Self-Harm and Depression in Teens and Young Adults

Have you noticed your loved one acting differently, withdrawing from others, or talking about feeling worthless and hopeless? Maybe you’ve also seen some cuts and scars on them, or they always make up excuses for frequent injuries. Any of these signs could indicate that your loved one is engaging in self-harm. They may also be experiencing depression.

Sadly, self-harm and depression are relatively common in teens and young adults. Around 15% of teens ages 12-17 have experienced a major depression episode, and according to the American Psychiatric Association, the average age that someone may start self-harming is 13 years old.

It is so important to educate yourself on self-harm and depression, be aware of warning signs to look out for, and know how to best support your loved one.

Here’s what you need to know about self-harm and depression, the link between the two, and treatment options. 

What are self-harm and depression? 

Self-harm and depression are two different mental health struggles. They are separate, but sometimes they can overlap and coexist. For example, people who self-harm may also experience depression, and people with depression might engage in self-harming behavior. 

To better understand both, here are overviews of each:

Self-harm

Put simply, self-harm is when a person intentionally hurts themself. Aside from self-harm, some other names you might hear this phenomenon referred to as are:

• Nonsuicidal self-injury
• Self-injury
• Self-mutilation

There are many different ways someone can self-harm. Some examples are if someone: 

• Cuts or scratches themself (such as with a knife or razor blade)
• Pierces or stabs their skin with a sharp tool
• Burns their skin (such as with lit cigarettes or matches)
• Carves symbols or words into their skin
• Hits themself
• Bites themself
• Bangs their head against a surface

People who self-harm are typically not doing so with the intent of suicide, hence the term nonsuicidal self-injury. Instead, this behavior is usually an unhealthy and dangerous way for someone to deal with complicated feelings and emotional pain, such as depression. 

Why people self-harm

Here are a few reasons why people may self-harm:

• They are trying to cope with emotions such as sadness, emptiness, guilt, or anxiety
• They are trying to translate emotional pain into physical pain
• They want to feel some sort of control over their own life and feelings
• They want a physical distraction from their emotional pain 
• They want to punish themselves
• They want an escape from traumatic memories
• They want to feel something if they are emotionally numb 

When someone self-harms, they might temporarily feel some relief from their emotional distress and suffering. For example, they may feel a wave of calmness come over them or experience a pleasant release of tension. However, this relief doesn’t last long. People might feel very guilty or ashamed after they hurt themselves, and not to mention the root cause of their emotional pain is still present. This can result in an ongoing vicious cycle. 

Self-harm might be something that an individual does just a few times and then stops, or it may be an ongoing, repeated behavior. Regardless, self-harm is worrisome for both mental health and physical health. 

Warning signs of self-harm

It isn’t always obvious if someone is inflicting self-injury. However, there are some warning signs you can look out for that might indicate that your loved one is self-harming, such as:

• They have visible scars
• They often have physical injuries such as cuts, bruises, or burns
• They make excuses for their injuries and wounds
• They frequently wear long sleeves and/or pants, even when it’s hot out (this could be an effort to hide scars)
• You notice blood on their clothing or towels –– or your loved one suddenly insists on doing their laundry if you usually do it for them
• They are seeking out razors or other sharp-edged tools
• They are withdrawing and isolating themselves from family, friends, and social gatherings 
• They have trouble with interpersonal relationships 
• They talk about feeling worthless or hopeless 
• They have intense emotions that rapidly shift

Self-harm and other co-occurring conditions

Though self-injury is often linked to depression, a person does not have to be depressed to hurt themself. Some other mental health conditions that are also commonly linked to self-harm include:

• Borderline personality disorder
• Eating disorders
• Anxiety disorders
• Post-traumatic stress disorder (PTSD)

Depression

Depression, formally known as major depressive disorder, is classified as a mood disorder. It is characterized by an ongoing low mood or chronic sadness and a loss of interest or desire to do things that were once enjoyed. It can seriously affect someone’s quality of life and make it hard to function daily, whether at home, school, or work.
Everyone experiences depression differently. There is a wide range of major depressive disorder symptoms, such as:

• Feeling sad, hopeless, or empty
• Losing interest and pleasure in activities once enjoyed
• Having difficulty with sleep (either insomnia or sleeping too much)
• Feeling fatigued and lacking energy
• Irritability
• Experiencing frustration or outbursts 
• Feeling worthless
• Feeling guilty and blaming oneself 
• Noticing changes to appetite and weight (either losing their appetite and losing weight or having a greater appetite and cravings which cause weight gain)
• Feeling anxious, restless, or agitated
• Having difficulty concentrating, making decisions, or thinking in general
• Having trouble with memory 
• Experiencing unexplained aches and pains
• Speaking or moving slowly to a point where other people notice
• Thinking about death or having suicidal thoughts

Additionally, teenagers may have some more specific depression symptoms, including: 

• Not performing well at school
• Having poor school attendance
• Using illicit drugs or drinking alcohol
• Self-harming
• Avoiding socializing 

For someone to receive a diagnosis of major depressive disorder, they must experience symptoms for at least two weeks, and the symptoms must be severe enough to interfere with one’s day-to-day functioning. 

