Understanding Self Harm in Teenagers

Reviewed by Dr Lucy Russell DClinPsyc CPsychol AFBPsS

Discovering that your teenager is self-harming can of course be distressing.

Let’s stop, take a breath, and make sense of what’s happening. Why is your teenager self-harming, and how can you best support them?

Self-Harm in Teenagers: How This Article Will Help You

In this article I will explain what self-harm is and why your child might be hurting themselves. I will guide you on how to keep your child safe and find the right support for them.

Let’s help you to feel equipped and ready to support your child.

Why Do Teenagers Self-Harm?

“People self-harm for many different reasons.  Some people find it hard to explain why they do it, but often it’s a way for people to let out feelings that are hard to explain or control”.  (Lucas, age 19 for Young Minds)

Lucas’s words provide a glimpse into the intricate emotional landscape within teenagers.

These internal struggles, often concealed beneath the surface, can encompass a myriad of feelings, from confusion to overwhelming sadness. As these emotions churn, teenagers like Lucas search for ways to cope, sometimes leading to behaviours that might be hard for us as parents to understand.

Self harm can be a release, a form of expression, or a cry for help, signaling underlying emotional distress that needs attention and understanding.

What is Self Harm?

Self-harm is when people deliberately hurt themselves to cope with emotional distress.

It is not a mental illness in itself.

It is a coping mechanism which is often symptomatic of something deeper.

Young people can find the physical pain of self-harm preferable to emotional pain that feels hazy, hard to describe, control or alleviate.

Self-harm can be habit-forming but only provides short-term relief from emotional distress. The brain can start to connect a sense of relief from bad feelings with acts of self-harm.

Types of Self-Harm in Teenagers

Cutting is the most common form of self-harm and is most usually seen on wrists, arms, thighs and stomach.

Other methods can include:

• Head banging
• Hair pulling
• Burning and scalding
• Biting or scratching
• Stabbing
• Breaking bones
• Swallowing objects
• Self-poisoning and overdosing
• Digital self-harm or self-cyberbullying

Self Harm in Teenagers: Examples of Implements That May Be Used

1. Razor Blades
2. Cigarettes or lighters
3. Finger nails
4. Pen tops
5. Sharp objects
6. Household cleaning liquids
7. Medical box contents

Self Harming in Teenagers: Understanding Root Causes

You might be struggling to understand why your teenager has self-harmed.

This is completely natural if you have never self-harmed yourself.

However, it is essential that you understand your child’s “why”. This will enable you to connect with them and support them in a way which meets their needs.

Root Causes of Teen Self Harm

1. To Feel Better by Easing Emotional Distress

A young person rarely self-harms to be ‘cool’ or fit in with their peers. Self-harm is a reaction to emotional pain and distress. This behaviour is an indication of an underlying emotional difficulty.

Teenagers who self-harm may lack self-esteem or have poor self-worth. They may believe they are at fault for the way they feel. They may feel great shame and feel self-punishment is necessary.

Sometimes, young people decide that the only way to release pent-up shame, guilt, anxiety or panic feelings is to feel physical pain. 

2. To Feel Something Rather Than Nothing

I have heard so many young people tell me that self-harming makes them “feel real” or feel present in the moment when they have felt separate from themselves.

Teenagers who have experienced traumatic events can feel waves of emotional numbness as the brain blocks out the trauma. 

This is called dissociation.

For some, cutting is a way of testing whether they can still “feel” physical pain. Sometimes teens use cutting or other self harming to “wake up” from their emotional numbness.

3. To Get a “Buzz”

This is rarely the primary reason why someone starts self-harming.

However, many teenagers report that self-harming can give them a feeling of elation or a “buzz”. Adrenaline and a dopamine “hit” are involved.

However, this feeling is only temporary.

Often the young person feels much worse when it subsides.

4. To End Their Life

Suicidal thoughts are much more common than suicidal behaviour. Most teenagers who self-harm do not actually intend to end their lives.

However, sometimes this is the intention. If your child expresses suicidal thoughts you must seek to understand whether they have any intentions or plans to end their life.

If they do, this is a red flag that your child needs urgent help. Call the emergency services, take your child to the emergency department, or seek an urgent mental health appointment.

5. Not For Attention

Self-harm is not generally a form of attention-seeking by teenagers.

Many teens (although not all), harm themselves in private and try to conceal their injuries.

Even on those occasions when self-harming is done publicly and could be interpreted as “attention-seeking”, we must re-frame this view. “Attention-seeking” is an unhelpful phrase.

