WARNING: This article includes subject matter that may be disturbing to some readers
The month of March is synonymous with spring-time, of the equinox, when both of the Earth’s hemispheres bathe in the light of the sun, a time of hope, of rejuvenation, and of nature’s new growth. However, for many teenagers who self-harm, who cut and burn themself in secret, hidden places away from their parents’ prying eyes, this month is no different from any other. The internal chaos, hard to either rationalize or vocalize, never sees the sun, and never stops for them.
“When wounds are healed by love, The scars are beautiful.” – David Bowles, U.S. poet, writer, and author of “Shattering and Bricolage”
March is also “Self-Harm Awareness Month,” recognized internationally now for over a decade, across the U.S., Canada, and the majority of western Europe aims to spread knowledge, encourage education, and end the stigma and shame associated with the behavior for those teenagers and adolescents who feel it is their only refuge.
Over 2 million cases, predominantly young people, and with teenage girls being the majority, are reported annually in the U.S. alone. According to reputable studies including the assimilation of over 40 countries’ community-based data:
- Around 17% of all people will self-harm at some point in their lifetime
- 90% of self-harm begins in adolescence
- The average age for self-harm to begin is only 13, which appears to align with the possible emergence of mental health disorders, such as depression and anxiety
- 45% cut themselves as a method of self-harm
- Self-harm is more common among teenage girls, leading to the gender-based stigma that girls who self-harm are attention seekers
- Rates of self-harm are increasing; there has been a 50% increase in ER visits among young women since 2009
Self-Harm: The Complete Guide for Teenagers & Parents
Teenagers who use self-harming behavior as a coping mechanism may not even bother wondering why they are doing it in the first place – they may only know that it brings a relief, if only a temporary one, to the seemingly endless way they are feeling.
The parent who discovers that their child, their teenager, is self-harming may well be at a complete and utter loss as to why their son or daughter is doing such a thing. The only reality will be the immediate reaction and consuming states of both panic and confusion.
This article is intended as a complete as possible informative guide for both teenagers who engage in self-harm, and their parents, with, among other information, accompanying advice about symptoms, diagnosis, associated mental health conditions, available treatments, and more appropriate coping mechanisms for the teenagers themselves.
“People use self-injury in a lot of ways that other people use drugs or alcohol, or food or sex…to try to feel better in the short run.” – Janis Whitlock, Cornell University research scientist, Ithaca, N.Y. and co-author of “Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones”
What is Self-Harm?: The Clinical View
Self-harm, also known as self-injury, is medically defined as Nonsuicidal Self-Injury Disorder (NSSID). However, it is yet to be regarded as a diagnosable mental health condition. At present, the American Psychiatric Association (APA) has NSSID listed as one of the “Conditions for Further Study” in the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), meaning that it may become a diagnosable mental health condition in the future.
According to DSM-5, NSSID involves symptoms including:
- Engaging in self-harm on five or more days over the last year
- The absence of suicidal intent
- Self-injuring to find relief from an unwanted feeling, solve a relationship conflict or create a desired feeling
- In general, self-harm involves unwanted feelings like depression, anxiety or anger, an intense focus on completing the behavior, and frequent thoughts of self-injury
Although self-harm could be viewed as a “fringe condition,” not clinically regarded as a diagnosable mental health condition, with around 2 million cases reported annually in the U.S., it is more common than actually realized. Possibly one reason for this lack of awareness around the self-harm is that the sufferer can easily hide or explain away their injuries. In fact, part of the “appeal” of the condition is the level of secrecy associated with it.
