Alexandra Van Rijn was in elementary school when she started banging her head against a wall to deal with her anxiety.
In her late teens, when she was inflicting burns and cuts on herself, she decided to seek help.
"I got to a point where I didn't want to be doing it anymore," the 22-year-old Fredericton woman said in an interview.
"So I started making a lot of positive changes in my life."
Self-harm and self-injury are the terms used when people purposely burn or cut themselves, bang their heads against walls or physically hurt themselves in other ways without suicidal intentions.
And in New Brunswick, self-harming that results in hospital visits happens at a higher rate than in Canada as a whole.
Starts with stress
Rijn was 19 when she got help and has not engaged in self-harming for three years.
Rice Fuller, a psychologist and director of UNB Fredericton counselling services, said that often self-harm starts when people don't know how to cope with deep emotional stress.
"We understand it as a coping mechanism — that people will engage in that type of behaviour as a way to deal with emotional pain or extreme anxiety or just extreme emotional distress."
Self-harm is not considered a mental illness but a behaviour and is more common among adolescents and university-aged people.
The New Brunswick Department of Health says that for the years 2009 through 2014 the province saw an average 17 per cent more self-injury hospital admissions than the Canadian average.
In 2013-2014, the Canadian Institute for Health Information found there were 72 hospital admissions in New Brunswick because of self-harm per 100,000 people, compared with the national average of 67. The year before, there were 81 hospital admissions per 100,000 people, compared with a national average of 66. The institutes's statistics apply only to patients 15 years or older.
The New Brunswick Health Department suggested in an email to CBC News that it is honing an action plan to better address problems such as self-harming behaviour.
Sarah Bustard, a spokesperson for the department, said it is collaborating with Education and Early Childhood Development, Justice and Public Safety, and Social Development to expand what it considers "our extremely successful" model for serving children and youth with emotional, behavioural and mental health problems.
Rijn is now a model and an executive assistant at Wear Your Label, a clothing company that donates part of its proceeds to mental health initiatives. She said she hopes to spread the message to self-harmers that they're not alone, and there are resources that can help them.
"It's difficult to be that vulnerable with them," said Rijn, who has been invited to share her experience at conferences. "But for me, what pushes me to do it is even if I make a tiny difference in one person's life then it's totally worth it."
Rijn believes now that she self-harmed because she didn't know how to deal with her anxiety.
She said she was afraid to get help because there was a stigma surrounding self-harm, and she was afraid of being judged.
That's a common fear, Fuller said, and self-harmers even worry about telling loved ones.
"People not in mental health, people's reaction can be one of shock or horror," he said. "We know this type of response is not helpful."
Rijn was fortunate. When she confided in close friends and family, they encouraged her to seek help and counselling, which she did.
She will soon head to Dalhousie University to take part in a panel on mental health. Rijn said she appreciates being able to talk to people.
"If I could define it in one word, it's empowering, really empowering, talking about and being able to reach people who might be in a place that I was in five years ago," said Rijn.
Fuller said that anyone who believes a loved one is self-harming should be as practical and forthcoming as possible, letting the person know help is available.