Introduction: Self-harming behavior is prevalent both in community and in clinical population of adolescents. Potential negative outcomes of such behavior range from low quality of life, academic failure, development of mental health problems in later life to risk of suicide attempts and completition. Broadening and deepening of understanding of psychopathological and enviromental background and function of self-harming behavior is needed. Main goal of this study was identification of psychopathological features in referred adolescents with self-harming behavior which differentiate them from referred adolescents who do not engage self-harming behavior. Data provided with this study could be used in planning, preparing and conducting optimized treatment programs for adolescents and their caregivers, on primary and secondary prevention and treatment levels. Materials and methods: During their initial interview with an child and adolescent psychiatrist adolescents filled out self-rated questionnaires. General questionnaire (with detailed family history), Youth Self Report, (ASEBA, 2001.), Functional Assessment of Self Mutilation (Lloyd E.,1997) - Adapted and modified, Parental bonding instrument (Parker, 1979.), Toronto Alexithymia Scale 20 (Taylor, 1992.) and Defense Style Questionnaire (Bond, 1983.). One hundred and fifty adolescents, 54% female, 46 % male (14–18 years old, median age 17 years) participated in the study. Exclusion criteria were psychotic disorders, cognitive impairment, pervasive spectrum, psychiatric emergency. They were assigned to two groups according to self-harming status. In the self-harming group there were 24 males i 55 females, and in the non self-harming group there were 45 males and 26 females. Results: Self-harming behavior among females, compared to non self-harming group, corelates with low parental, especially paternal, care, commorbidity of depressive and externalising problems (clinical level on all YSR problem scales, except aggression), poor peer relationships, usage of immature defense mechanisms, and latent alexithymia. Self-harming behavior had negative interpersonal function. Self-harming behavior among males was correlated with maternal chronic illnes, maternal overprotection, commorbidity of externalising and latent internalising problems, usage of immature defense mechanisms, significant alexithymic difficulties, poor peer functioning. Self-harming behavior had positive interpersonal and identity and identification seeking function. Predominant parental style in both groups with self-harming behavior was affectionless control. Clinical levels of YSRs’ Total problems scale were found in both gender. Conclusion Self-harming behavior is prevalent among adolescents. Affected adolescents carry heavy psychopathological burden, with a risk for numerous negative events and outcomes including fatality. It has diverse, individually specific manifestations and functions which complicates research, understanding and clinical work. Hence, there are no specific, standardized preventive measures and treatment strategies developed yet. Interventions dealing with self-harming behavior should encompass multidisciplinary and multilevel approach, significant others need to be actively included in the process. Close follow-up and availability of help is needed because of the suicidal risk.