Self-harm or self-injurious behaviour, involves repetitive, intentional, direct injury to the body. The most common forms of self-harm include cutting the skin with a sharp object, severe scratching, burning, and banging or hitting parts of the body. Self-harm is most commonly seen in adolescence and young adulthood between the ages of 12 and 24 years. Self-harm can occur in both sexes, although females engage in more frequent self-harm behaviours than males. Although self-harm is usually carried out without suicidal intent, it can sometimes lead to a serious medical emergency and can be life-threatening. There is also an increased risk of suicide in individuals who self-harm.
Why do some teenagers self-harm?
Despite the common belief that self-harm is an attention-seeking behaviour, this is usually an inaccurate or insufficient explanation. Most people who self-harm are actually very self-conscious about their wounds and scars and may try to conceal them with clothing.
Self-harm may be used to fulfil a number of different functions, including:
- To manage negative emotions such as anger, depressed mood, anxiety, etc.
- To communicate a need for help and support
- To deal with poor body image, low-self-esteem or self-hatred
- To punish themselves for something they’ve done
- To avoid feeling numb
- To feel more in control
- To avoid thinking about unpleasant memories
- To express feelings that they have difficulty expressing in words
There is also some research to suggest that the sudden experience of pain that comes through self-harm produces endorphins or “feel good chemicals” in the brain which may reinforce the use of self-injurious behaviour to manage unpleasant thoughts, memories and emotional experiences. Experts believe that self-harm is a way of managing intense unpleasant emotional experiences. Although the motivations to self-harm can be varied, individuals who self-harm appear to have a tendency to use avoidant strategies to cope with problems, have difficulties tolerating strong emotions and/or have problems with regulating and managing unpleasant emotional experiences.
How to talk to your teenager about self-harm
Teenagers are often secretive about their self-injurious behaviour as it is often associated with feelings of shame, guilt and embarrassment. They may be worried that if their parents or friends found out about their behaviour that they would ‘freak out’ or assume that the teen is crazy. Keeping self-harm a secret can perpetuate the problem as it can create feelings of being disconnected from others and helplessness, both of which are feelings which can trigger self-harm behaviour in the first place.
It is normal for parents to experience a range of emotions when confronted with the possibility or reality that their teenager has been harming themselves. How you respond to this information when your teen shares it with you is an important part of building a trusting relationship where you can support your teen to get assistance with managing their difficulties. Some guidelines for managing your teen’s disclosure regarding their self-injurious behaviour include:
- Any episode of self-harm should be taken seriously and responded to as a serious concern
- Recognise that self-harm is not just about “getting attention”. It is your child’s way of communicating that they are struggling with managing their emotions and that they need support and assistance
- Notice your own emotional responses to your child’s disclosure and how these might affect the way you respond to your child. For example, if you feel angry your immediate response might be to yell at your teen, which will not be helpful
- Respond to your teen by listening attentively and clearly to what they are trying to communicate
- Ask your teen how you can respond in a helpful and supportive way and make a commitment to following through with this request
- Demonstrate concern for the difficulties your teen is experiencing and encourage or assist them to seek support from a professional
- Make sure that you also have support from a spouse, friend or professional if your teen’s disclosure has brought up difficult thoughts and feelings for you as a parent
It’s never too late to respond in a helpful way to your child’s disclosure of self-harm. Even if your teen has already told you about their self-harm and you responded in an unhelpful way it is still possible to have a supportive conversation with your teen based on the above guidelines that will help to establish open communication so that you can support them with managing these difficulties.
FOR TEENS – How to talk to your parents or a trusted adult about self-harm
It is common to feel worried or uncertain about talking to someone about your self-harm, however, if you do not confide in anyone it will be difficult for you to get the support you need to change your behaviour. There are many options for people you can talk to about your self-harm including your school counsellor, a trusted adult such as a family friend, aunty, or teacher, your parents, or a professional such as a GP or psychologist. If you are worried about how your support person will react when you tell them you could ask them to read the section above on this webpage or you could choose to write them a letter which outlines the difficulties you have been experiencing and how you would like them to respond in a way that will be helpful for you. You are not alone; there is help available to change your self-injurious behaviour if you are willing to speak to someone about it.
Treatment for self-harm
Given that difficulties managing emotions is believed to be the primary mechanism behind self-harm, psychological treatments such as Dialectical Behaviour Therapy (DBT) have focused on improving emotion regulation in teens who self-harm.
Emotion regulation involves:
- an awareness, understanding and acceptance of one’s emotions
- the ability to inhibit impulsive behaviours (such as self-harm, reckless behaviours or physical aggression) and to engage in goal-directed behaviours (e.g. attend classes, complete homework, engage in social relationships, do exercise, be creative with art, music or writing) when distressed
- use of appropriate strategies to manage the intensity and/or duration of emotional responses
- willingness to experience negative emotions as part of pursuing meaningful activities in life
In addition to emotion regulation skills, DBT also teaches mindfulness, distress tolerance skills and interpersonal effectiveness skills. The efficacy of DBT with individuals who self-harm is now well-established.
Therapy for self-harm may also include:
- creating a safety plan that involves avoiding tools that can be used for self-harm and creating supportive social connections with parents, other adults and friends
- enhancing aspects of life that are separate from self-harm such as relationships, positive qualities, hobbies, etc
- learning to treat the body in a more positive way e.g., bubble baths, massage
- improving self-image, self-esteem and body image
- understanding unhelpful thinking styles and learning to develop more helpful ways of thinking
- focussing on creating an overall healthy lifestyle
Although not every adolescent who self-harms has additional psychological difficulties, self-harm is commonly associated with a number of other psychological problems, such as depression, anxiety, eating disorders, trauma or abuse, substance abuse problems and difficulties interacting with peers and family. Cognitive behavioural therapies (CBT) and other evidence-based therapies can be used to treat these co-occurring difficulties.
Important note about immediate safety issues
It is important to note that some injuries resulting from self-harm may require immediate medical attention, and presentation to the Emergency Department may be necessary. If you are concerned that you may seriously harm yourself it is recommended that you call Lifeline on 13 11 14, speak to another responsible adult, or take yourself to the Emergency Department at your nearest hospital, rather than wait for an appointment.
If you would like to find out more about our treatment for self-harm and emotion regulation in adolescents, or to book an appointment with one of our child clinical psychologists who provides treatment for these difficulties, please email or call the clinic on 02 9438 2511.