This case study focuses on a 14-year-old girl presenting with self-harming behaviours, reported as a means to cope with deep emotional emptiness. Despite high academic achievement and advanced language skills, her clinical history reveals long-standing difficulties in social interaction, behavioural rigidity, sensory sensitivities and motor stereotypies dating back to early childhood. Upon entering high school, she experienced a decline in academic performance, feelings of inadequacy and somatic complaints (chronic headaches), while she maintained a perfectionist and emotionally guarded stance that led her to refuse psychotherapy. The clinical picture suggests the importance of looking beyond self-harm as a primary symptom to investigate potential underlying neurodivergent traits, such as high-masking Autism Spectrum Disorder.