SELF-HARM
IN TEENS

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Self-harm means intentionally hurting oneself. It’s also known as self-mutilation, self-abuse, or non-suicidal self-injury (NSSI). There are several reasons why a teenager might engage in self-harm, including to relieve emotional pain or distress. Whatever the reason, if a child that one loves and cares for feels so bad that they are harming themselves, it’s a cry for help.

The parents or caregivers of teens who self-mutilate often feel shocked, confused, sad, angry, and helpless in the face of such behavior. They can see that their child needs help but might not know where to seek such support. Massachusetts Center for Adolescent Wellness can help your teen find other ways to cope and get to the root cause of self-harming behaviors.

Types of Self-Harm

There are many different types of self-harm, i.e., various activities that can be used to inflict injury upon oneself. The two most common forms of self-harm are cutting and burning of one’s own body. Some less common types include punching walls, pulling out body hairs, and ingesting toxic substances or sharp objects. ¹

Skin Cutting: The Most Common Form of Self-Harm

Using a knife, razor blade, or another sharp object to cut one’s skin is one of the most common forms of self-harm. A teen who engages in this type of self-injury will have visible, though often concealed, scars and cuts on their hands, wrists, legs, stomach, or other parts of their body.

The cuts may be in the form of carved words or symbols—or just straight or jagged lines. There may be deep gashes or many smaller cuts at one place on their body. A teen engaged in this form of self-harm will often hide the mutilation by wearing long pants and sleeves, neck scarves, and lots of jewelry. ²

Other Types of Teen Self-Harm

While cutting is the most common form of non-suicidal self-injury (NSSI), and there are many other varieties. Some teenagers only engage in self-harming behavior once or twice. But those for whom self-mutilation becomes an ongoing habit often hurt themselves in more than one way.

Along with cutting, other types of self-harm may include: ³

• Piercing one’s skin with sharp objects
• Breaking one’s bones or bruising oneself
• Drinking toxic substances (like bleach or detergent)
• Swallowing sharp objects
• Overdosing on drugs or alcohol
• Exercising to the point of injury or collapse
• Getting into fights in which one is likely to be injured
• Having unsafe sex

• Head-banging
• Pulling out head or body hair
• Punching oneself or objects (like a wall)
• Burning oneself with matches, cigarettes, or candles
• Scratching or biting one’s skin to the point of drawing blood
• Picking at scabs and wounds
• Inserting objects into body openings

Why Do Teens Self-Harm?

While there is no single clear cause for adolescent NSSI, several factors may play a role. Perhaps the most common and obvious of these is emotional distress.

Does Emotional Distress Cause Teens to Self-Harm?

Most teens who self-harm are seeking quick relief from overwhelming emotional distress. The NSSI behavior is a dysfunctional coping mechanism to deal with difficult emotions. While self-harm is never a permanent solution, it may be experienced as providing temporary psychological and physiological relief from a teen’s emotional suffering.

The source or variety of emotional pain that an adolescent is dealing with may include:

• Feelings of tension, anxiety, and suffering associated with painful emotions such as anger, grief, guilt, shame, or self-loathing
• Wanting to punish themselves for something bad they believe they’ve done or for what they perceive to be their faults or flaws
• Feelings of loneliness or worthlessness lead to a desire to fit in with a peer group that encourages and rewards self-harming behavior.
• Feeling emotionally numb or dead inside
• Feeling emotionally alienated from or invalidated by their parents
• Rebelling against overly demanding parents who enforce strict control over discipline and decision-making
• Feeling overstimulated, misunderstood, or fearful of close relationships with family or friends
• Feeling overwhelmed by school and family responsibilities—being overscheduled, pressured, and rushed through their adolescent years by parents, teachers, and peers
• Feeling overwhelmed by school and family responsibilities—being overscheduled, pressured, and rushed through their adolescent years by parents, teachers, and peers
• Using self-harm to feel more in control of their emotions
• Using self-injury to distract themselves from challenging emotions or life circumstances
• Feeling a lack of control or hopelessness in some aspect of their lives

Teen Self-Harm & Social Media

Teens can be particularly vulnerable to often-toxic social media platforms. Adolescent girls and boys, especially girls, are continuously bombarded with images about how they should look and act—ideals that are impossible to live up to. This increasing gap between fantasy, expectation, and reality can set the stage for eating disorders and self-harming behavior.

Spending extended hours each day in front of computers, TV, and phone screens have become standard practice among adolescents. Such excessive screen time can easily create feelings of envy, fear, isolation, and self-rejection. And these powerful negative emotions can set the stage for self-harming behavior.

Also, excessive time on social media platforms often takes the place of enjoying in-person time with friends and family or engaging in other healthy activities such as exercising, playing sports, spending time in nature, making art, or getting a good night’s sleep—all of which are productive ways of coping with stress.