There are countless ways in which teenagers and adolescents can engage in self-harm, but the most common is cutting the skin with razor blades or pieces of glass. Injuries can range from moderate to severe. The most common forms of self-harm include:
- Skin cutting: 70-90%
- Headbanging/hitting: 21-44%
- Flesh burning: 15-35%
Other forms of self-harm include:
- Scratching or picking scabs to prevent wounds from healing
- Poisoning or overdosing on medications that not harmful
- Pulling out one’s hair, eyelashes, or eyebrows with the intention of hurting oneself
- Inserting objects into one’s body
Self-Harm: Signs & Symptoms
Obviously, with the need for secrecy associated with this condition on the part of the sufferer, it is accepted that identifying the signs and symptoms of self-harm is often difficult. However, for the parents, other family members and friends of teenagers who they suspect may be resorting to self-harm, such signs and symptoms can include:
- Consistent injuries: The consistent injury, such as cuts, burns, bruises and scabs to arms, legs or other parts of the body
- Overdressing: In particularly warm weather, those who self-harm may wear coats, hats, scarves, long sleeve shirts or pants to hide recent marks on their body
- Repeatedly making excuses: Constant excusing of why or how they got injured
- Avoidance, isolation and social withdrawal: Normally from sports, activities and relationships they have previously enjoyed
- Cutting / Burning Implements: Finding razors, pocket knives and other sharp objects, cigarette lighters, matches, and other implements that could cause harm
- Other psychological signs: Changes in sleeping and eating patterns, hiding or washing their own clothes separately, avoiding situations which exposed their arms, eg, swimming, and a dramatic drop in performance at school or work, among others
- Emotional warning signs: It is also important to remember emotional warning signs, such as difficulty handling emotions or relationships problems
Why Do Teenagers & Adolescents Self-Harm?
For a parent of a child or teenager, or another observer, self-harm is an utterly confusing condition, seemingly impossible to understand, and easily the most common response is usually “WHY?” Many people, including parents, have a hard time talking about self-harm because it seems so completely unnatural to them. Therefore, it is important to understand what can actually motivate a teenager to harm and hurt themselves.
“I knew it was wrong and I knew it was harming me, but it was kind of nice. After I had cut myself or burned myself, then I felt really numb and calm for a few hours. That was really nice compared to the chaos that I felt all the time.” – Cassandra Waldbauer, at just 12 years old
Firstly, and importantly, not all teenagers do it for the same reason, and, by far, the best way to help your teenager is to help him or her address the underlying issues of the behavior. Always remember that when someone self-harms, they do not intend to die. It is not a suicide attempt.
Important: However, and there is no way to sugar-coat this, persistent self-harm,
if left untreated and possibly involving a mental health disorder, including substance
addiction, can often lead to a serious suicide attempt.
Self-harm is primarily a coping mechanism, however misguided, as a parent, you believe that to be. For many, it is a way of coping with intense emotions, stress, and anxiety. For others, it is a way of disassociating themselves from their problems – a distraction from this emotional pain. In fact, research has shown that self-harm can activate different chemicals in the brain which can then relieve an intense emotional state, although this is only for a short period of time.
Other motivations or reasons behind teenage self-harm can include:
- Reducing tension
- Alleviating anger
- Punishing themselves because of self-loathing / self-hatred
- Getting help from or showing their distress to others
- Escape a lack of feelings
Are There Predictors of Teenage Self-Harm?
There is not one absolute predictor of the possibility of self-harm, but the following do increase the risk of the behavior in teenagers:
- Mental health disorder
- Addictive behavior/substance abuse
- Abuse or neglect (past or present)
- Relationship loss (e.g. deaths, break-ups)
- Past episodes of self-harm
- Excessive self-criticism
- Family members or friends who self-harm
Is There a Link Between Self-Harm & Diagnosable Mental Health Disorders?
Many parents will obviously wonder if their teenager’s self-harm is an indication of a possible mental health disorder, either now or in the future. Studies agree, and have shown there can be a discernible link between certain mental health disorders – most commonly, depression, anxiety, bipolar disorder, borderline personality disorder, and PTSD (post-traumatic stress disorder).
Furthermore, a 2016 study carried out by the Karolinska Institute, Stockholm, and Stockholm’s Department of Clinical Neuroscience, Sweden, found that in a follow-up of self-harming 18-24-year-olds admitted to hospital were at an increased risk of developing a mental health disorder later in life.
