Self-harm is difficult for many parents to understand, and it’s normal to feel angry and confused when you notice signs of it in your teen. You might wonder whether this behavior is just a cry for attention, a phase, or something they’ve picked up from a friend. In most cases, however, self-harm is a sign of a serious emotional problem that chronically affects 6% of adolescents and young adults in the U.S.
Self-harm—otherwise known as non-suicidal self-injury (NSSI)—is just what it says: hurting yourself on purpose (but does not include normal piercing or tattooing). There is no single reason that teens begin to self-harm, but it could include a combination of factors such as trying to distract themselves from emotional pain by turning their attention to physical pain or providing a momentary sense of release and calm.1 Other teens who have experienced trauma sometimes harm themselves as a way of asserting control over their body and their lives, and some with mental health issues shut out emotions to such an extent that they no longer feel anything. These teens may turn to self-harm as a way of feeling something.1
While self-harm is, by definition, not a suicide attempt, those who self-harm may also be at increased risk of suicidal behaviors.1 Though teens who self-harm do so in an attempt to feel better, and not to end their lives, emotional distress is at the source of both acts of self-harm and suicide, which in and of itself places those adolescents at a higher risk for developing suicidal ideation if not treated.1
Other potential risks of self-harm include:
- Permanent scars or disfigurement.
- Feelings of shame and guilt.
- An escalation of underlying mental health problems.
- Severe, even fatal injuries.
Several mental illnesses are also associated with self-harming behaviors. A few behavioral health issues, such as substance use and eating disorders, share some features—such as struggles with self-control—with NSSI. Teens with mental health issues may also have complex and powerful emotions that they are ill-equipped to handle, which may also factor in to self-injurious behaviors.2
Self-harm often co-occurs with these common mental health conditions:3
It is very important for parents to learn to recognize the signs of self-harm in their teenage children, because, left untreated, it can be very dangerous. This article will teach you what to look for and what steps to take if your child is self-harming.
Recognize the Warning Signs in Your Teen
Self-harm can take a variety of forms. While some teens stick to one method, such as cutting, others vary their tactics. Cutting is defined as any intentional cut that breaks the skin and causes bleeding. Cutting can be done with any sharp object, including razors, knives, needles, sharp rocks, or broken glass.1
Other common methods of self-harm include:1
- Burning the skin with cigarettes, candles, or hot metal.
- Punching oneself to the point of bruising.
- Severely scratching or pinching the skin until it bleeds or bruises.
- Punching or banging objects (like hitting the wall) to the point of bleeding or bruising.
- Cutting or carving words into the skin.
- Biting the skin till it bleeds or leaves a mark.
- Pulling out hair, eyebrows, or eyelashes with the intention of hurting oneself.
- Puncturing the skin with objects or embedding things under the skin.
- Rubbing the skin hard with a pencil eraser or something else that causes a burn.
Most teens feel ashamed after they harm themselves and may go to great lengths to keep their behavior a secret. In some cases, the evidence of self-harm might be well hidden, but others may be more noticeable.
Examples of body parts teens might self-harm include:2
- Lower legs.
Self-harm can be difficult to spot, so it is important to learn all the warning signs, such as:1
- Unexplained cuts, bruises, burns, or other signs of damage.
- Clusters of scars or marks.
- Evidence of bandaging or wound care.
- Inappropriate dress for the season (e.g., long shirts or pants in the summer).
- Unwillingness to disrobe in front of others (e.g., for swimming or the gym).
- Accessories that are never removed (e.g., wrist bands, gloves, bracelets).
- Cutting implements in odd places (e.g., knives in the bathroom, razors in the bedroom).
- Isolation and withdrawal (e.g., spending a lot of time alone, withdrawing from friends and family).
- Difficulties managing emotions, especially anger.
- Evidence of shame, self-loathing, or low self-esteem.
Be Calm and Listen to Your Child
If you discover that your teen is self-harming, it is normal to experience a variety of powerful emotions, such as anger and guilt. You may feel like your child is doing this to you and you may be tempted to just tell them to stop. For your child’s sake, however, try to remain calm and approach the situation with empathy and understanding.
Self-harm, regardless of the severity of the injuries, is a sign of serious emotional problems, and it must be addressed as soon as possible. Don’t presume that your child will simply grow out of it. It is important that you acknowledge your child’s behavior and demonstrate your concern in a constructive manner.2
One of the most important things you can do is validate your child’s feelings (which is not the same thing as validating their behavior). Recognize that your child is suffering. Avoid statements that sound judgmental or belittling, such as “your life isn’t really that hard,” or “it’s only high school, don’t take everything so seriously.”