In the context of self-harm it could be re-interpreted as:

• Attempting to find recognition of their intense emotional pain and suffering.
• Needing to be seen and heard.
• Trying to get help.

Who is at Risk of Self-Harm?

Any teenager may self-harm depending on their circumstances, but it’s more common in:

• Teen girls.
• Young people with low self-esteem.
• People with mental health conditions such as depression, anxiety, borderline personality disorder or an eating disorder.
• LGBTQI+ people, possibly because of the stress of stigma and discrimination.
• People who have a history of trauma, neglect or abuse.
• People who have been bereaved by suicide.
• Teenagers who feel unsafe at school or at home.
• Someone experiencing negative body image perceptions.

This video from Childline can be helpful for teens who have had suicidal thoughts.

Teen Self-Harm and Risk of Death

There are many levels of self-harm. For example with cutting, it can range from mild scratches to the skin with a ruler, through to serious and dangerous cutting leading to heavy bleeding.

At any level, self-harming behaviour can “go wrong” or go further than intended. This could lead to more serious injury than intended or accidental death.

For this reason, however hard, it’s vital that you are non-judgmental and encourage openness. If you criticize or show lack of understanding, this will encourage secrecy in your teen’s self-harming behaviours. If you don’t know what’s going on, you can’t keep your teen safe.

Teen Self-Harm: Who is Most at Risk of Serious Injury or Death?

Historical Self-Harm

If a child has self-harmed before, they are more likely to become suicidal.

Mental Health Disorders

Depression, severe anxiety disorders such as OCD, or so-called “personality disorders” can increase the risk of suicidal self-injury.

Desensitisation

In a crisis situation, self-harmers who have become desensitized and habituated to pain through repeat harming episodes, may view a suicide attempt as less frightening (Stewart, 2014).

Impulsiveness and Risk-Taking

If your child has a tendency to act impulsively or is a risk-taker, there is a higher chance of accidental death or serious accidental injury.

Trauma

Trauma can lead to unbearable mental pain. Early unresolved traumatic experiences or ongoing trauma are both risk factors.

Signs of Teenager Self Harm

Self Harming in Teenagers: Behavioural Signs

• Covering up with long sleeves or trousers. Noticeable particularly if this isn’t weather appropriate.
• Avoiding activities like swimming or going to the beach where they might have to uncover.
• Noticeable changes in sleep or eating behaviours.
• Avoiding activities they used to enjoy.
• Not wanting to go to school or college.
• Hiding self-harm objects.
• Not taking care of their appearance.
• An increase in use of social media.

Teen Self Harm: Emotional Signs

• Mood changes, swings and irritability.
• Feeling anxious, worthless or depressed.

Teenage Self Harm: Physical Signs

• Signs of a new injury – vagueness is common when challenged.
• Scarring – noticeable especially if there are several scars in close proximity.
• Redness or bruising.
• Sore or bleeding fingers around the nails or scratches to areas of the skin.
• Patchy hair loss.
• Noticeable agitation or lethargy.

Talking About Self Harm in Teenagers

It takes real courage and trust for a teenager to reach out about self-harm.

Some teenagers confide in friends or a family member. But they might ask them not to tell anyone else, which can be burdensome for the person they have shared this information with.

Your teenager might tell someone about their self-injury because they have recognised they would like help and want to stop. However, some may find it really difficult to tell others for fear of being misunderstood or judged negatively.

As we have discussed, there are often strong feelings associated with acts of self-harm such as:

• Guilt
• Self-loathing
• Shame
• Stigma

How to Approach Talking About Self-Harm With Your Teenager

Ensure you are calm, ready to listen and don’t over-react.

Some young people deny they are self-harming, while others might admit to it, but say that it’s not a problem. Some teens may reject help or conversely, are relieved that someone knows and wants to help.

Worries and fears for your child’s safety are probably the first thing you will be thinking about.

It might be really hard to do, but it’s important to put aside your own feelings and concentrate on the reasons behind your teenager self-harming rather than focusing on the self-harm itself. (Of course, the exception to this is when your teenager is in immediate danger and you need to seek urgent help.)

Before talking, consider what you want to say.  Here are some examples:-

• “I can sense you’re upset and maybe scared. I’m here to listen and help you in whatever way you need”.
• “I have noticed some scars on your leg, and have wondered if you’re OK? I’m happy to talk with you about it when you’re ready”.
• It’s entirely normal to experience strong emotions but these don’t last forever. If you feel able, let’s talk about it. Why don’t we go for a walk and get some fresh air”.

Reassure your child and let them know you’re there to support them and you will get through this.

Aim for a sense of togetherness, teamwork and trust.

