Clinically Reviewed by Dr. Caroline Fenkel, MSW, LCSW
Hurting yourself—or thinking about hurting yourself—is a sign of emotional pain. Most people who self harm do so as a way to cope with anger, negative feelings, painful memories, or difficult circumstances. But unlike other harmful coping mechanisms that can be easier to detect, most young people who self harm are adept at hiding this behavior from their friends, family, teachers, and others. The ease of hiding self-harm markings and injuries, in combination with the lack of widespread social awareness about self-harm, makes identifying the warning signs difficult.
Here are a few of the warning signs of self-harm to look out for, especially in teens:
- Frequent cuts, burns, bruises, scratches, or other physical injuries
- Making excuses for new injuries
- Wearing long pants and long sleeves even in hot weather
- Signs of blood on towels or clothes, or unexpectedly doing their own laundry
- Taking out their own trash
- Razor seeking
- Withdrawn from friends, family, or social activities
What Does Self-Harm Look Like?
Self-harm, also known as self-mutilation, self-injury, or non-suicidal self-injury (NSSI), occurs when someone deliberately harms themself. The most common forms of self-injury are skin cutting, head banging or hitting, and burning. Of the many types of self-harm, cutting is the most common, making up about 70-90% of self-injuries. Cutting often (though not always) occurs on the arms, legs, genital region, or abdomen. Young people may use a variety of objects and methods to self-harm, including razor blades, scissors, pens, or even bottle tops. Though some teens who self harm may leave their wounds visible to draw attention as a cry for help, most people who cut themselves conceal their marks or scars, or give false explanations for how they happened (blaming their scratches on a pet or a fall, for example).
Other forms of self-harm include:
- Pulling out hair (also known as trichotillomania)
- Picking at existing wounds
- Carving symbols or words into the skin
- Piercing the skin with sharp objects such as needles or hairpins
- Drinking toxic substances like bleach or detergent
Education around self-harm is key to reducing its prevalence. In recent years, the number of teens seeking emergency care for self-harm has increased by 300%. This is a staggering statistic. It's imperative for providers to help parents learn more about recognizing self-harm, understanding self-harm, and intervening in an instance of self-harm.
Self-Harm As A Coping Mechanism
Recent research has found that nearly 1 in 5 young people will self-harm at some point during their teenage years. This is a troubling statistic for parents to process, yet an important one to understand. For the majority of adolescents who struggle with self-harm, the main purpose of the behavior is not actually to harm themselves. Rather, it is often used as a coping mechanism to deal with intense, negative feelings such as self-hatred, despair, emptiness, or guilt.
The catharsis experienced when someone self-harms can be addictive. Research has found that the same dopamine cycle that characterizes the classic understanding of addiction also presents itself when someone self-harms: you feel intense negative emotions; you desperately search for an outlet or way to stop the pain; you engage in self-harm to experience a release; you find temporary (perhaps even euphoric) relief; you feel guilt or shame about self–harming; the negative feelings begin to increase again; the cycle goes on.
Teens are particularly susceptible to this cycle. The teenage brain has a larger number of neural pathways that are driven by dopamine than the average adult brain, meaning that the “rush” of self-harm might be “higher” for teens. This continues to spur repeated cycles of self injury, which may progress into additional forms of self-abuse, including substance use disorders and even suicidal ideation.
But why are so many young people self-harming? The answer, in many ways, is systemic. Recent findings suggest that the rate of self-harm among teens increased to 27% from 2020-2021, with mass social isolation due to the COVID-19 pandemic playing a significant role in this uptick. Nearly half of all young people in the U.S. reported feeling persistently sad or hopeless in 2021. Stripped of social bonds and adequate resources during a time of global crisis, many adolescents turned to self-harm as an outlet to target newfound feelings of depression, anxiety, and trauma. These same feelings often accompany other mental health issues. One study found that of those who self harm, 20% have personality disorders, 13.5% have adjustment disorders, and 11% have mood disorders.
Who Self Harms?
