How to understand self harm (teenagers)

By Luna Greenstein

Self-harm is difficult to understand because it goes against the natural human instinct of self-preservation. Maybe that’s why some people react to it in a negative, judgmental way. They can’t imagine ever being in a state of mind where they would hurt themselves, so they can’t understand why anyone else would.

This lack of understanding can lead to insensitivity and stigma towards people who are often already struggling with serious emotional turmoil. Self-harm is usually a sign that a person is having a tough time coping with their emotions. It’s frequently “used” as a coping mechanism for unmanageable mental health symptoms, although the experts don’t completely understand why some might self-medicate with drugs or alcohol, while others self-harm.

Several mental health conditions are associated with self-harming behaviors, including borderline personality disorder, depression, eating disorders, anxiety or posttraumatic distress disorder. People experiencing these conditions might self-harm for one or more of the following reasons:

  • To help manage unbearable emotions and symptoms
  • To help regain a sense of feeling (for those experiencing numbness)
  • To help relieve stress and pressure
  • To help feel in control
  • To reenact a trauma in an attempt to resolve it
  • To protect others from emotional pain

Any person can self-harm, but the largest percentage of people who engage in these type behaviors are teenagers (17.2%) and young adults (13.4%). According to psychologist Dr. Jennifer Muehlenkamp, “Those are the key ages because youth are experiencing multiple changes at the same time. They’re becoming more independent and transitions such as from junior high into high school or to college creates a lot of change. There’s a lot of new stress and pressures.”

What Should I Do?

Self-harm seems to provide some level of relief from emotional pain, and can become addictive. Like alcohol and other drugs, self-harm is a behavior that a person might feel they need increasingly more of to feel the same effect. It could also lead to other self-destructive coping mechanisms. So, if you or someone you know self-harms, here are a few first steps you can take to change this behavior.

Seek Treatment

Self-harm is a serious mental health symptom that requires evaluation and treatment. If you are having difficulty coping with intense emotions without the use of self-harm, consider talking with a mental health professional about one of the following treatment methods:

  • Cognitive behavioral therapy (CBT) focuses on recognizing negative thought patterns and increasing coping skills.
  • Dialectical behavioral therapy (DBT) helps a person learn positive coping methods.
  • Psychodynamic therapy identifies how negative behaviors have been caused or influenced by past experiences and unresolved feelings.

Practice Positive Coping Mechanisms

It’s helpful to understand what triggers you (or your loved one) to self-harm. That way, you can implement healthy coping mechanisms to manage those triggers. Some examples are:

  • Direct the urge at something else – Use a punching bag, scream into a pillow or rip up a magazine
  • Self-soothe – Take deep breaths, take a bath or try meditation
  • Express yourself – Write how you feel or write creatively
  • Create something – Paint, draw or craft
  • Focus on music – Listen to your favorite song or play an instrument
  • Exercise – Run, dance or just go for a walk
  • Avoid alcohol and drugs – Substances can lower your self-control and increase risk of self-injury

Self-harm is a challenging mental health symptom to overcome—and lack of understanding only makes it that much more difficult to work through. When it comes to serious mental health symptoms like self-harm, we need to show others and ourselves compassion rather than judgement. There is no shame in needing support and help.

Learn more about self-harm during NAMI’s Ask the Expert Webinar on Thursday, March 1.
Click here for more information on the webinar and to register!

Laura Greenstein is communications manager at NAMI.

Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.

Adah Chung is a fact checker, writer, researcher, and occupational therapist.

Cutting is a type of self-harm in which teens deliberately cut or scratch themselves with knives, razor blades, or other sharp objects, but not with any intention of trying to commit suicide.

Other self-harm behaviors can include head-banging, branding or burning their skin, overdosing on medications, and strangulation.

These behaviors are more common than you might think with an estimated range of 6.4% to 30.8% of teens admitting to trying to harm themselves.  

Why Teens Cut Themselves

Parents and pediatricians often have a hard time understanding why teens would cut or do other things to harm themselves. Not surprisingly, cutting is a complex behavioral problem and is often associated with a variety of psychiatric disorders, including depression, anxiety, and eating disorders.   Teens who cut themselves are more likely to have friends who cut themselves, low self-esteem, a history of abuse, and/or thoughts of committing suicide.

While it is sometimes seen as an attention-seeking behavior, cutting is a way for kids to release tension, relieve feelings of sadness or anger, or distract themselves from their problems.

Of course, any relief is only temporary. While some teens who cut may have a friend who cuts or may have read about it or seen it on TV, most kids who start cutting say that they were not influenced by anyone or anything else and came up with the idea themselves.

