Adolescents Who Self-Harm: How Can We Help?

Kimberly Cerdorian R.N., L.P.C., PsyD Candidate

She had kept this mostly hidden and was careful not to let anyone see the blood.  She also thought she was careful not to cut too deeply, because she did not want to seriously hurt herself. Cindy had been taking a razor blade to her upper arm for months before her parents saw the scars. She said that many of her friends were doing it and she was just going with the crowd.  But this explanation seemed hollow.  She said that cutting herself made her feel numb to the troubles in her life.  She said that she sometimes enjoyed watching the blood pour from her body; she had a feeling of accomplishment about this. Her parents were horrified and confused.  How could an intelligent girl like their daughter be willingly carving into herself, hidden in her room, alone?

Our teenagers are going through a tumultuous time of physical, emotional, intellectual, and social changes. They are growing up in a complex world that shapes and tests the coping skills they have developed, and unfortunately their copings skills can become harmful. Sometimes their parents are out of touch with the cultural realities that they face. Accordingly, their parents, a past source of support and consultation, now seem unavailable to them. The incidence of self-harm by adolescents, without intent of suicide, is dramatically increasing.

Conservative estimates suggest that approximately 3 million Americans harm themselves by cutting and burning every year.  Most began as teenagers. When you discover that a teen is engaging in self-harm behavior, you must determine whether they are suicidal. If you hear any thinking from a teen that revolves around dying, that teen needs to be seen by a mental health professional immediately. However, what is increasingly true is that many teenagers harm themselves as a way to relieve emotional pain and distress, and even to prevent suicide. It becomes a behavior that can be both adaptive and self-destructive. 

Self-harm can take many different forms. It may include cutting with needles, fingernails, razor blades or knives, or burning with lighters, matches, or cigarettes. It may also include high-risk behaviors such as abuse of drugs or alcohol, having multiple sexual relationships or an eating disorder. Such behavior can occur once or become a habitual way to release pent-up emotion.  Many teenagers who self-harm have experienced abuse.  Noted British psychotherapist, Cairns Clery, found that 71% of adolescents sexually abused as children engaged in self-harm behaviors.

Usually, however, far less serious causes are to blame for cutting and other behaviors. Multiple factors contribute to self-harm behavior.  For example, a teenager may feel a lack of control or a sense of hopelessness. A teen may have an untreated depression, a tendency towards impulsiveness or conflicts regarding sexual orientation. Other conditions may also be involved, including academic, family or social problems such as parents divorcing or unwanted pregnancy. While there may be an element of attention-seeking behavior or a desire to punish self or loved ones, this is far less common. Most self-harm behavior is done secretly-but it can create difficulties for others. In school settings, self-harm has been described as “contagious” and can spread rapidly from one troubled adolescent to another.

Focusing on the physical can provide escape from emotional pain, and teens frequently turn to self-harm to manage psychological distress. The practice can help a troubled adolescent to feel something or, paradoxically, to stop feeling and calm down. When anxiety induces a sense of unreality, emptiness, emotional numbness, or depersonalization, self-harm can bring a strong outpouring of emotion followed by feelings of calm and relief.

It can also bring about a new sense of self, a new awareness of being alive or a sense of satisfaction, giving the teen a way to take control when no other control in life is perceived. Adolescents may turn to self-harm when their ability to cope in a healthy way is exceeded. In 1996, Dr. Janice McLane of Morgan State University called self-harm, “a voice on the skin,” an articulation of trauma.

Do not be confused into thinking that self-harm provides positive benefits.  Cutting and other self-harming behaviors manifest a lack of effective coping strategies.  The behavior is physically damaging and provides only short-term relief from issues that are much more long-standing and deep. 

Finding a therapist who is educated and comfortable addressing self-harm issues and treatment can be difficult. Adolescents who self-harm need to feel understood, listened to nonjudgmentally and responded to in relation to the unspoken suffering behind their self-harm. The aim of treatment is to help the teen understand the reasons for the action, and to provide alternative, healthier coping strategies.

Adolescents who self-harm need trusting relationships with adults who are capable of empathetic listening and healthy communication. They need to learn to process pain by thinking and talking instead of turning to physical means. A few positive ways to find healthy expressions of the emotions or pain they feel is through journaling, creative writing, art, drama therapy, meditation, singing, or martial arts. 

Parents need to stay connected with and involved in their teenager’s life. It is essential to focus on maintaining a loving relationship even when your teenager makes choices you are not happy with. You can love the child and not the behavior. Hand out reasonable consequences while you work on maintaining or regaining a dialogue about what is happening and how the teen is feeling. If family therapy is needed to decrease stress in the home, the parents can present a model of self-care by taking responsibility for and beginning to work on their own issues.

Teenagers must retain or regain a sense of responsibility, which requires choosing between self-harm and healthier alternatives. While some can stop self-harming immediately by talking about the stresses they are experiencing, others require treatment over time to stop the behavior.

Self-harm is symptomatic of deep underlying pain and a lack of necessary coping skills. Self-harming adolescents need adults who will attempt to understand the reality of their world, who will acknowledge their pain and who help them develop the skills to cope with a challenging world.  They need our love and nurturance, not shock and recrimination.