This article was written with significant contributions from Chesleigh Keene, Ph.D. researcher and counseling psychologist at the U of Arizona.
What is Self-Injury in Teenagers?
Self-injury in teenagers is often referred to as ‘cutting’ though it can include all kinds of self-injury. It means inflicting harm on yourself to cope with pain, sadness, or anxiety.
The most common forms of self-injury are scratching, cutting, and hitting (particularly in younger children).
Parents often feel frightened, shocked, angry, sad, or guilty when discovering or observing their child self-injure. Specific acts of self-injury, such as cutting, are particularly upsetting to parents. Unexplained scratches that frequently appear may be suspect. If you observe small, linear unexplained cuts, know that this style of injury is the most common presentation of cutting behavior.
Want to learn more? Take a Cadey course.
Symptoms of Self-Injury in Teenagers
Here are some warning signs of self-injury in teenagers.
- Scratching, picking, pinching, cutting, hitting, biting, or burning marks: your child has marks on their skin that are not there by accident
- Wearing long-sleeved clothing: your child can cover up their injuries by always being in long-sleeves
- Expressing self-loathing or excessive self-criticism: your child talks harshly about themselves
- Pulls away from you during times of high stress: your child hides in their bedroom or bathroom when they are sad or anxious
- Hides sharp objects (razors, knives, pins, or needles) in bedroom or backpack: your child hides sharp objects in their rooms or belongings; or you notice that sharp objects are going missing in the house
- Spends long periods of time in the bathroom or bedroom: your child is spending long periods of time alone and is asking for more privacy during times of sadness. This time may give them opportunities to harm
Causes of Self-Injury in Teenagers
Clinically, self-injury can be associated with mood, trauma, personality, eating, or depressive disorders.
However, self-injury is separate from suicidal behaviors. Self-injury does not mean your child wants to die. Instead, self-injury is tied to relieving emotional pain, intense feelings, emotional numbness, or anxiety. Sometimes, the behavior is short-lived, but the behavior can escalate if left untreated, particularly with cutting and scratching behaviors. It is important that self-injury is taken seriously by trusted adults in a teenager’s life.
The most common causes of self-injury are as follows :
- Relief from feelings: an expression of feelings like depression, isolation, frustration, and alienation
- Stopping, inducing, or preventing dissociation: a defense mechanism for intense or overwhelming emotions that may stem from feeling separated from oneself
- Physically expressing pain: a physical experience of emotional pain
- Communication: a way to tell loved ones about pain or emotional distress
- Self-nurturing: a method of taking care of oneself, wound care
- Self-punishment: a reaction to shame or self-criticism over past ‘wrongs’
Self-injury is a behavior that any number of factors can initiate.
Self-injury can arise when your child has not found an adequate means of expressing their emotional pain or when your child experiences low self-esteem or physical discomfort.
It may come about as a result of emotional, sexual, or physical abuse. Other risk factors may include very low body image or significant depression. Children from healthy homes may also self-injure. Research shows that cutting behaviors have an element of contagion, so peer pressure may be a factor . Most often, self-injury serves as a vessel for emotional relief.
The act of harming oneself provides a feeling of control and can release endorphins, much in the same way drugs can. Thus, the cutting behavior creates an experience that releases the pressure of negative emotions and provides the reward of relief. This experience of relief may feel like a warm wave of calm that washes over the individual, and it can become addictive.
How to Help Your Child or Teen Stop Self-Harming
Seek therapy: Because self-injury can be an addiction, some treatment strategies are similar to those used for other addictions. For example, psychologists help children or teens identify triggers, understand the emotions related to those triggers, provide distraction during the ‘tension’ phase, and develop positive coping strategies to manage strong emotions . Often, they can avert the urge if they find a way to self-distract during the ‘tension’ phase (the part where the body is gearing up to self-injure). A positive coping strategy can take place instead.
Don’t ignore: If you have suspicions or have confirmed that your child is self-injuring, it is best to address the behavior immediately. While some children and adolescents self-injure because they want to fit into a peer group, self-injury should not be treated as a ‘phase’ or something you can ignore. Seek professional help for your child.
Don’t treat it as a cry for attention: A misconception among many adults is that self-injury is a ‘cry for attention,’ which is generally not the case. Most likely, your child is experiencing difficult emotions, and the act of self-injury provides a legitimate relief. Adolescent mental health services can help your child process these emotions and develop good coping strategies.
Validate feelings: The most effective way for you to help your child is to validate their feelings and understand their self-injury. To achieve both, you will need to be present and available to your child.
Provide a calm and comforting environment: Even if you do not feel it, provide a calm and comforting environment. The very fact that your child is intentionally hurting herself is an indication that she is not coping well with stressful situations. Try not to make interactions more stressful. Offer your love and support, and reassure your child that you want to help.
Don’t assume you know what your child is feeling: this assumption can create distance and misunderstanding. Ask your child to describe his experience. You have your own emotions in this experience, so it is important to use them productively.
