The tattoos on Zandile Simelane’s arms tell a story that most people can’t read. Hidden beneath the delicate blue ink of flowers and butterflies, small white scars rise, remnants of the time when cutting herself seemed like the only way to express how much she was hurting.”I didn’t want to die,” the now 31-year-oldtoldBhekisisa’stelevision programme, Health Beat, about her teenage self. “I just needed someone to help me through the pain.
A part of me was just screaming — screaming internally to say: ‘What is going on? I don’t know what type of help I need, but help me.’” For Zandile, the pain began in the years after her mother died, when she was a teen. Her mother, she says, was her whole world and home was her safe place — infused with her mother’s energy, it was welcoming, filled with warmth and bursting with life.
After her funeral, Zandile’s life changed completely. She moved in with her father and her stepmother, with whom she didn’t have much of a relationship. It wasn’t long before she was sent off to boarding school in Durban.
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“I’m caught smoking behind the hostel. I’m coming to school drunk,” she recalls. One day, angry and desperate, she pierced her own ear.
Soon, she started cutting herself. “Maybe if I cut myself, something will happen,” she remembers thinking. Maybe the pain on the outside would finally match the pain inside.
Maybe blood would say what she could not. Maybe someone would notice. Eventually, they did.
A roommate saw that something wasn’t right with Zandile and spoke to a teacher. Soon she was in a psychologist’s office and not long after, a hospital bed. Her father arrived from Eswatini in less than two days.
Her pain, she says, was finally heard. And the relief poured out. “I was so grateful about how they responded.” For some teens, emotional pain manifests as self-harm — including cutting, burning, hitting, biting, scratching and picking at skin.
It’s a coping mechanismpsychiatrist Danella Eliasovoften sees in her practice near Hillbrow. “A kid who is cutting themselves or hurting themselves is a distressed kid,” Eliasov told Health Beat. “They’re feeling emotional pain and they’re expressing it almost as physical pain because they’re struggling to express it in words.” But, she emphasises,self-harm is not suicide.
“Self-harm is hurting yourself without the intention to die. You just want to almost hurt yourself … because you’re desperate and don’t know what else to do.” TheDiagnostic and Statistical Manual of Mental Disorders(DSM-5), which is used globally by mental health professionals, classifies self-harm behaviours that occur more than five days in the past year as non-suicidal self-injury disorder (NSSI-D). But, it also notes that NSSI-D is a “condition requiring further study”, meaning it isn’t a fully-established diagnosis.
Researchers have been trying to get a better sense of its prevalence and how it fits in with the criteria outlined in the DSM-5.A 2015 reviewof 16 studies in seven countries found roughly 18% of adolescents engage in self-harm at some point in their lives, though only 1.5% to 7% met the criteria of five days in the past year. The studies found it was more likely to occur in girls than boys, while the average age at which self-harm begins is about 13. But aJanuary 2025 study based in KwaZulu-Natalshowed far higher numbers in South Africa.
From a sample of 636 students aged 12 to 18, about one in four self-harmed for at least five days in the past year. In aSouth African Journal of Educationstudy in 2019, more than half of 623 students aged 13 to 24 said they had self-harmed at some point before, and, of those, 62% first self-harmed at age 13 or younger.
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