For these reasons, experts suggest that teenagers’ increased use of digital technology in recent years could be linked to the increasing prevalence of self-harming behavior. Recent research has shown that depressive symptoms and suicide rates among teens increased between 2010 and 2015. Also, adolescents who spent more time on social media and smartphones were more likely to suffer from mental health disorders.⁸

Self-Harm & Mental Illness

Self-harming behavior, in and of itself, is not considered a mental illness. Instead, it’s a dysfunctional coping mechanism that, in some cases, may be symptomatic of an underlying psychological disharmony. That said, several mental disorders tend to be associated with self-harming.

Mental health disorders associated with self-harm can include:

• PTSD
• Anxiety
• Depression
• ADHD
• Eating disorders
• Borderline personality disorder
• Obsessive-compulsive disorder

Adolescents may self-mutilate because the physical pain of harming themselves seems better than the numbness and sense of emptiness experienced with depression. In this way, self-harm and depression are often linked.

Because self-injury can provide a temporary release from emotional suffering but is never a permanent solution, a child’s self-harming behavior may become ritualized—repeated over time. In this way, self-harming may become a compulsive behavior.

Also, teens who harm themselves often do so while under the influence of alcohol or drugs. So, alcohol abuse or substance abuse may play a part in such behavior. Other risk factors that may increase the likelihood of teen self-harm include having experienced trauma, neglect, or abuse; or being a victim of bullying.

Self-Harm & Endorphin Release

How can inflicting physical pain upon oneself relieve emotional pain? This is a question that parents and caregivers of teens who self-harm often ask.

In addition to the psychological mechanisms described above, there is also a physiological reason why self-injuring behavior can provide relief. This physiological mechanism has to do with the so-called endorphin effect.

Endorphins are neurotransmitters released by the brain to alleviate pain and promote pleasure. They’re the human body’s natural pain relievers and “feel-good” chemicals. Endorphins are designed to help the body and mind cope with trauma. Endorphins are produced by the body during both painful experiences as well as during pleasurable activities such as laughing or dancing.

A rapid burst of endorphins—an endorphin “high”—can:

• Reduce physical pain and discomfort
• Alleviate emotional stress and anxiety
• Enhance mood
• Increase feelings of pleasure
• Boost self-esteem

This natural functioning of endorphins in response to physical injury provides an explanation for why a teen may self-harm. The endorphin “rush” delivers at least a temporary escape from the struggles they don’t know how to manage in any other way.

When a teen cuts or burns or in some other way injures themselves, endorphins are secreted into their bloodstream; and they experience a numbing or pleasurable sensation. As with drug addiction, the endorphin “high” delivers fast-acting relief from the teen’s emotional distress. However, since it never addresses the root cause of the suffering, the behavior needs to be repeated.

More healthy ways to release endorphins include:

• Exercising
• Receiving a massage
• Receiving acupuncture
• Enjoying safe sex
• Listening to music

• Eating dark chocolate
• Laughing
• Dancing
• Meditating

Activities such as these can increase a teen’s overall well-being and self-confidence. As a result, their urge to self-harm may naturally decrease.

Signs That a Teen May Be Self-Harming

Since teenagers tend to engage in self-harming behaviors in secret or with their friends, their parents, teachers, and other caregivers may not be aware of this problem. There are, however, certain red flags—signs that a teen may be self-harming. Indications that an adolescent may be self-injuring include:

• Cut or burn marks on the teen’s arms, legs, or abdomens—as observed by a teacher, physician, or parent.
• Unexplained scratches, bruises, or other wounds on the teen’s wrists, arms, thighs, or torso—which they explain as the result of an accident.
• Knives, razor blades, box cutters, safety pins, nail scissors, shards of glass, bottle caps, or other sharp objects are hidden in the teen’s bedroom.
• Discovering blood stains on bedding, clothing, towels, or tissues.
• The teen regularly removes body hair.
• The teen locks themselves in their bedroom or bathroom for an extended time after a bad day at school or a family conflict.
• The teen avoids activities where they would need to reveal their skin, such as swimming or changing in a locker room.
• The teen’s friends cut or burned themselves.
• A sibling of the teen reporting that they discovered blood-encrusted razors or observed the teen self-injuring.
• The teen is always wearing clothes that cover up their skin, such as long sleeves or long pants, or neck scarves, even in hot weather.
• The teen wears excessive jewelry around their neck or wrists.
• The teen exhibiting impulsive and unstable behavior.
• Expressing feelings of hopelessness or worthlessness.
• Having difficulties with relationships.
• Increasing isolation and social withdrawal.

Statistics: How Many Teens Self-Harm?

Some general statistical trends regarding self-harming behavior among teens include:

 

A recent study by the CDC ⁴ found that up to 30% of teenage girls and 10% of boys report that they have intentionally injured themselves. One study found that as many as 25% of young people engage in self-harming behaviors. ⁵

 

Between 2001 and 2015, self-injury increased by 166% in girls aged 10 to 14 and 62% in girls aged 15 to 19. ⁶ Most of these increases involve the most common form of self-harm, cutting.

