Self-injurers frequently harm themselves in private and hide their injuries (e.g., scars, burns) from others or make excuses for them. This makes it difficult to determine whether self-injury is actually occurring. However, sometimes it is possible to witness the act itself.

Additional signs of self-injury include:

• Frequent injuries (cuts, burns, bruises, broken bones) with suspicious excuses
  
  
• Cuts or scars that are usually short and appear precise or controlled
   
• Similar scars in various stages of healing
  
  
• Wounds that do not appear to heal
  
  
• Noticeable hair loss on the scalp, eyebrows or beard
  
  
• Inappropriate clothing worn to conceal the skin (e.g., long sleeves in warm weather)
  
  
• Blood stains on clothing
  
  
• Long periods of personal isolation, after which new injuries are evident
  
  
• Knife or razor in purse or book bag
  
  
• Difficulty talking about feelings
  
  
• Relationship problems
  
  
• Poor functioning at home, work or school
  
  
• Low self-esteem, extreme self-criticism