This study compares the self‐reported family functioning of 21 adolescents presenting at four UK medical wards with self‐harming behaviour with those obtained from a sample of adolescents drawn from the local community. Adolescents hospitalized for self‐harm reported that their families were more dysfunctional than healthy controls on the family perceptions scale. However, this difference was not observed when covariates such as emotional and behavioural distress were controlled for. Poor levels of agreement between adolescents and adult family members in relation to family perceptions were also observed. The findings suggest that adolescents who engage in significant self‐harm perceive impairments in their family functioning. These reported impairments may be the result of concurrent emotional and behavioural distress or some form of interaction between family functioning and distress. A comprehensive family assessment to detect absolute changes and disparities in perceived family functioning may therefore help guide family interventions in this context. Practitioner points Adolescents who are hospitalized for self‐harm report significant impairments in family functioning compared with healthy controls. Adolescent and adult family members appear to disagree on the degree of impaired family functioning. A comprehensive family assessment may therefore help guide family interventions in hospitalized adolescents. 自残青少年对家庭功能的理解 本研究对比了来自当英国地社区的21位由四个内科病房报告出的有自残行为的青少年对家庭功能的自我报告。这些因为自残而住院的青少年陈述表明他们的家庭在家庭印象量表上比健康控制下的家庭呈现出更多的 功能不良。 然后, 再控制情绪和行为痛苦这些协变量之后, 这些不同不复存在。针对家庭印象方面, 青少年和成人家庭成员间的理解也被观察到很不统一。这些发现表明存在严重自残行为的青少年认为他们家庭的功能是不可修复的。 这些报告出的不可修复感可能就是同时存在的情绪和行为痛苦的结果或者可以说在家庭功能和痛苦方面存在相互作用。在这样的背景下, 更全面的家庭评估以用于探查再家庭功能认知方面的绝对的改变和差距可能对指导家庭干预有帮助。 对实践者有用的几点建议 因自残行为住院的青少年, 和健康控制下的家庭对比, 报告出更严重的在家庭功能方面的不可修复感。 针对家庭印象方面, 青少年和成人家庭成员间的理解被观察到很不统一。 更全面的家庭评估以用于探查再家庭功能认知方面的绝对的改变和差距可能对指导家庭干预有帮助。 关键词：自残；年轻人；家庭功能；家庭理解；以解决方案为导向的家庭治疗