Dual Diagnosis: Self-Harm & Substance Abuse
Self-harm behavior, substance abuse disorder (SUD), and alcohol use disorder (AUD) are all forms of self-medication, albeit addictive and possibly dangerous ones in their own right. Because teenagers and adolescents are under pressure academically, and, at that stage in their development, will have poor impulse control, peer influences (both good and bad), and underdeveloped brains (the human brain doesn’t reach maturity until the age of 25), a form of self-medication can be appealing to them.
Not only does the act of self-harm have particularly addictive elements to those who do it, but teenagers are also at an age when it is accepted they will, in all probability, experiment, or at least try social drugs and alcohol.
A study of co-occurring self-harm and substance abuse (also known as dual diagnosis) carried out by Oxford University, England, found that 8.7% of people who deliberately self-harm also abused drugs and / or alcohol, and often for the same reasons – as a way to self-medicate. Furthermore, they may actually abuse the substance as a poison in further attempts to self-harm.
Both drugs and alcohol will slow pain reaction times by decreasing the sensitivity of nerve endings, making self-harm increasingly dangerous, eg. cutting too deeply or severely. Additionally, drugs and alcohol will increase feelings of depression and anxiety, leading to more severe methods of self-harm – including suicide. Therefore, those who suffer from substance addiction, as well as self-harm, need specialized dual diagnosis treatment that simultaneously treats both conditions.
What is Happening in the Brain of a Teenager Who Self-Harms?
One way of looking at exactly why teenagers and others choose to self-harm is to look for any chemical reaction in the brain that occurs when they actually do it, especially as many report experiencing a sense of calm at the time of the self-harm and for a short period afterward.
“I was all about those cuts – like they were something about me that only I knew. They were like my own way of controlling things. I don’t cut myself anymore, but now I have to deal with the scars.” – Sandy, teenager (name changed)
Only last year (November 2019), German Professor Dr. Christian Schmahl reported to
the Association for Child and Adolescent Mental Health (ACAMH) conference in London, England, that his research on the neurobiology of self-harm had shown the following:
- Self-harming teenagers have distinctive brain and physiological activity in response to pain and to the sight of blood – in a surprise reaction, they are calmed by the intense pain and flooded with relief. In the aftermath of the physical pain, they are happier, more content and satisfied. It was found that certain teenagers (those more prone to self-harm behavior) had lower activity in the brain’s amygdala, where the brain locates the rawest, reactive feelings.
- For years, it was believed that self-harm was triggered by stress. However, in Schmahl’s studies to investigate this, saliva samples of self-harming teens showed a lower level of the stress hormone cortisol. On the other hand, it was also shown that those who self-harm have a higher than normal pain threshold. He concluded, therefore, that self-harming teenagers may be trying to address this cortisol imbalance.
- Furthermore, Schmahl believes that when teenagers cease to self-harm, either as a result of therapeutic treatment or maturity, their neurobiological responses return to normal. In other words, their reaction to pain is no longer blunted.
Self-Harm: Advice for Teenagers
Teenagers who self-harm should understand that the behavior is a coping mechanism, and nothing more. In the long term, it is not going to fix anything – in fact, it may well make things worse. Here is a short piece of professional advice aimed at helping teenagers resolve the behavior, and, more importantly, the underlying reasons why their self-harm happens.
Tell Someone / Ask for Help
People who have received treatment for self-harm, and who have put that period of their lives firmly in the past, all say the same thing: You must tell someone. They also say that doing so brings a tremendous feeling of relief.
Finally admitting to someone you trust, like a parent, best friend, school counselor, teacher, coach, doctor, or nurse, is vital for both your physical and mental health. Only then can you get the real help you need. If that seems too overwhelming, simply write a note to that person, and everything else will fall into place for you.
Identify the Underlying Reasons
It’s really important for you to think about which feelings and situations are likely to trigger your desire to self-harm. Is it anger? The pressure to be perfect? Relationship problems? A really painful loss or trauma? Bullying or harsh criticism?
