Adolescent Self-Harm - A Parent's Guide

Few things strike terror into the hearts of parents like discovering their child or adolescent is self-harming. I have sat with multiple parents who report they cannot understand why their child would do that to themselves. Does it mean they want to die? Does it mean they hate themselves? Does it mean they have a serious mental illness?

Sometimes yes, but often no. 

Self-harm is reasonably common in Australian teenagers with as many as 17% of females and 12% of males between the ages of 15-19 reporting they have self-harmed at some point. Some may become aware of it, try it once and never again; whilst others will try it once and discover it serves a function for them and then repeatedly engage in it. Some teenagers regularly self-harm whereas others report only doing it occasionally. 

Self-harm is sometimes referred to as Deliberate Self Harm (DSH), Parasuicidal behaviours,  or Non-Suicidal Self-Injury (NSSI) depending on its nature. It is a non-specific psychiatric symptom that is sometimes associated with those experiencing depression, anxiety, eating disorders, developmental disorders, and borderline personality disorder; however, it can be engaged in by those with any mental illness, or by those without.  This means that by itself, it is not an indicator of any one particular disorder. Mental health issues are certainly a risk factor for self-harm behaviours, and whilst statistics vary depending on whether individuals require medical treatment or emergency care, it is thought that as many as 50% of young people who self-harm would likely not actually meet full diagnostic criteria for a mental illness.

For many, self-harm is also not a sign that they are suicidal. In fact, it is often described as the opposite by many who engage in it: a way to actually help them live with the difficulties they are experiencing. If an individual is experiencing suicidal thoughts or plan it is crucial that they get appropriate help. Even in the absence of suicidal intent though, self-harm must still be taken seriously. It can have short and long-term medical consequences and is certainly an indication that there is something the individual is struggling with. The most common forms of self-harm include deliberately cutting, overdosing on medications, or burning oneself. Other methods including hitting or punching, hair-pulling, scratching or interfering with wound healing.

Why do teenagers self-harm?

Adolescents, and in fact many adults, self-harm for a variety of reasons. Research suggests that for many, self-harm serves as an emotion-regulation strategy. Meaning that it is a way of coping with difficult or overwhelming emotions that they are struggling to know how to manage. Similarly, others report doing it to distract from or suppress painful thoughts, memories or images. Sometimes people report doing it to feel “something” when they otherwise feel numb, whereas for others they report doing it to feel “less” or to feel something “different”. Some people say the physical pain relieves the emotional pain, whereas others say it gives them a sense of control over the pain they are in. Some teenagers try it because their friends do and they are curious or want to fit in, and for others it may serve a function of self-punishment if they are experiencing intense shame or disgust towards themselves. For others it serves as a way of communicating their pain to others. At least half of young people who self-harm do not seek help though, meaning it is often done as a private way of self-soothing or regulating distress rather than as a way of eliciting a response from others. Whatever the function for the individual, it is usually in response to painful feelings or experiences of some description, and those who self-harm require compassion and empathy, not judgment.

Adolescence is a challenging time, with many developmental, hormonal, and psychosocial stages impacting a young person’s mental health and emotion-regulation capabilities. Common experiences which can trigger a young person’s distress include bullying, academic concerns or pressure, family or parental conflict, social concerns, relationship difficulties, low self-esteem, perfectionism, sexuality, gender identity concerns, body image concerns, and trauma.

What do I do if my teenager is self-harming?

·      Firstly, take a deep breath and calm yourself before reacting. It is totally understandable you may be feeling shocked, scared, angry, sad or confused… and at the same time there’s a much greater chance you’ll be able to manage the situation effectively by being contagious with your own calm. If your teenager is already in emotional pain, adding your own intense emotions on top of whatever they are already feeling is unlikely to be helpful.

·      This doesn’t mean you can’t share your concern; but try to do it with empathy and a non-judgmental approach to convey to them that you care about them and want to find a way to help. Many teenagers are very worried about their parents finding out about their self-harm for fear of judgment, criticism, invalidation, punishment, or shame. 

·      Approach it with compassionate curiosity and empathy rather than judgment. To you it may seem irrational to be hurting yourself when you’re already suffering, but to a lot of young people they perceive the self-harm to be helpful rather then harmful. Or at least that it provides immediate short-term benefits which outweigh any consequences or risk. Try to understand what function it serves for them rather than making assumptions.

·      Remember, for most of us, whatever occurs in life we are doing the best we can at any given point in time. This doesn’t mean we can’t learn to do better or get help to do better if we’re struggling, but it does mean that if your teenager is self-harming, it is likely that it is the most effective way they currently have to help themselves cope.

·      Many teenagers want to stop or reduce self-harming. What often holds them back is not knowing how to do this without giving up their most valuable coping-strategy. To take away their way of managing their distress without replacing it with something else can often increase their distress significantly. Once you understand the function, it’s possible you can help them try some alternative ways to meet the need they have.

·      On the other hand, your teenager may not be ready or motivated to stop self-harming immediately. Or they may try to stop and yet be unable to cease it straight away. Try not to panic, blame, or shame them if this occurs. If it has been happening for a while it may take time to change these behaviours.

·      Get support for yourself. Whether it’s a partner, friend, family member, or even professional help, this can be an extremely stressful situation to try to navigate. Ensuring you have people to support you whilst you try to support them can be invaluable.

·      Get professional help for your teenager if you are concerned. For some teenagers, their parents knowing about either the self-harm itself, or the underlying pain they are in, can bring about a sense of relief they are no longer alone or needing to hide it. For others, their parents knowing fills them with dread, shame, or guilt which exacerbates their struggles. Your teenager may open up to you once they know you know, or alternatively they may clam up and refuse to talk about it. If you believe your teenager is experiencing mental health concerns or trouble coping in some way, it may be beneficial to get them professional assistance to help them work through their issues or learn healthier coping tools.

·      Finally, try not to allow your mind to spiral you into panic. Self-harm is generally very treatable. Whilst it seems scary and naturally elicits a lot of concern, we deal with people on a daily basis that engage in self-harm. We have a number of evidence-based treatments we can discuss with you and your teenager that can help.