Self Harm in Children and Teens

What is Self-Harm?

Self-harm (also known as self-injury or self-mutilation) refers to someone intentionally hurting their own body. Sometimes the injuries are shallow, but they can also be severe and even life-threatening.

People self-harm in many different ways, including:

Cutting themselves with a sharp object like a knife, razor, or scissors (the most common method)
Burning themselves with cigarettes, matches, or lighters
Pulling out their hair
Poking or inserting objects through various body openings
Punching themselves or punching things
Picking at existing wounds or scratches
Carving words or symbols into their skin

While self-harm itself isn’t a specific mental illness, it can be a compulsive behavior that can disrupt someone’s overall functioning. People may self-harm once or very sporadically. In other cases, however, the self-harm is more compulsive, meaning that over time, the person feels more intense urges to engage in the behavior.

Types of Self-Harm

Not everyone who self-harms does the same thing. Cutting might be the best-known version of self-harm, but it's far from the only method. Here is a look at some of the different forms of self-harm children and teens might engage in.

Cutting

Cutting refers to using a sharp object like a knife, scissors, or razor blade to puncture the skin. People often cut on their arms, legs, or stomach.

Learn more about the dangers of cutting for teens.

Burning

Burning refers to burning oneself with fire or other chemicals. People may use candlesticks, matches, candles, or lit cigarettes to burn themselves.

Head or Body Banging

Headbanging refers to hitting one’s head repeatedly against a hard surface, such as a wall or table. Body banging can mean punching inanimate objects like a wall to hurt oneself or slamming one’s entire body against something.

Hair Pulling

Some people may engage in hair pulling to hurt themselves. It should be noted that this method is not the same as trichotillomania (a compulsive disorder associated with recurrent urges to pull hair). When hair pulling is done with the primary intention of hurting oneself, it is considered self-harm.

Intentional Restriction

Any form of deliberate deprivation—such as restricting food, voluntarily wearing light clothing in freezing temperatures, or avoiding drinking water when thirsty—can be a form of self-harm.

Learn more about restricting food behaviors.

Signs of Self-Harm

Self-harm isn’t always obvious. Due to shame and fear of getting in trouble, many people go to great lengths to conceal their behavior. It’s important to pay attention to the following physical warning signs:

Evidence of scars (which are often on the arms, legs, or stomach)
Evidence of fresh burns, cuts, scratches, or bruises
Wearing long sleeves or pants, even in warm weather
Finding sharp objects like scissors, knives, or razors in strange places like purses or drawers

It’s also crucial to consider any emotional changes, since self-harm is often a reactive coping skill to manage distress. The following symptoms could indicate someone is self-harming:

Experiencing difficulties with relationships
Making statements about feeling depressed, worthless, or hopeless
Impulsive behavior that doesn’t have a definitive cause
Existential questions about personal identity
Sudden withdrawal from loved ones or from usual interests and hobbies

Why Do People Self-Harm?

Self-harm isn’t random, and it is important to know that people hurt themselves for different reasons. People who self-harm are not usually suicidal (more on that below), though they may be at a higher risk of suicidal ideation if they do not get help.

Here are some of the reasons children and teens may self harm.

To Release Emotional Pain

Some emotions can feel so intense that people don’t know how to cope with them. These emotions may include:

Anger
Sadness
Fear
Guilt
Shame
Anxiety

Although feelings tend to pass naturally, sitting with them can be incredibly distressing and uncomfortable. People sometimes lack insight into their emotions, and they also may not have adequate coping skills to manage them. As a result, self-harm offers some sense of immediate relief. Even though this relief is temporary, it can feel like “enough” to get through the next moment.

Additionally, self-harm can help avoid confronting difficult emotions directly. The emotions don’t disappear entirely, but self-harm often acts as a temporary distraction.

To Feel Something Instead of Numbness

People with histories of trauma often report feelings of numbness or disconnection, sometimes reporting moving through their days as if they are zombies. Instead of feeling emotions intensely, they indicate feeling nothing at all.

Self-harm triggers physical pain, which can unleash a powerful emotional reaction. Even though it hurts, the person may rationalize that pain feels better than nothing.

To Punish Themselves

Many people who self-harm also struggle with low self-esteem. Therefore, self-harm acts as a punishment. People might engage in this behavior when they believe they have made a mistake or when they feel anxious or insecure.

That said, shaming oneself rarely motivates change. Instead, it tends to make the person feel even worse and perpetuates a vicious cycle of self-loathing.

To Restore A Sense of Control

Life can feel incredibly challenging at times. When someone struggles with feeling out of control, they may seek to find methods to restore a sense of power. This need is particularly common when people have endured severe abuse and trauma.

Unfortunately, their methods aren’t always healthy or productive. Self-harm can foster a sense of control, even if it seems distorted or irrational. Because the person knows they can’t control their outside world, they focus their methods inward.