Signs of Cutting

Cutting is most common in teens and young adults—especially among teen girls—and often starts around age 12-14.  

Teens who cut themselves are usually described as being impulsive. Some are also described as being overachievers.

In terms of warning signs and red flags, your teen may be cutting if she:

  • Always wears long-sleeved shirts or long pants (even when the weather is warm) to cover new cutting marks or older scars on her arms, wrists, or thighs (those are common areas of the body where cutting occurs)
  • Routinely has suspicious cuts, scratches, or burns on her belly, legs, wrists, or arms
  • Is developing symptoms of depression, anxiety, or alcohol abuse  
  • Has trouble controlling her emotions (like if your teen doesn’t know how to handle herself when she feels sad or angry)

If you think that your child is cutting, ask them about it gently. If the answer is yes, it’s important not to get mad or overreact. You don’t want to make them feel bad for doing it. Keep in mind that cutting is often a symptom of a larger problem, and you, as a parent, can help your child figure out the underlying cause by seeking professional help (more on that below).

Treatments

It is critical to seek treatment for your teen right away if she is cutting, both to help treat any underlying psychiatric problems, like depression or anxiety and to prevent cutting from becoming a bad habit. The longer a teen cuts herself, the harder it becomes to break the habit.

Cutting can also lead to more problems later in life. In fact, the S.A.F.E. Alternatives (Self Abuse Finally Ends) treatment program describes cutting as ‘ultimately a dangerous and futile coping strategy which interferes with intimacy, productivity, and happiness.’

These are some forms of treatment that may help your teen quit cutting and learn healthier coping strategies.

Psychotherapy

Teens who cut should be evaluated and treated by counselors or psychologists who have experience in treating teens with this particular condition. These types of professionals are skilled at talk therapy and can provide a safe, non-judgmental space in which your teen can speak openly about the problems that she’s facing.

Remember, it can sometimes be hard for a teen to completely open up to a parent, so talking to someone who is removed from their everyday lives might be easier for your child.

Psychiatry

An evaluation by a child psychiatrist (a medical doctor who can prescribe drugs) might also be a good idea for further treatment ideas, which might include antidepressants when necessary.

Treatment Center

You might look for a treatment center in your area that specializes in cutting. The name of the treatment center might include the phrases “self-harm,” “self-injury,” or “self-mutilation.”

Support Group

Your teen might also find help by joining a self-harm support group. Meeting others who cut might help her feel less alone and might help her learn how others have successfully stopped cutting themselves.

Treatment for cutting will likely focus on helping the teen develop healthier coping mechanisms when faced with feelings of anger, stress, or sadness. It will also help boost a teen’s self-esteem, help manage any underlying psychiatric problems, and help make sure that the teen isn’t having thoughts of suicide.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Self-harm is reaching epidemic proportions in the UK.

Posted September 4, 2015

THE BASICS

  • What Is Self-Harm?
  • Find a therapist near me

How to understand self harm (teenagers)

Acts of self-harm such as self-cutting may be carried out for a variety of reasons, most commonly to express and relieve bottled-up anger or tension, to feel more in control of a seemingly desperate life situation or to punish oneself for being a “bad” person.

For some people, the pain inflicted by self-harm is preferable to the numbness and emptiness that it replaces — it is something rather than nothing, and a salutatory reminder that one is still able to feel, that one is still alive. For others, the pain of self-harm merely replaces a different kind of pain that they can neither understand nor control. Acts of self-harm reflect deep distress, and are most often used as a desperate and reluctant last resort — a means of surviving rather than dying, and sometimes also a means of attracting much-needed attention.

In general, it appears that teenagers, particularly teenage girls, are at the highest risk of self-harm. Perhaps this is because older people are more adept at dealing with their emotions, or because they are better at hiding their self-harming activity. It may also be because older people may only self-harm indirectly, for instance, by misusing alcohol or drugs.

Self-harm is reaching epidemic proportions in the U.K. In a speech delivered to the Mental Health Conference in January 2015, the then Deputy Prime Minister Nick Clegg claimed that emergency departments see 300,000 cases of self-harm each year. This in itself is a gross underestimate of the true incidence of self-harm, as the vast majority of cases do not report to the hospital.

According to the British Psychological Association and The Guardian, the most recent Health Behaviour in School-Aged Children (HBSC) report is due to reveal that of 6,000 young people aged 11, 13, and 15 surveyed across England, about 20 percent of the 15-year-olds reported self-harming within the past 12 months.

