The association between communication with parents & self-harm in 14-19-year-old adolescents was examined. 52 adolescents presenting to the emergency department were compared with 52 hospital-based controls. The absence of a family confidant was very strongly associated with adolescent self-harm, even after controlling for a wide variety of possible causal factors. The effect of poorer communication on self-harm was strongest in the group with an internal locus of control. (18 refs.)