What is the link between self-harm and depression?

As we’ve learned, people might self-harm to feel relief from emotional pain, and people who have major depressive disorder deal with a great deal of emotional distress alongside a slew of other symptoms. 

If someone is depressed and does not know how to cope healthily, they may turn to self-harm to feel some relief from their pain. For example, they might hurt themselves to deal with the emotional pain they’ve been feeling or want to feel a physical distraction that takes away from their depression, even if just for a moment. In other cases, people with depression might feel numb. These people might self-harm to escape the numbness and feel something, even if it’s pain.

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On the flip side, it is possible for someone who self-harms to develop depression. People who self-harm are hurting emotionally. They might be dealing with low self-esteem, bullying, being part of a marginalized group, or being a victim of abuse. These are situations that could potentially increase someone’s risk of developing depression. Furthermore, the shame and guilt that someone feels after self-harming and the vicious cycle can undoubtedly affect an individual’s mental health. 

What is nonsuicidal self-injury disorder (NSSID)? 

In 2013, the American Psychiatric Association added nonsuicidal self-injury disorder (NSSID) to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a “condition for further study.” The APA determined that more research should be done on NSSID as a disorder on its own since many past references about self-harm in past editions of the DSM were related to borderline personality disorder. However, it has become clear that many people, including people without BPD, engage in this behavior. 

For someone to be diagnosed with NSSID, the APA proposes the following diagnostic criteria:

• The individual must self-harm five or more days in a year
• The individual self-harms for at least one of these reasons:

• They want to feel relief from distressing thoughts or feelings
• They want to resolve an interpersonal issue
• They want to improve their mood
• The individual must experience at least one of the following before engaging in self-harm:

• They are dealing with difficult feelings or thoughts or interpersonal difficulties
• They are preoccupied with self-harm and have trouble controlling the fixation
• They frequently think about self-harming
• The individual’s self-harm causes them distress and impairments in their life

Hopefully, with this mention in the DSM, more research will be conducted surrounding non-suicidal self-injury to understand better how to help people who deal with it.

What is the treatment for self-harm and depression?

It is crucial for someone who struggles with self-harm and depression to get mental health treatment as soon as possible to keep them safe and get them feeling better. The two main treatments are psychotherapy (talk therapy) and medication.

Since many people who self-harm do so to cope with difficult emotions such as sadness, anger, anxiety, or guilt, therapy is an essential component of healing. In therapy, an individual can learn more about why they feel and think the way they do, gain insight into their distressing emotions, and understand the triggers that lead them to hurt themself. In turn, they learn better, healthy coping methods that don’t involve self-injury.

Two of the most common types of psychotherapy for self-harm and depression include:

Cognitive behavioral therapy (CBT)

CBT is a type of talk therapy that helps people become more aware of their thoughts and feelings, giving them the power to reframe their negative beliefs and address unhealthy, unhelpful behaviors. Individuals will learn new coping skills and strategies to deal with depressed thoughts and difficult emotions. CBT allows people to develop healthier thought patterns and behaviors, improving their mental health and well-being.

Dialectical behavior therapy (DBT)

DBT is a form of treatment that helps people understand and regulate their emotions, and it’s commonly used for people who self-harm. They will learn about acceptance and change– accepting themselves and their current challenges while also understanding that making positive, healthy changes is possible. In a DBT program, there is individual therapy, skills training, and supported groups. Skills taught in DBT include mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. 

Additionally, on top of therapy and medication, practicing self-care is critical. Lifestyle changes, even small ones, can positively impact mental health, helping to relieve some depression symptoms and improve mood. Here are some ideas for your loved one: 

• Getting at least 15 minutes of physical activity every day
• Eating a healthy, balanced diet
• Getting sufficient good quality sleep
• Staying away from alcohol and drugs
• Maintaining a robust social support system
• Practicing mindfulness or meditation
• Creatively expressing emotions through art or music 

Plus, if your loved one is depressed and self-harming, it’s essential to let them know you are there for them. Educate yourself on the matter, show up for them in a non-judgmental and supportive manner, and help them get the professional treatment they need. 

How Charlie Health can help

If your loved one is a teen or young adult struggling with self-harm and depression, Charlie Health may be able to help.

Our virtual Intensive Outpatient Program provides personalized services for teens, young adults, and families dealing with various mental health conditions, including self-harm, depression, and other co-occurring disorders.

Dealing with a mental health condition can feel extremely difficult at times, but there is hope for your loved one to feel better. Get started with Charlie Health today.