Self-harm is a very emotional topic that can be difficult for teens to talk about. If your child is self-harming, then they may already have trouble talking about their feelings. Direct questions can feel overwhelming at first, so don’t pressure them to talk. Try asking specific, compassionate questions that may guide them toward getting help.1
These examples of thoughtful questions can help you open positive communication with your child:
- How do you feel before you harm yourself? How do you feel after?
- What thoughts, events, or feelings lead you to harm yourself?
- How does hurting yourself make you feel better?
- Is there something that is stressing you out right now that I can help you with?
- If you don’t want to talk now, that’s fine, but I’m here when you need me. Is it okay if I check in with you about this, or would you prefer to come to me?
- Will you agree to come to me next time you hurt yourself so that I can help you care for the wound?
Approaching your child in a combative or defensive way can actually lead to more self-harm. These are a few things to avoid when talking to your teen about self-injury:
- Harsh or lengthy punishments
- Invasions of privacy (searching the bedroom without permission)
- Trivializing (“I know how you feel” is often unhelpful)
Help Them Find Treatment
Teens self-harm because they have trouble dealing with emotions. Treatment focuses on teaching them the skills they need to handle those feelings in a healthy way, so finding a good program is the best first step to take. Because, while hiding all the sharp objects in the house might be a good idea, it doesn’t address the underlying problem. If someone really wants to hurt themselves, they are going to find a way.
Self-injury in adolescents has only recently been recognized by the psychiatric community as a commonly occurring problem. As such, not all psychiatrists are equally familiar with the topic. In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the only mental health condition that lists self-harm as a symptom is borderline personality disorder (BPD).4 A therapist who is unfamiliar with adolescent self-harm may mistakenly assume that it only presents with BPD, but this is not true.
Once you have determined that your teen is suffering from self-harm, take them to get a comprehensive psychiatric evaluation from a psychiatrist who has experience treating this issue. A good place to start your search is the American Academy of Child and Adolescent Psychiatry’s physician finder. The doctor will screen for underlying psychiatric issues that could be causing your child to self-harm and provide a diagnosis.
To date, only a few clinical trials have evaluated specific treatments for adolescents who self-harm, so the most studied approaches pertain to adults and specifically focus on dialectical behavioral therapy (DBT), which uses a combination of individual and group counseling to teach emotional regulation skills.5 Participants work on coping strategies that help them tolerate stress, control their behavior, and acknowledge their feelings.5
When counseling a teen who self-harms, many therapists like to bring in the family at some point during treatment, which can include extended family or friends. Many teens who injure themselves have trouble vocalizing their feelings and may come from families who find it difficult to share emotions. So the goal of family therapy is to encourage more open and honest communication between all family members.6
The idea of family therapy may be intimidating or scary to some people, but it can be a positive experience for everyone involved. Teenagers often feel invisible and misunderstood, while parents feel confused about what their teen wants from them. Family therapy is an opportunity to clarify family dynamics and encourage a supportive, healthy environment for everyone.
Any type of talk therapy or psychological counseling can help your teen learn to cope with emotions more effectively. Cognitive behavioral therapy (CBT) is another common therapeutic approach that focuses on identifying negative thought patterns and developing healthy coping skills. Teens learn how to recognize the triggers that lead them to self-harm so that they can avoid them in the future. They also learn to substitute harmful behavior with positive outlets, such as art and exercise.3
Mindfulness-based therapies can help teens be more present in the moment, instead of dwelling in the past or fearing the future. This helps reduce anxiety and depression while helping teens be more perceptive about the emotions of people around them.7
Depending on which, if any, psychiatric conditions your child is diagnosed with, their doctor may choose to put them on medication. Antidepressants and anti-anxiety medicine can be helpful for many teens, but there can be adverse outcomes associated with these medications, including an increased risk of suicide and overdose. You and your child’s psychiatrist can weigh the risks and benefits of medication.8
No matter the form of treatment you find, the important thing is to support your child in getting the help they need.
- Whitlock, S., ACT for Youth Center of Excellence. (2009). The Cutting Edge: Non-Suicidal Self-Injury in Adolescence.
- Ferrales, D. & Koukel, S. (2014). Teens and Self-Cutting (Self-Harm): Information for Parents. New Mexico State University.
- National Alliance on Mental Illness. (2017). Self-Harm.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Association Publishing.
- Peterson, J., Freedenthal, S., Sheldon, C., & Andersen, R. (2008). Nonsuicidal Self Injury in Adolescents. Psychiatry (Edgmont), 5(11), 20–26.
- Sweet, M. & Whitlock, S. (2010). Therapy, What to Expect? Cornell Research Program on Self-Injury and Recovery.
- Chiesa, A. & Serretti, A. (2011). Mindfulness Based Cognitive Therapy for Psychiatric Disorders: A Systematic Review and Meta-Analysis. Psychiatry Research, 187(3), 441–453.
- National Institute of Mental Health. (2016). Mental Health Medications.