The last similar survey of self-harm in England, published in the British Medical Journal in 2002, surveyed 6,020 pupils aged 15 and 16. At the time, “only” 6.9 percent of the pupils reported self-harming within the past 12 months, compared to about 20 percent in the 2013-14 HBSC study.

The vast majority of cases of self-harm that present to the hospital involve either a tablet overdose or self-cutting, although self-cutting is much more common in the community at large. Occasionally, other forms of self-harm are also seen, such as banging or hitting body parts, scratching, hair pulling, burning and strangulation. The drugs most commonly involved in tablet overdoses are painkillers, antidepressants and sedatives.

According to the most recent report on self-harm in Oxford, England, of those people who present themselves to the hospital, about 25 percent report high suicidal intent, and about 40 percent are assessed as suffering from a major psychiatric disorder excluding personality disorder and substance misuse. This suggests that many people who self-harm are not in fact mentally ill.

The problems most frequently cited at the time of presentation are problems with relationships, alcohol, employment or studies, finances, housing, social isolation, physical health, bereavement, and childhood emotional and sexual abuse.

For some people, self-harm is a one-off response to a severe emotional crisis. For others, it is a more long-term problem. People may keep on self-harming because they keep on suffering from the same problems, or they may stop self-harming for a time, sometimes several years, only to return to self-harm at the next major emotional crisis.

THE BASICS

  • What Is Self-Harm?
  • Find a therapist near me

Self-harm is generally believed to be rare in many non-Western countries, suggesting that it is in fact a culture-bound syndrome. Foreign doctors often claim never to have seen a case of self-harm prior to working in the UK.

The testimony of Dr. Eric Avevor in The Psychiatrist is fairly representative:

The subject [of self-harm] was hardly mentioned, let alone taught, as a topic throughout my undergraduate medical training in Ghana. In my medical school clinical years and throughout my work as a house officer in the largest teaching hospital in Ghana, I never saw or heard of a single case of self-harm. I later worked as a medical officer (hospital-based general practice) in a busy district hospital for three years and here too I never encountered such a case…I had a cultural shock in my first psychiatric senior house officer post in the U.K. when I quickly realised that self-harm was the ‘bread and butter’ of emergency psychiatric practice.

Self-Harm Essential Reads

Have You Talked to Your Teen or Tween About Self-Injury?

Talking About Self-Injury

As Dr. Avevor concedes, this stark difference could owe to the under-reporting of cases in Ghana. But even if very common, under-reporting seems unlikely to account for the full difference.

Neel Burton is author of The Meaning of Madness and other books.

Find Neel on Twitter and Facebook.

How to understand self harm (teenagers)

Speech by the Deputy Prime Minister to the Mental Health Conference delivered on 19 January 2015. Transcript: https://www.gov.uk/government/speeches/nick-clegg-at-mental-health-conf…

The British Psychological Society (2014): Teen levels of self-harm on the increase. News item published on 23/05/2014. http://www.bps.org.uk/news/teen-levels-self-harm-increase

Bacino L (2014): A World Health Organisation survey reveals that a fifth of 15-year-olds in England say they self-harmed over the past year. The Guardian, May 21, 2014. http://www.theguardian.com/society/2014/may/21/shock-figures-self-harm-…

Hawton K et al. (2002): Deliberate self harm in adolescents: self report survey in schools in England. British Medical Journal 325:1207.

Avevor, ED (2007): Self-harm—a culture bound syndrome? Ghana and UK experience. The Psychiatrist 31(9):357.

Tips for supporting your teenager

There are a number of things that you can try to help your teenager with self-harm. If you’d like to understand more about self-harming behaviour, read our fact sheet on self-harm and teenagers.

Otherwise, see below for some ideas on what you can do to help your teenager find other coping skills.

How to understand self harm (teenagers)

Seek medical attention for self-harm

Learn how to help your teenager seek medical attention for self-harming behaviour.

How to understand self harm (teenagers)

Talk about self-destructive behaviours

Learn how to talk to your teenager about self-harm and potentially destructive behaviour.

How to understand self harm (teenagers)

Positive coping skills for self-harm

Learn how to support your teenager to develop positive coping skills to prevent self-harm.

How to understand self harm (teenagers)

A parent’s story about self-harm

Read Rick’s story about his son Carl who was self-harming.

How to understand self harm (teenagers)

A teenager’s story about self harm

A teenager learns the importance of trust after eventually opening up to her mother about self harm.

Page last review by ReachOut Parents Clinical Advisory Group on 14/04/2016

Damaging your body may be a way to control negative emotions. New research from UiO shows that young people also use self-harm to communicate and share difficult feelings, which they are unable to express in words.

