Teenagers who self-harm present one of the most challenging situations a parent will face. While you may think this is a rare occurrence, 17 percent of adolescents report that they have self-harmed. It is a highly concerning behavior that demands our utmost attention. Here is what you need to know about coping with children who self-harm.

What is Self-Harm?

Self-harm is often referred to as non-suicidal self-injury or NSSI. When we speak of self-harm, we mean any non-socially sanctioned (e.g., piercing, tattoos) intentional injury to our bodies without the intent to die. It is an act most closely associated with borderline personality disorder (BPD) but many teens without BPD do it.

Types of Self-Harm

1. Cutting is by far the most common form of self-harm. People frequently use razors, knives, scissors, or other sharp objects to cut the arms or legs. These cuts may be light or draw blood, depending on the individual.
2. Burning is another popular type of self-harm. Using a match, lighter, or end of a cigarette to burn the skin.
3. A rarer method of NSSI is inserting items under the skin, like a paperclip or small object.
4. Picking is an under-the-radar form of self-harm. Some pick the skin to form a fresh wound. Others continuously pick an existing wound so it never heals. Picking is more socially acceptable than cutting or burning so it may go unnoticed.
5. Other types of self-harm may include: punching yourself, banging your head against a wall, or hair pulling.

Why Do People Self-Injure?

The reasons for self-harm are complicated and multifaceted. The following are some potential reasons and risk factors of which to be aware:

Reasons Teens Self-Harm

• Individuals who self-harm often have difficulty tolerating emotional distress. The physical pain from NSSI is preferred over the emotional pain.

• In contrast, teenagers who feel emotionally numb may self-harm so they feel something. The pain is more desirable than not feeling at all.

• Looking at self-harm from a more physiological perspective, NSSI releases endorphins, which are feel-good hormones. Therefore, self-harm acts as a positive reinforcement.

Common Risk Factors

• Childhood physical and sexual abuse, along with neglect, are often associated with a higher rate of self-harm.

• People suffering from depression and low self-worth are linked with self-harming behavior.

• Adolescents with eating disorders also share a high association with NSSI. Self-harm may give people a sense of control they otherwise feel they are missing.

• Youth who are bullied or rejected by peers are more likely to self-injure. Social isolation appears to be a prime risk factor.

Is Self-Harm the Same as Suicidal Thinking?

Self-harm and suicidality are not the same. In fact, most people who self-harm do not have suicidal ideation. Self-harm, however, may be a precursor for those who commit suicide. Over half of the children who die by suicide have a history of self-harming. NSSI may normalize self-injury and make it easier for those with suicidal ideation to follow through if they do have suicidal thoughts.

Treatment of Self-Harming Behavior

Self-harm is a serious condition that parents need to take seriously. A teenager who self-injures likely requires professional help. Parents should seek a clinician who specializes in the following therapies:

Cognitive-Behavioral Therapy (CBT)

CBT is the most studied therapy in treating NSSI. Variations of CBT have shown some effectiveness in reducing self-harming behavior. Particularly, problem-solving therapy and acceptance and commitment therapy (ACT) have shown promise.

Dialectical Behavioral Therapy (DBT)

Although technically an offshoot of CBT, DBT deserves its own mention in treating NSSI. It was initially developed to treat borderline personality disorder and its focus on emotion regulation, problem solving, and distress tolerance make it a primary intervention for self-harm.

Medication

The research on treating NSSI with medication is in its infancy. However, selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) have shown some potential in reducing self-harming behavior.

Note: Family involvement is key in treating NSSI. As such, caregivers must be prepared to be involved in their child’s therapy. Strong family relationships and social support serve a protective function against self-harm.

Tips for Parents

The following recommendations will help you identify and manage self-harming behavior:

Be Direct When Discussing Self-Harm

Individuals who self-harm want to hide it. They possess considerable shame regarding their behavior. Parents must talk candidly about NNSI without judgment. They need to validate and show compassion for their client’s pain to decrease their shame and increase their openness to further discussion.

Identifying Triggers

Recognizing what precedes self-harming behavior is a main goal of recovery. Once emotional and behavioral triggers are identified, adolescents can work on replacing self-injurious behavior with more adaptive responses. Parents see their children every day and can be a great help in recognizing what takes place before an adolescent wants to self-injure.

Compassion Not Criticism

Believe it or not, parents may feel inclined to punish their children for self-harming behavior. Instead, parents must learn that compassion, rather than criticism, is the means to improvement. Exhibiting love and support is integral to your child’s recovery.

Mindfulness

Mindfulness meditation has several components that are valuable in treating self-harm. Often, feeling numb is the reason why children self-injure. Mindfulness helps people connect to their feelings and alleviate that numbness. Alternatively, mindfulness meditation can aid children in focusing on their bodily sensations and environment rather than their emotional pain. Through mindfulness, people also learn to face their feelings without judgment, causing less torment. Parents are asked to encourage—and even model mindfulness activities.

Relapse Prevention

Someone who exhibits NSSI requires a higher level of monitoring than the usual person. Parents must be prepared to keep a close eye on their children to help prevent relapse. This can be difficult because teenagers value their space and privacy. However, open communication will help adolescents understand the need for more parental supervision.

Self-harming behavior is an alarming development for any parent. NSSI is a condition that needs to be taken seriously, even though it is not usually indicative of suicidal behavior. Parents should seek professional help for their children and prepare for higher-than-usual levels of monitoring and involvement. With love and support, you can help your teenager deal successfully with the damaging urge to self-harm.