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Self-harm is increasing among young people. Research highlights how engagement with texts, pictures or videos sharing self-harm content online (SCO) may escalate self-harm. However, few studies have examined young people’s experience with SCO in clinical samples. The present study aims to explore how young people who self-harm and are in treatment become and stay engaged with SCO. The data consists of in-depth interviews with 12 young females (15–19 years of age). The analysis follows the steps of Reflexive thematic analysis. Three meta-themes were identified: 1) “Engaging in self-harm content online – A way to get to know oneself,” 2) “Negative consequences and self-reflection – What am I doing to myself?,” and 3) “A need to take charge – I must take care of myself.” Engagement in SCO is discussed as a peer arena to obtain self-knowledge, self-reflection and self-protection in a digital age. Engagement with SCO can trigger self-harm and increase mental health problems but may influence affect regulation and mentalization for young people. Therapists should therefore explore patients’ engagement in digital risks like SCO to understand upsides and downsides of the activity, the difficulties in ending the engagement, and the interconnectedness between challenges in online and offline life.