Keeping Your Teenager Safe

Self-injuring isn’t a healthy way to deal with even the most extreme emotions or pressures.

However, teenagers often do it because they feel it’s the best strategy – or their only strategy – at the time.

Our job as adults is to: a) help address the root cause, and b) help them develop a range of alternative coping strategies.

If you know that your teenager is self-harming it’s important they are aware of the risks.  Repeated self-harm can lead to serious injuries, infections, scarring, medical conditions and suicidal behaviour.

There are things that you can do to help keep a self harming teenager safe.  A mental health professional may be needed to help draw up a risk and safety plan.

Teen Self Harm Safety Guidelines for Parents

• Treat a wound or if it requires medical attention, take your child to the GP or hospital.
• Remove sharp objects from the kitchen or bathrooms.
• Monitor your teenager and check-in with them frequently.
• Lock away medicines and alcohol.
• If you are concerned that your teenager is about to seriously hurt themselves and you don’t feel you can keep them safe, don’t hesitate to call 999 or take them straight to A&E.

If your child appears to be feeling better, don’t automatically assume that they are no longer at risk of hurting themselves. 

Some children and young adults will actively hurt themselves when they experience higher or euphoric mood states and have more energy to carry out self-injury actions.

Managing Teen Self-Harm

Encourage your teenager to explore different ways to manage difficult feelings, other than self-harm. 

Part of their recovery is finding ways to express themselves and ask for help. 

Here are a few ideas on how they might do this.

•  Use distraction techniques such as walking the dog, baking in the kitchen (something proactive).
• Reach out. Have 1 or 2 designated trusted people as emergency/emotional contacts.
• Keep a mental health journal. Use it to express feelings and worries.
• Have a regular time set aside to talk about worries.
• Stay connected with other people.
• Spend time doing enjoyable activities that give your teen a sense of purpose and value.
• Talk to a mental health professional about your teenager’s self-harm.

Getting Help for a Self Harming Teenager

It can be difficult for teenagers to stop self-harming.

It requires determination, courage and strength and often, the support of others who understand and care.

Professional help can make a real difference.  Your child’s doctor can help them (and you) to determine whether a referral for an assessment by a mental health professional would be appropriate. 

In the UK your child may be referred to their local NHS Child and Adolescent Mental Health Services (CAMHS).

Self Harm in Teens: Types of Therapy

Effective therapeutic treatment pathways include Counselling and psychological therapy.

There are several types of therapy which can be helpful in working with teen self harm.

Dialectical Behaviour Therapy (DBT) for Teen Self Harm 

DBT is a psychotherapy that aims to help young people with extreme and chronic emotion dysregulation.

In other words it helps people with emotions that are very strong, quick to start, and slow to end.

DBT helps build new skills while reducing self-destructive and harmful behaviours and patterns.

Cognitive Behaviour Therapy (CBT) for Self Harm in Adolescence

Cognitive Behaviour Therapy (CBT) is a well-established psychological therapy rooted in the principle that our thoughts, feelings, and actions are interconnected.

At the core of CBT is the idea of recognizing and challenging inaccurate or unhelpful thinking patterns. For teenagers who self-harm, these patterns might include feelings of worthlessness, overwhelming guilt, or intense self-criticism.

By identifying these harmful thought cycles, CBT provides tools and strategies to interrupt and gently adapt them.

The goal is not just to modify thoughts, but also to equip self harming teenagers with alternative coping mechanisms for challenging situations.

This might involve teaching them teenagers techniques, problem-solving skills, or strategies to improve their self-esteem.

ACT (Acceptance & Commitment Therapy) and Self Harming in Teens

Acceptance & Commitment Therapy (ACT) offers a unique approach to understanding and addressing self-harming in teenagers.

At a time when adolescents often grapple with self-identity, peer pressure, and overwhelming emotions, ACT provides an avenue for them to confront these challenges head-on.

The foundation of ACT is about accepting one’s thoughts and feelings, not as definitive truths but as passing emotions. For a teen who self-harms, this acceptance can be transformative. Instead of feeling trapped by their emotions, or consumed by guilt and shame, they learn to observe their feelings without judgment.

By noticing and accepting their emotions, self-harming teens can develop psychological flexibility. This flexibility allows them to adapt to various situations without resorting to self-harm. ACT introduces them to a wide range of coping strategies, from mindfulness exercises to value-based actions, which can serve as healthier alternatives to self-injurious behaviours.

ACT also places a significant emphasis on discovering meaning and purpose. For teenagers, this can be a guiding light, helping them channel their energy and emotions towards goals and values that resonate deeply with them.