Rather than saying something like, “How can you do something so crazy,” a better way to express the fear and shock you feel would be, “Seeing you hurt yourself is hard for me. I want to get you help, but I also want to understand how self-injury makes you feel better.”
Power struggles, ultimatums, and your own emotional outbursts will be unproductive. If your child does not want to engage in a discussion, let them know that you will be there when the time is right.
Teach coping skills: Children who self-injure typically lack coping mechanisms and skills for discussing their inner experiences, so they may need time to figure out how to talk to you about their emotions.
Comfort kit: One powerful strategy for self-injuring adolescents is the idea of a Sensory Box or a Comfort Kit . You and your child can seek to discover a set of objects and thoughts that bring a feeling of comfort and relaxation.
In this box, you and your child would collect positive sights (postcards, greeting cards, pictures), sounds (music, ocean sounds, meditation sounds), smells (essential oils, aromatherapy), and tactile objects (blankets, towels, stuffed animals).
The Comfort Kit  might include a set of index cards that lists specific strategies and positive phrases the child will use instead of resorting to self-injury.
Allow time: your child’s improvement may take a while. Remember your child is working hard to change a behavior that has been effective in the past. You can help by making time for relaxation. It can be helpful to remove some pressure or responsibilities from your child as they work to end self-injurious behaviors.
As your child learns self-care skills and improves self-esteem, self-image, and emotional coping, you can expect self-injury to diminish. While your child is working to be mentally healthy and stable, it can be helpful to seek your own therapy in an attempt to ensure that your home is a safe haven and a refuge for your child.
When to Seek Help for Self-Injury in Teenagers
Mental health professionals are the most qualified to evaluate your child’s self-injury. An evaluation can offer important information about the cause and course of treatment.
Self-injury may indicate that your child struggles with a psychological issue, such as depression, posttraumatic stress disorder (PTSD), borderline personality disorder, or bipolar disorder. That self-injury may be a method of coping with intense emotions.
Professional Resources on Self-Injury in Teenagers
If your child is struggling with this symptom to the point that it is getting in the way of their learning, relationships, or happiness, the following professionals could help.
- Dialectical behavior therapy (DBT) individual or group format (psychotherapist): a program that helps people gain control over self-destructive impulses (such as self-injury). The individual and group format supports the individual in learning how to tolerate emotional distress and learn and sustain new coping skills.
- Family therapy (psychotherapist): a mode of therapy that addresses what may be occurring in the family system that relates to self-injury behaviors. A family therapist will help the family learn to communicate more directly with each other and confront family stress.
- Group therapy (psychotherapist): a group setting offers the unique opportunity to discuss your experiences with other people who have similar experiences and struggles. Groups help reduce any shame associated with self-injury, and group members often learn coping strategies from other members.
- Psychologist: a psychologist can consider symptoms in a mental health context and provide one-to-one support in ending self-injury behaviors. Often Cognitive Behavioral Therapy or the related DBT mentioned above are good treatment modalities for self-harm.
- Psychiatrist: a psychologist can determine if a pharmacologic approach can aid in ending self-injury. Antidepressants may help with mood symptoms, and anti-anxiety medication may help with the impulsive nature of self-injury.
Similar Conditions to Self Injury in Teenagers
If your child is struggling with a similar problem not directly addressed in this section, see the list below for information about other related symptom areas.
- Compulsions: some children who self-injure may have other compulsions, such as constantly ‘checking’ lights and switches, lining up toys, hoarding food or objects
- Perseverating: some children who self-injure may get stuck on things and may have trouble ‘letting it go’
- Cognitive distortions: some children who self-injure may be struggling with the thinking patterns associated with anxiety and depression
- Emotional regulation: some children who have difficulties managing strong feelings of anger, sadness, or anxiety may also self-injure
- Family problems: some children who have recent difficulties in their families such as a recent death, divorce, substance abuse problem, or other family discord may also self-injure
- Repetitive self-injury in children: some children headbang or bite themselves repetitively, which is a form of self-injury. This self-injury tends to stem from frustration at not being able to communicate or as a way to seek sensory stimulation because of a different experience of sensory perception. A young child can get very hurt with this kind of self-injury, so evaluation and therapy are recommended. The best treatment for developing replacement behaviors are ABA therapy to change the behavior and Speech Therapy to work on proactive forms of communication
Book References on Self-Injury in Teenagers
 Randall, Kaye (2017). Critical Mental Health: A conference on suicide and self-injury. Accutrain: Developmental Resources. www.dev-resources.com
Resources on Self Injury in Childhood
Dialectical Behavioral Therapy: What is DBT?
The Cornell University Research resource on self-injury, a comprehensive website for parent, caregivers, and mental health care providers.
A touching reflection of a mother whose daughter was self-injuring. https://mobile.nytimes.com/2015/03/01/style/bringing-a-daughter-back-from-the-brink-with-poems.html
Bowman, Susan & Randall, Kaye (2012). See my pain: Creative strategies for helping people who self-injure.