Purpose <p>Self-inflicted injuries are a leading cause of death in young adults. Trauma to the anterior neck, such as from cutting and hanging, can have serious consequences given the complex anatomy and closeness of critical structures. Considering the recent increase in intended and inter-personal violence, we evaluated the occurrence and clinical characteristics of self-harm neck injuries in young adults.</p> Methods <p>We retrospectively reviewed all neck traumas treated at the Helsinki University Hospital in patients aged 18 to 30 years in 2005–2023. Patient records were systematically evaluated for cohort demographics, injury type, clinical characteristics, given treatment, follow-up, and possible psychiatric comorbidities.</p> Results <p>In total 169 events were recorded, with an evident increase in the recent years (45% of all in 2020–2023) and particularly in females. Females were younger than males (<i>p</i> = 0.010) and their trauma generally milder, often managed in outpatient care (82%). Severe penetrating injuries occurred primarily in males (<i>p</i> = 0.005) who were older (<i>p</i> = 0.004) and without prior suicidal events (<i>p</i> = 0.005). They required surgical interventions and prolonged in-house treatment. Overall, the cohort was characterized by a heavy burden of psychiatric comorbidities (98%) and substance abuse (53%); 78% had other suicidal events. Four patients (2.9%) deceased from a recorded suicide during the study period.</p> Conclusions <p>We report an alarming increase in suicidal self-harm especially among young females and severe intended neck traumas in older males without preceding suicidal behavior. Our findings warrant timely preventative actions on an individual and societal level and call for refined guidelines for clinical management.</p>