According to CDC data, 30% of teenage girls and 10% of teenage boys admit to intentionally hurting themselves each year. Since 2015, self-injury rates have increased 166% for girls aged 10 to 14, and 62% for girls aged 15 to 19. The increase in self-injury among teen girls may be due to their higher propensity to develop depression compared to teen boys. Research has also found that adolescent girls with persistent depression are more likely to engage in self-harm. With 1 in 5 teenage girls being estimated to have depression, knowing how to spot the signs of self-harm is a critical tool for parents and loved ones.
There is also a disproportionate rate of self-harm among members of the LGBTQIA+ community. 47% of individuals who are LGBTQIA+ will commit an act of self-harm in their lifetime–more than double the rate of non-LGBTQIA+ people. Stressors related to bullying, not feeling accepted or safe in being their authentic self, and the compounded effects of minority stress create the conditions for many LGBTQIA+ teens to feel helpless and not know where to turn for support.
Teens of any of socioeconomic status, gender, ethnicity, or sexual orientation can engage in self harm. Despite many pop culture references that would suggest otherwise, self-harm doesn’t have a specific “look”. That’s why vigilance and an understanding of the nuances of the signs of self-harm are essential if you want to be able to effectively identify self-harming behavior.
Link to Suicide
While self-harming behavior is not always indicative of suicidal ideation or intent, research has found a high correlation between the two. It has been estimated that 70% of teens who self-harm have attempted suicide at least once, and 55% have attempted suicide more than once.
The addictive nature of self-harm makes it even more likely that young people may escalate their self-harm to include even more damaging and risky behaviors, which may include suicide attempts.
Those who participate in digital self-harm–a growing avenue for self harm that’s characterized by online posting, sending, or sharing of hurtful content about oneself anonymously–are 9 to 15 times more likely to attempt suicide. As many teens spend a greater amount of time on the internet, often without parental supervision, it’s imperative that families be aware of this type of digital self-harm. Violence is popular online, which means that posts related to self-harm and suicide (despite efforts by platforms to monitor and censor them) tend to be high-performing. This makes it more likely that a teen who may not have otherwise come across self-harm content does so inadvertently. On the other hand, teens who create violent content around suicide and self-harm often report feelings of shame and guilt once they realize the permanence of their actions. These feelings may also contribute to higher rates of suicidal ideation among teens who participate in digital self-harm.
An important final note on the consequences of self-harm: even those who do not attempt suicide following periods of self-harm remain at risk for serious injury. It’s not uncommon for self-harm behaviors, such as cutting, scratching, and piercing skin, to cause permanent scars, infections, and even hospitalization.
Discovering that your teen is engaging in self-harm can be deeply upsetting. You may feel shock, disbelief, sadness, or anger. These emotions are all valid. It’s important to remember that your teen is probably feeling some, if not all, of these emotions as well.
The first step if and when you discover that your teen has been hurting themselves is to remain calm. You may not understand the full extent of their behavior, or why they’re self harming, but it’s important to quickly create a safe space for dialogue. Keep the conversation open, fluid, and non-judgmental. Let them know that their feelings are valid. Remind them that you love them and that you don’t want them to be in pain. Ask them to try to explain how they’re feeling and if they struggle to do so, affirm that it’s okay to not have the words yet.
Some teens may dissociate after an episode of self-harm. If this is the case, quietly say their name out loud and be patient until they seem to be more present. In the meantime, provide first aid to any wounds and assess if a higher level of medical care is needed.
The next step is to seek professional mental health support for your teen. Self-harm is often an indicator of more serious mental health issues, which may require more support than once-weekly talk therapy can provide. Charlie Health offers a personalized approach to higher levels of care. Our virtual Intensive Outpatient Program (IOP) is designed to support young people who are struggling with self-harm, among other common mental health concerns.
We help teens build connections with peers in groups, develop practical coping skills in individual therapy, and heal as a collective in family therapy. Our evidence-based, virtual care model offers urgent solutions to families dealing with self-harm and allows your teen to heal from home. We offer flexible scheduling options and also partner with all major commercial insurance providers and Medicaid to get your family the support you need. At Charlie Health, we believe that accessible care is a right, not a privilege.