 

Self-harm behaviors are most common among teenagers. Most youth who repeatedly self-harm stop after their teenage years. ²

 

Kids of all genders engage in NSSI, including males and children who identify as non-binary or transgender. However, more adolescent females engage in self-harming behavior than males. And female teens who self-harm are more likely to cut, while male teens are likelier to hit themselves. ²

 

Self-harming adolescents are rarely suicidal. Most self-harm comes from a momentary need to escape, not a wish to die. However, newer research suggests that teens who engage long-term in NSSI experience higher rates of suicidal thoughts than their peers who do not engage in self-harm. ²

 

Teens who suffer from anxiety, depression, attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), eating disorders, substance use disorders, personality disorders, and other mental health conditions are at higher risk of self-harm. Therefore, treating both the mental health condition and the self-injury is essential. ²

 

While not considered a suicide method per se, self-harm in teens may be associated with an increased risk of suicide. According to one study, up to 70% of teens who self-harm have attempted suicide at another time, and 55% have made multiple suicide attempts. ⁷ Therefore, teens who cut or engage in other forms of self-harm should receive professional mental health treatment as soon as possible.

Effective Treatment for Teen Self-Harm

Self-injury can lead to long-term and dangerous psychological and physical health consequences.

Possible complications of self-harm include:

• Increased feelings of shame, guilt, and low self-esteem
• Wound infections
• Permanent scars or disfigurement
• Broken bones
• Isolation that results in losing friendships
• Higher risk of major depression, drug and alcohol addiction, and suicide

For all these reasons, it’s vitally important for teens who self-harm to receive treatment from mental health professionals (as well as from medical doctors, as necessary). Psychological healing modalities that have proven effective in the treatment of NSSI include:

Family Therapy. This modality supports a self-harming teen by identifying dysfunctional family dynamics, improving family communication, teaching conflict resolution and problem-solving skills, and fostering healthier and meaningful relationships between the teen and their parents.

Cognitive Behavioral Therapy (CBT). This modality can help a teen identify and modify unhealthy thoughts and behaviors that trigger self-harm. They can then learn to replace the negative with more positive and healthy thoughts and behaviors.

Dialectical Behavioral Therapy (DBT). This modality can help a teen recognize the emotional patterns underlying the self-harm and develop ways to modify this behavior.

Meditation. A meditation practice can help teens learn how to witness their emotions with equanimity rather than getting caught up in them. So they can relate to challenging emotions and manage distress without resorting to self-harm. A study conducted at Johns Hopkins University found that meditation was just as effective as antidepressants in treating symptoms of anxiety and depression. ⁹

Find Help for Teen Self-Harm in Massachusetts

The Massachusetts Center for Adolescent Wellness is an outpatient treatment center for teens aged 13 to 17 struggling with mental health disorders or substance abuse. Our skilled mental health professionals provide effective treatment for teen self-harm.

MCAW focuses on having family involvement in recovery and treatment to:

• Help replace self-harm with positive coping skills.
• Build self-esteem and authentic connections.
• Build a support network including family, peers, guidance counselors, and mentors.

We are committed to providing the highest quality individualized treatment to support each client’s unique circumstances. For teens who self-harm, MCAW offers a path of deep healing and transformation—an opportunity to rebuild and thoroughly enjoy a new and healthier life.

References & Resources

1. Adolescent Self-Harm. American Association for Marriage and Family Therapy.
   https://aamft.org/Consumer_Updates/Adolescent_Self_Harm.aspx
2. McKean, Alia & Rahmandar, Maria. When Children and Teens Self-Harm. Healthy Children.
   https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/when-children-and-teens-self-harm.aspx
3. Self-Harm. Mental-Health.gov
   https://www.mentalhealth.gov/what-to-look-for/self-harm
4. Martin A. Monto, Nick McRee, Frank S. Deryck, “Nonsuicidal Self-Injury Among a Representative Sample of US Adolescents, 2015”, American Journal of Public Health 108, no. 8 (August 1, 2018): pp. 1042-1048. https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304470
5. Hetrick, Sarah, et al. Understanding the Needs of Young People Who Engage in Self-Harm: A Qualitative Investigation. Front. Psychol., 10 January 2020
   https://www.frontiersin.org/articles/10.3389/fpsyg.2019.02916/full
6. Mercado MC, Holland K, Leemis RW, Stone DM, Wang J. Trends in Emergency Department Visits for Nonfatal Self-inflicted Injuries Among Youth Aged 10 to 24 Years in the United States, 2001-2015. JAMA. 2017;318(19):1931–1933.
   https://jamanetwork.com/journals/jama/article-abstract/2664031?redirect=true
7. Nock MK, Joiner TE Jr, Gordon KH, Lloyd-Richardson E, Prinstein MJ. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Res. 2006 Sep 30;144(1):65-72.
   https://pubmed.ncbi.nlm.nih.gov/16887199/
8. Tweng, Jean, et al. Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time. Association for Psychological Science.
   https://psycnet.apa.org/record/2017-58243-001
9. Goyal, Madhav et al. Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. AMA Intern Med. 2014;174(3):357-368.
   https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1809754