Understandably, many people have trouble figuring this part out on their own, and this is where a mental health professional can be helpful. Below, you’ll find some great techniques for helping yourself stay safe if that urge comes along.
Make an Alternative Plan
You need to avoid the actual act of self-harm. Make a plan of what you will do instead. Once you are in treatment, your therapist will discuss this with you, and help with these. Remember, the desire to self-harm is not there all the time – this desire will pass if you wait for it to do so. Techniques to avoid self-harm include:
- Call a friend and talk about something completely different
- Go for a walk or run, or take a bike ride
- Play with a pet
- Other Methods for Calming Yourself:
- Listen to soothing music
- Breathing exercises
- Relaxing yoga exercises
- Express Your Pain:
- Draw the pain (honestly, it works)
- Write about your pain, anger or hurt
- Write lyrics to an imaginary song to express your feelings
- Release the Tension:
- Go for a walk or run, or take a bike ride
- Write about your pain, anger or hurt
- Grab a stress ball and squeeze
- Feel Connected:
- Call a friend (far better than texting)
- Play with a pet
- Breathing exercises
- Relaxing yoga exercises
- Substitute the Behavior:
- Watch TV or stream a movie (comedies work best)
- Play a non-violent computer game
- Go for a walk or run, or take a bike ride
Remember, you can do this. Self-harm behavior can be a difficult pattern to break, but it is possible. Therapists and counselors are trained to help people like you to discover your inner strengths (and you have those – and more than you know) that will help you heal in a healthy and effective way.
Self-Harm: Advice for Parents
What can parents (and even friends) do to help a teenager suffering from self-harm? It is important that your conversations are honest and judgment-free:
- The best approach when speaking to your teenager is to be direct and to express concern. Do not be angry with them, and do not simply avoid the issue. It needs to be addressed
- Listening is more important than talking – listen supportively and respectfully, paying attention to the underlying feelings and emotions that your teenager talks about
- It is important you are not judgmental, don’t give any ultimatums, and do not try to make your teenager feel guilty in any way
- Promising rewards or making threats are seldom effective in resolving this type of issue – remember, your teenager will need professional help
- Your goal here is to create a shared space for open communication
- Do not equate self-harm with suicidal behavior; however, you need to be aware and look for signs of suicidal ideology
- Become educated about self-harm… and then stay educated
- Be 100% supportive and let your teenager know that you understand any journey to recovery may be long and difficult, but that you are with them completely
- Do your due diligence when selecting any form of recovery – ensure it is professional, and run by qualified and accredited people
- Local support groups may help you understand further
- Include physical activity and relaxation exercises as a regular part of your own daily routine, and remember to eat healthily
Finding Professional Treatment for Teenagers Who Self-Harm
If your teenage son or daughter is engaging in self-harm behavior, the bottom line is that he or she needs professional help, especially as there is an elevated risk of suicidal behavior for teens who self-harm, even though self-harm is not considered suicidal in nature.
Furthermore, if there is an underlying mental health disorder, such as anxiety or depression, medication might be prescribed. Therefore, it is important to get a comprehensive evaluation by an adolescent psychiatrist or therapist, or by another qualified professional through an accredited adolescent program.
Ashwood Recovery: Adolescent Day Treatment Program
Our sister facility – Ashwood Recovery, based in Nampa, Idaho – offers a specialized Adolescent Day Treatment Program called “Imagine” that provides therapy for 12-17 year-olds who are struggling with behavioral and mental health conditions. Their successful program uses a wide range of proven techniques to help your teenager recover from self-harm behavior, such as:
- CBT (Cognitive Behavioral Therapy)
- DBT (Didactic Behavioral Therapy)
- Grief and Loss, Trauma Therapy
- Crisis Intervention
- Co-Occurring Intervention
- Family Therapy
- Relationship Counseling
- Interpersonal Therapy
- Mindfulness and Meditation
- Art, Music and Pet Therapy