To Ask for Help

Self-harm can be a subconscious attempt to ask for help, particularly if the wounds are visible to others. Some people struggle to identify what they need, or they struggle to reach out altogether. Therefore, the self-harm behaviors might indicate that the person wants someone to see what’s going on and support them.

Who Engages in Self-Harm?

Self-harm doesn’t discriminate, which means anyone is susceptible to this behavior. The statistics are staggering.

Research shows that 4% of adults in the U.S. report actively self-harming. Among adolescents, who appear to be at an elevated risk, 10–20% engage in this behavior. Finally, in college students, the rate ranges anywhere from 17–35%.

That said, statistics are not always accurate. People often minimize or lie about their behaviors due to fear or shame. It is also important to understand the relationship between trauma and self-harm. Therefore, these figures could be significantly higher.

What Makes People Prone to Self-Harm

While anyone is vulnerable to self-harm, some risk factors may increase someone’s likelihood of engaging in this behavior.

Having a Mental Illness

One in four people have a mental illness. Mental illnesses can include depression, anxiety, personality disorders, eating disorders, and substance use. Mental illness can emerge at any age, but symptoms often first manifest in adolescence or early adulthood.

Mental illness can dramatically impact someone’s quality of life. It may affect their self-esteem, relationships, work performance, and physical health. Symptoms may range in severity, but many people struggle with feeling sad or frustrated over their conditions.

Self-harm can coincide with mental illness. If people don’t have adequate coping skills to manage their symptoms, they may turn to self-injury to deal with their emotions. Moreover, self-harm may act as a way to self-medicate their emotional pain.

Identifying as LGBTQ+

LGBTQ+ teenagers self-injure at much higher rates than their heterosexual peers. One study showed that 38–53% of individuals in this population engaged in these behaviors.

Unfortunately, the LGBTQ+ population experiences high rates of emotional isolation, fears of safety, and overarching stigmatization. All of these factors can impact someone’s mental health. Additionally, many people struggle to cope with these difficult realities, and they hurt themselves as a result.

The Risks of Self-Harm

As mentioned, most people who self-harm don’t want to seriously hurt themselves; they want temporary relief from their emotional pain. That said, there areserious risks associated with this behavior, including:

Uncontrollable bleeding
Infection
Permanent scars
Broken bones
Worsened self-esteem
Intensified guilt, shame, or worthlessness
Suicidal thoughts
Problems with interpersonal relationships (due to lying or withdrawing)
Increased feelings of depression or anxiety

Self-harm is always a serious issue, even if the person downplays the behavior. Self-injury itself is a problem, but it’s also a manifestation of deeper problems.

The Relationship Between Self-Harm and Suicide

Usually, people don’t self-injure with the intention of seriously hurting themselves. Instead, as mentioned, they want to cope with their pain, punish themselves, or maintain a sense of control.

With that in mind, many people who self-injure also have other risk factors like depression, anxiety, substance use, eating disorders, and/or histories of trauma. Any of these risk factors can increase the risk of suicidal ideation.

Moreover, research shows that self-harm can lead to suicide when:

It no longer seems like an effective coping method.
People become so desensitized to hurting themselves and experiencing pain that suicide attempts do not feel frightening

Helping a Loved One Who is Self-Harming

If you know that someone you love is self-harming, it’s normal to feel scared and worried. You’re not alone in your feelings. Nobody likes thinking about a loved one hurting themselves intentionally.

However, it's important to take the right approach in offering help. Before you intervene, consider the following do's and don'ts.

Do Speak to Them at a Neutral Time

Choose an appropriate time and location to voice your concerns. Make sure to honor your loved one’s privacy and don’t bring the subject up in front of other people.

Think about what you want to say ahead of time and try to keep your own emotions in check. While you may be scared or frustrated, you must try to cope with these emotions outside of this conversation. If you can remain calm and even-keeled, you model openness to learning more about their experience.

Don’t Promise Confidentiality

Your loved one may plead with you to keep this a secret. Although you might want to give them that promise, it usually isn’t the best idea. Treating self-harm often requires discussions with other trusted adults and medical professionals. It’s not your job to be your loved one’s therapist or medical doctor.

That said, you can promise that you will not disclose this information to anyone who doesn’t need to hear it. That means, for instance, you won’t be sharing the news with nosy friends or relatives.

Do Ask Open-Ended Questions

When you talk with your loved one, it’s important to gather the necessary details to ensure their safety. Examples of open-ended questions include:

How long have you been feeling this way?
How often do you self-harm?
What triggers you?
What other coping strategies have you tried to use?
What can I do to best support you?

As you ask these questions, pay attention to your tone and body language. While you can’t account for how you feel, you can try to make the conscious effort to maintain a relaxed, non-judgmental position.

