Teen Self-Harm

What is self-harm?

Self-harm (also known as self-injury or self-mutilation) refers to someone intentionally hurting themselves. The injuries can be shallow, severe, or 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 objects

• 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, 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 not the only method. 

Here are 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.

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. 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 apparent. 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 usual interests and hobbies

Why do people self-harm?

Self-harm isn't random, and 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. 

Although feelings tend to pass naturally, sitting with them can be incredibly distressing and uncomfortable. People sometimes lack insight into their emotions and may not have adequate coping skills to manage them. As a result, self-harm offers some sense of immediate relief. 

Additionally, self-harm can help avoid confronting difficult emotions directly. The feelings 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. 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 feel anxious or insecure.  

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

When someone feels out of control, they may seek methods to restore a sense of power. This need is prevalent when people have endured severe abuse and trauma. 

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. 

What makes teens 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.

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 complex realities, and they hurt themselves as a result.

The Risks of Self-Harm

As mentioned, most people who self-harm don't want to hurt themselves seriously; they want temporary relief from their emotional pain. That said, there are serious 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 also a manifestation of deeper problems. 

The relationship between self-harm and suicide

Many people who self-injure also have other risk factors like depression, anxiety, substance use, eating disorders, and histories of trauma. Any of these factors can increase the risk of suicidal ideation.

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, feeling scared and worried is normal. You're not alone in your feelings. 

However, it's important to take the right approach when 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. Honor your loved one's privacy, and don't discuss the subject in front of others.

Think about what you want to say ahead of time and try to control your emotions. 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 will 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 that promise, it usually isn't the best idea. Treating self-harm often requires discussions with other trusted adults and medical professionals. 

That said, you can promise not to disclose this information to anyone who doesn't need to hear it. That means, for instance, you won't share 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?

Pay attention to your tone and body language as you ask these questions. While you can't account for how you feel, you can consciously maintain a relaxed, non-judgmental position. 

Don't Ask Judgmental Questions

Many people feel ashamed or guilty about their self-injury. They often 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. 

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. They know they are in pain and 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 to heal.

• What 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, begging someone to stop is rarely helpful. Chances are they already feel immense shame over their behaviors and are 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. If you make this demand, two common scenarios may occur. 

First, they might try their best to stop, but the effort would come from 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 be tempted to ground them, remove their electronics, or restrict their privacy. These intentions often come from a good place but don'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; instead, 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 find it hard to stop. 

Many times, people look inward and blame themselves. 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 someone you love who self-harms, talking about the benefits of professional treatment is a good idea. Treatment can include a variety of options, including: 

• Individual therapy

• Group therapy

• Family therapy

• Psychiatric medication 

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