhir has been practising plastic and reconstructive surgery for over four decades. At Image Medical Center in Nehru Place, New Delhi, he works with patients across a wide range of complex scar presentations, including women dealing with the particular kind of forearm scarring that comes from years of self-harm.
His work with ADRC-enriched fat grafting — a technique he has been involved in developing and refining in India — is especially relevant here. With scarring that goes deeper than the surface, a treatment that supports tissue repair from within produces different results than one that only addresses what's visible externally.
Dr. Anup Dhir was the first plastic surgeon in India accepted as an international active member of the American Society of Aesthetic Plastic Surgery. He has 40 years of experience behind him, and he understands that patients who come in with self-harm scars are not simply asking for a cosmetic procedure. They've done something hard to get to this point. The consultation should reflect that.
A scar is proof of something you survived. It doesn't have to be the thing that introduces you to every room.
Leave a request to connect to Dr. Anup Dhir for an Appointment.