Don’t Ask Judgmental Questions

Many people feel ashamed or guilty over their self-injury. Often, they don’t want to burden their loved ones with their secret. They worry about others overreacting, or not reacting at all. If they sense any hint of judgment, they may balk at your questions, lie to you, or respond with extreme defensiveness.

It’s essential to remain as calm and neutral as you can when speaking to your loved one. Avoid the following statements:

Why would you ever hurt yourself?
Why would you do something like this to us?
How could you think this is okay?
Why don’t you just stop?

Don’t Demand to See Evidence

If your loved one opens up about self-harming, it’s reasonable to want to see their scars or wounds. However, demanding to see them can make them feel anxious, guilty, or ashamed. If you’re worried about their imminent safety, consider:

Asking them how they engage in self-harm
Inquiring where they self-injure
Asking them if they’re willing to go to the doctor to get a physical exam
Determining if they have ever faced medical issues related to bleeding excessively, infections, or prolonged pain

Do Take the Time to Educate Yourself

It’s normal to have misconceptions about mental illness. However, you owe it to yourself and your loved one to inform yourself about the reality of these conditions. Misconceptions can hurt both of you.

Don’t Accuse Them of Seeking Attention

Self-harm might be a cry for help, but people may not realize this is their intention. Often, the desire for attention occurs when someone can’t quite express how they feel. They know they are in pain and they want someone to notice, but they aren’t sure how to do it.

Instead of accusing them of seeking attention, consider reframing your statement or question to:

I can see that you are struggling.
I want to give you the love and attention you deserve in order to heal.
What do you think might help you express your feelings differently?
How can I make sure I’m supporting you right now?

Don’t Make Them Promise to Stop

Although it may seem counterintuitive, it’s rarely helpful to beg someone to stop. Chances are they already feel immense shame over their behaviors, and they already feel worried about disappointing you.

Self-harm is often compulsive, and the pattern mimics that of other addictive behaviors. That means stopping isn’t as easy as wanting to do it. Even when people want to quit, they often find it extremely difficult to do so.

If you make this demand, two common scenarios may occur. First, they might make their very best effort to stop, but the effort would come from a place of wanting to please you. While this can work in the short-term, it’s rarely sustainable. If they relapse into their self-harm, they might experience even higher levels of shame over disappointing you. Second, they might agree to stop in order to end the conversation, and then lie about self-harm if asked. They may engage in different methods to avoid you “finding evidence.”

Don't Punish Them

You might feel tempted to ground them, take away their electronics, or place restrictions on their privacy. These intentions often come from a good place: you punish them thinking this will help them stop hurting themselves.

This thought process doesn’t work effectively. Punishing self-injury only perpetuates more shame, anger, and guilt.

Keep in mind that your loved one isn’t choosing to suffer. They don’t want to hurt themselves, rather they often don’t feel like they have another choice.

Don’t Assume It’s All Your Fault

As you can see, people self-injure for so many reasons. Sometimes they don’t even know the real reason behind the behavior; they’ve just developed a pattern, and they find it hard to stop.

Many times, people look inward and blame themselves. It’s unhelpful to jump to these conclusions. Even if you and your loved one have a rocky relationship, you’re not solely responsible for their decisions. Your loved one will need to assume some personal accountability to get better.

Do Offer to Support Them in Getting Help They Need

Once you find out someone you love self-harms, it’s a good idea to talk about the benefits of professional treatment. Treatment can include a variety of options, including:

Therapy provides a safe and supportive environment for your loved one to learn how to process their emotions more effectively. Therapists can also teach them alternative coping skills for managing their distress.

To offer your loved one support, consider:

Looking at different therapists with them
Helping them make initial phone calls
Supporting them in filling out intake paperwork
Attending a therapy session with them
Offering to go to therapy yourself

Final Thoughts

Self-harm is a complex issue that requires compassion and awareness. If you know or suspect that your loved one is struggling with this issue, it’s essential to reach out for help. Neither of you is alone, but self-harm often doesn’t disappear on its own.

With the appropriate treatment, your loved one can learn to live a more fulfilling and meaningful life. At Idaho Youth Ranch, we support young people by teaching them the skills they need to cope with stress, trauma, and other related mental health issues. We are here for you and your family. Contact us today to learn more.

Sources

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WHO | Mental disorders affect one in four people. (2013). Who.Int.https://doi.org//entity/whr/2001/media_centre/press_release/en/index.html
HealthDay. (2019, June 3). Lesbian, Gay Youth at Higher Risk for Self-Harm. WebMD; WebMD.https://www.webmd.com/parenting/news/20190603/lesbian-gay-youth-at-higher-risk-for-self-harm#1
Self-harm and Suicide - Centre for Suicide Prevention. (2016, December 9). Centre for Suicide Prevention.https://www.suicideinfo.ca/resource/self-harm-and-suicide/
Self-harm | NAMI: National Alliance on Mental Illness. (2020). Nami.Org. https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Self-harm