Self-harm is a prevalent and complex problem that primarily affects adolescents and young adults [1,2,3,4,5]. In 2007, there were an estimated 77,024 injuries treated in U.S. emergency departments for self-harm that involved cutting or piercing [6], the most common forms of self-harm [7]. However, most youth who harm themselves in the U.S. do not seek treatment [8]. Suicidal behaviors, that is self harm with the intent to die, is less prevalent than self-harm without the intent to die [9]; however, the behaviors are complex and interrelated [10]. An estimated 70% of adolescents who engage in repetitive self-harm also attempt suicide [11]. In one survey 9.7% of adolescents reported having ever attempted suicide [12] and the estimated lifetime prevalence of self-harm ranges between 13.0% and 23.2% [3], although a higher prevalence (46.5%) has been reported [13]. A recent study of middle school students found that 28.4% reported self-harm in the past year [14].
