Identifying & Helping Self-Harm in Teens

Behaviors that result in either physical or psychological injury to oneself can be described as self-harm. It has always been prevalent among teenagers, with cutting and bruising oneself being the most common examples. Self-harm is most commonly seen as a symptom of Borderline Personality Disorder. Still, it could be a transdiagnostic marker of psychopathology and suicide risk, according to an article published in the European Child & Adolescent Psychiatry, a peer-reviewed journal. 

The article states that self-harm is divided into two essential categories. These include nonsuicidal self-injury (NSSI) and suicidal behavior. The worldwide prevalence of self-harm among adolescents is a staggering 16.9%. The Covid-19 pandemic, the Ukraine War, and a host of other reasons may have contributed to the increase in the prevalence of self-harm. In most cases, self-harm is intricately linked to past and present traumatic incidents. 

To understand self-harm among teens with more clarity, we contacted Kelly Kellerman at Thriveworks. 

Thriveworks is a mental health company with over 340 clinics nationwide. The firm also offers online services. We spoke to Kelly Kellerman, Licensed Clinical Social Worker with Thriveworks in Oakland. Kelly specializes in generalized trauma and PTSD, and has been trained in trauma-informed care.

1. What problems/challenges are you seeing today with teens? 

I have witnessed increased self-harm or self-injury, which means hurting oneself on purpose. It can include cutting, scratching the skin with a paperclip or other sharp objects, skin picking, and hitting oneself. It can also include participating in high-risk behaviors like drug and alcohol use and practicing unprotected sex. A new and rising trend is digital self-harm which focuses on emotional harm by a teen anonymously posting hurtful comments about themselves online. Please note most teens who self-harm are not necessarily attempting suicide.

2. In what areas are these challenges evident? 

These challenges are evident when teenagers experience difficult emotions like stress, anger, depression, and anxiety. Other risk factors include a history of trauma, neglect, or abuse. Those who self-harm may be trying to release emotional pain or cope with feeling numb because they don’t know other coping skills. It can be a way to communicate a need for help when they cannot do so with words.

3. Before the pandemic, what were the most common challenges you faced with teens? 

Self-harm has been a typical challenge with teens long before the pandemic. Being disconnected from friends and pushed further toward technology, phone, and online usage have increased feelings of lack of emotional connection. The more time teens spend on their phones and social media, the more they compare themselves with others. This can make a teen feel overwhelmed and unprepared to manage that stress. 

4. What advice would you offer to parents with post-pandemic teen problems? 

I urge them to speak to teens with love and compassion without panicking. Parents can discuss their observations with their teens and say, “You must be struggling right now. I am here for you.” Validating that all feelings are ok is very important. I would encourage them to request their teens share their problems with them by saying, “Let me know what you have been thinking about and what you are feeling.” One does not have to be a therapist to be a supportive caregiver. Parents must also offer to get them help so teens can learn new coping skills. In addition, they can share healthy coping skills that have worked for them.

5. What is the best therapy teens can get? 

Talk therapy is a standard treatment for self-harming behavior. Cognitive behavior therapy (CBT) can help teens learn that thoughts and feelings are related. CBT teaches them how to challenge and replace negative thoughts and dysfunctional beliefs. In other words, instead of using maladaptive thinking patterns repeatedly, they can learn another way of looking at things. Kids today have access to technology, which provides instant gratification. As a result, teenagers don’t have a road map to manage discomfort without falling back upon instant gratification. A therapist can teach teens skills like mindfulness, grounding, breathing exercises, self-care/self-soothing, and acceptance to manage distress instead of avoiding it. Improving self-esteem is also a part of the treatment. Parents can also benefit from therapy and need connections, so they don’t feel alone.

Seek help for self-harm before it is too late

Although self-harm and self-injurious behavior may not necessarily lead to suicide attempts, they are serious indications of an underlying mental health disorder. In addition to Borderline Personality Disorder, self-harm can result from past and ongoing trauma, a way to seek help, and communicate distress when everything else fails. 

If you notice that your teen has been engaging in different self-injurious behavior, getting them the support they need is essential. Try to find a trauma-oriented therapist with experience in working with adolescents who harm themselves. Cognitive behavior therapy (CBT) and other forms of talk therapy can reduce the frequency of self-injurious behaviors. 

As Kelly Kellerman rightly says, parents must take an active role in helping their teens seek treatment for self-harm.