It shifts the focus from immediate emotional relief through self-harm to long-term fulfilment and purpose.

Family Therapy for Self Harm in Teens

Family therapy involves exploring family relationships and dynamics and improving communication.

Family dynamics often play a pivotal role in the emotional well-being of teenagers. Family Therapy, in the context of self-harming behaviours in teens, seeks to uncover and address the complexities of these dynamics.

At the heart of Family Therapy is the exploration of family relationships. By delving deep into these connections, therapists identify patterns that may contribute to a teenager’s decision to self-harm.

Factors like unresolved conflicts, lack of understanding, or generational trauma can play a significant role in a teen’s emotional landscape.

Communication is a critical component of healthy family relationships. In some instances, teenagers resort to self-harming as a silent cry for help, if they feel unheard or misunderstood by family members.

Family Therapy provides a structured environment where all members can voice their concerns, feelings, and fears, fostering understanding and empathy. It equips families with the tools and strategies for healthier interactions.

Self Harm in Teenagers: Risk Assessment

If your teenager is repeatedly self-harming, the risk should be properly assessed by a mental health professional such as a psychiatrist or clinical psychologist. This allows the development of a clear and logical self-harm management plan.

The mental health professional will typically carry out a risk assessment by talking to your child, talking to you, and sometimes by using screening questionnaires. 

This allows the professional to make clinical decisions about the best course of treatment for them. For example, whether a self-harming teenager would benefit from psychological therapy or medication.

Teenage Self Harm Safety Plans

After determining the level of risk, the psychiatrist or clinical psychologist may construct a self-harm safety plan between themselves and the child (and parent/guardian if the child is under the age of 18 yrs old).

A safety plan is a document that includes coping strategies and individuals or agencies that may be contacted during a crisis. 

A teen self-harm safety plan details warning signs to be aware of, and outlines steps the young person is willing to take in order to keep safe, including alternative coping strategies.

The teen self harm safety plan often takes the form of a contract.

In the contract the professional, teen and parent each agree to different actions.

For example, the teen may agree that they will not self-harm between the current therapy session and the next one. Or they may agree that if they feel they are going to self-harm, they will tell a trusted adult.

The parent may agree that if their teen self-harms, they will stay calm. They may agree to provide antiseptic wipes or plasters and help their teen to clean any wounds.

The mental health professional may agree that they will stay non-judgmental at all times. They may agree that they will help the teenager to develop new coping strategies.

Teenage self harm contracts should be reviewed and adapted regularly.

Self harm safety plans provide a framework of shared responsibility and safety whilst giving the teenager some autonomy around decisions and outcomes.

Summary: Why Do Teenagers Self-Harm and How Can We Support Them

Self-harm is not a mental illness but a means of coping with difficult emotions and feelings.  There are many underlying reasons for self-harm.

The best way to support your teenager is by listening to what causes them distress and what they get from self-harm. 

From there you can think about alternative and healthy ways of approaching their difficulties.

It is likely you will need support from a mental health professional.

Self Harm in Teenagers: Resources for Parents

Book: The Parent’s Guide to Self-Harm: What Parents Need to Know by Jane Smith

Our article: ‘A Psychologist’s Top 8 Parenting Teenagers Books’.

Self Harm Resources for Teenagers

Book: Stuff That Sucks by Ben Sedley

Book: The DBT Skills Workbook for Teen Self-Harm: Practical Tools to Help You Manage Emotions and Overcome Self-Harming Behaviors by Sheri van Dijk

App: Calm Harm – a free app that helps people manage or resist the urge to self-harm.

A great tool for your teenager to try: Use This Circle of Control Exercise For Better Mental Health [Free Printable]

Related Articles

A Parent Guide to Healthy Coping Skills for Teens

Your Parent Guide to Low Mood and Depression in Children

Signs of an Insecure Teenager: Parent Guide

Anxiety Worksheets for Teens: A Toolkit for Managing Stress and Worry [Free PDF]

3 Effective Strategies to Stop Walking on Eggshells with Your Teen

Hayley Vaughan-Smith is a Person-Centred Counsellor accredited by the National Counselling & Psychotherapy Society. She is the founder and counsellor at The Ridge Practice in Buckinghamshire, and counsellor at Everlief Child Psychology.

Hayley has a special interest in bereavement counselling and worked as a bereavement volunteer with Cruse Bereavement Care for four years.

Hayley is mum to 3 grown up girls, and gardening and walking in nature is her own personal therapy. Hayley believes being in nature, whatever the weather, is incredibly beneficial for mental health well-being.

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