Most research on self-harm has been based on the researcher’s description of adult patients. Psychologist Line Indrevoll Stänicke at the University of Oslo wanted to bring out the youth’s own explanations to get a better understanding of the young patients’ ailments.

“From the studies of adults we know that self-harm may be a form of communication. Our new findings, from a systematic review of studies, show that young people believe self-harm to express feelings they think they must hide. To hurt yourself becomes a way of sharing difficult emotions they believe no words can describe”, says Stänicke.

The youngsters in the study describe an overwhelming pressure and intense frustration, which they think they must escape, and which they can’t show others. They are afraid these emotions will be problematic for others to cope with.

“When adolescents believe the society don’t want to hear of difficult feelings or experiences, they may seek other channels to express them, such as their own body, says the researcher.”

Conflict between processing and care

Stänicke finds that youths relate self-harm to current dilemmas in their everyday lives with their closest relations.

“We should understand self-harm as a way of resolving conflicts between a need of processing and expressing emotional experiences and a craving for care. They may surpress difficult emotions to ensure that they are cared for.”

Young people are often in the age of 12-13 when they begin with self-harm, a period of major changes in body, emotions and social relationships. It might be vital to view self-harm in this context.

“Everything they faces in this period of life can create big challenges for the individual and the family. For some youngsters, impulsiveness, border testing and risk behavior may be a way to deal with their experiences. Young self-harmers need support and care, and to be seen and heard. In addition, they have to realize they need help and what is the best help for them.”

Mostly girls

Stänicke explains that serious self-harm may be associated with mental illness such as depression, anxiety, substance abuse, eating disorders and personality disorder. Self-harmers have a higher risk of committing suicide, an important reason to pay particular attention to this group.

“It is important to grasp this behavior and learn how we can help. When approximately 10 percent of the adolescents—mostly girls—are experienced in hurting themselves by cutting, scratching or hitting themselves, it is natural that there are large individual differences in this group. Some struggle with mental or relational difficulties in periods of life, but manage to quit self-harming on their own. For others, self-injury can be repetitive and comprehensive, as part of or in addition to a mental disorder. The latter group will need intensive treatment”, the researcher says.

Grown-ups should open up

She emphasizes that researchers already have knowledge of treatment methods that are effective and adapted to youths, but points out that there is no treatment method that helps everyone.

“I have interviewed young people about their own experience of self-harming and I asked them what about the treatment that was most useful. I have also investigated if there are some important differences between the answers. This knowledge is principal to those meeting the youngsters in a way that the patients feel understood and accepted. If self-harm is a way of expressing and sharing difficult experiences, it’s crucial that the adults create opportunities for—and are not afraid of—addressing the problems that may be the cause of self-harming behavior.”

Among young people in treatment, there will be some who wants to quit hurting themselves, while others may lack motivation because they feel that they have found a “final solution” to everything that feels difficult, according to Stänicke.

“By exploring the difficulties of self-harm, they may become more motivated to find other ways to endure and master what feels so overwhelming, frustrating and incomprehensible to them.”

Understanding of mental disorders

Stänicke points out how young people interpret actions such as self-harm, and words such as depression, anxiety and low self-esteem. Such actions and words may have an expanded and changed meaning for youths today compared to previous generations.

“Today’s youth have access to all the information in the world about mental problems and disorders. They express and use words differently from psychologists. For example, if a young girl says she feels depressed, it does not necessarily mean that she suffers from depression in clinical terms.”

The extent of self-harm among teenagers increases, especially among young girls. The researcher stresses that these actions must be viewed in the light of cultural opportunities and limitations to express experiences, thoughts and feelings.

There are many known risk factors for self-harm, including mental illness, substance abuse and alcohol abuse, low socioeconomic status, sexual orientation, as well as negative experiences such as trauma, sexual abuse, violence and bullying, according to Stänicke.

Increased insight means better treatment

However, the risk factors are quite general and could be attached to disparate ailments and disorders. Consequently, it’s essential to obtain knowledge about a young person’s severe experiences; abuse, difficult family relationships or bullying, or if they have friends who are self-harmers.

“I study the connection between self-harm and individual life stories, their current situation and psychological conditions. In the interviews, I investigate young people’s experience of the way in and out of self-harm. What made them start and what helped them quit? We also collect data on diagnosis, methods and frequency of self-harm, as well as the ability to mentalize. We are looking for important individual differences in the development of personality and self-image. We hope to be able to group self-harmers into subgroups and hence adjust the treatment more individually”, says Stänicke.