Deliberate Self-Harm in Adolescents
By Melissa M. Gonzalez, Psy.D.
While it can be hard to understand, some individuals turn to self-harm (also known as self-injurious behavior or self-mutilation) as a maladaptive means of coping with painful emotions. They deliberately inflict pain on themselves or engage in self-destructive acts. Alarmingly, the research suggests that the incidence of such behavior is increasing among adolescents, especially adolescent girls. However, because these acts are often hidden from others and are typically not reported, it is difficult to determine how common this practice actually is. According to the research available, self-harm appears to be istinct from suicidal behavior. Nonetheless, those who self-harm often experience suicidal ideation and may be at greater risk for suicide attempts. Intentional acts of self-harm should not be taken lightly, no matter how minor the injuries may appear.
Parents often wonder why their child would deliberately hurt themselves. In adolescents who self-harm, sadness, loneliness, and/or increasing tensions are often reported prior to episodes of hurting themselves. Some individuals use self-harm as a means of controlling their minds, stopping racing thoughts, or providing the relief necessary to relax. Others find themselves seeking to feel something when plagued by feelings of numbness or apathy. Furthermore, there are some individuals who report feeling the need to punish themselves. Ultimately, many of these individuals are simply trying to take control when they feel very much out of control. While self-harm is often not an attention-seeking strategy, such behavior may be used as an expression or physical manifestation of the adolescent’s pain. Additionally, it is important to understand that since adolescents are easily influenced by their peers they may be more likely to experiment with self-harming when they know of other peers who are already engaging in similar acts.
There is some research that suggests that while many teens may first experiment with self-injurious behaviors during times of high stress, many do not continue this behavior. However, for those who do continue to hurt themselves repeatedly, it seems likely that they are experiencing more significant emotional difficulties or chronic distress. From a clinical perspective, anxiety and depression are often present in those who self-harm as are bipolar disorders and Borderline Personality Disorder. Alcohol or substance abuse, problematic relationships with family or peers, low self-esteem, bullying, impulsivity, behavioral problems, and poor academic performance have also been associated with self-injurious behavior.
Self-harm may take a number of forms, including cutting, burning, poisoning, or hitting oneself; and cutting seems to be the most common method used by adolescents. Cutting may be preceded by hair pulling, picking at scabs, or scratching the surface of the skin without breaking the skin. Surprisingly, cutting has been found to have an almost addictive quality for some. This may be related to the release of endorphins while cutting and the sense of relief from painful emotions experienced immediately after cutting. Consequently, when teens stop cutting themselves, they often continue to feel “urges” to cut and they may relapse into self-harm in times of intense distress.
Teenagers often hide self-injurious behavior from their parents and sometimes even from peers. Parents may only find out about such acts accidentally or when their child hurts themselves badly enough to become scared or require medical attention. In order to hide their behavior, they may cut or burn themselves in locations on the body which are not often seen. Common sites include the thighs, arms, feet, and abdomen. Adolescents may attempt to cover up their scars with long sleeves or pants (even in warm weather) or with jewelry on wrists. Parents may find blood stains on clothing or towels if their child is cutting. Other warning signs include having friends who engage in self-harm, seeking isolation or privacy when extremely distraught, or keeping instruments in one’s room or bathroom that could be used for self-harm. Knives, razors, and needles are commonly used for cutting. However, some adolescents can get quite creative, for example using tweezers, sharpened hair pins, or pencil sharpeners that have been taken apart. For those who choose to burn themselves, lighters, matches, cigarettes, candles, curling irons, or flat irons may be used.
It is important for parents to seek help immediately if they learn that their child has intentionally hurt themselves. A qualified professional can then determine if the behavior qualifies as deliberate self-harm or was, instead, a suicidal gesture and if psychological diagnoses, such as anxiety disorders or mood disorders, are present. Treatments such as individual therapy, family therapy, group therapy, and/or the use of psychotropic medication may be considered in order to address this behavior once an appropriate assessment has been made. Individually, a therapist can work with the adolescent to understand their behavior, to address feelings that precipitate self-harm, and to develop healthier, more adaptive coping skills. Use of Dialectic Behavior Therapy (DBT) in individual and/or group settings may also be useful. Family therapy can offer support for parents, can provide guidance about ensuring the safety of the child, and work on the resolution of familial patterns or conflicts that may be contributing to the adolescent’s distress. First and foremost, the primary goal is, of course, the safety of the adolescent.