Decoding self-harm

by Heidi J. Dalzell

It’s a phone call no parent wants to get: The school counselor tells you your daughter has been cutting herself. How should you react?

Parents of teenagers often feel like travelers without a road map, faced with behaviors that are not always easy. Teens today face challenges and pressures that many of us never dreamed of. Add to that the fact that adolescents feel emotions very strongly, and the result can be teenage self-injury. While these behaviors are disturbing and often hard to understand, they can be decoded.

Just how prevalent is self-injury, what causes it and how can parents help?

Getting a handle on statistics about cutting is often challenging, as many people who study self-injury combine it with the related condition of eating disorders — another way that teens communicate to us through their bodies. SAFE, an organization that studies self-injury, provides a broad estimate, which suggests that one out of every 200 girls between the ages of 13 and 19 self-injures, and many of these girls continue this behavior into their 20s and beyond. Boys are not immune to self-harm, but their numbers are more difficult to determine, though prevalence appears to be on the rise. 

Functions of Self-Harm 

One of the most frequent questions a parent will ask is why children self-injure. It’s helpful to think of self-injury in two ways: as a coping skill and a way to communicate. Self-harm is a way to cope with, numb and release feelings and emotions. When you think of the intensity of teens’ emotions, as well as the fact that many teens have not developed coping skills, this makes some sense. Self-injury’s function of communication is related. Many teens describe wanting others to visually see how much emotional pain they are in, and scars provide those reminders. What is sometimes more difficult for parents is that self-harm may also be a way that teens rebel against parents or visually express anger. While healthy individuation is an important part of this stage, and expressing emotions such as anger are key skills, teens must be taught that self-injury is not a positive way to accomplish these goals. In decoding the reasons for self-injury, parents often feel that they are learning a new language from their teen.

Self-injury can also be caused by body hatred. We all remember the challenging changes our bodies went through during puberty, which can be overwhelming and can feel out of control. Girls are suddenly receiving attention from boys and men as their bodies become curvier and more feminine. Boys are comparing themselves with others who are more or less physically developed. While many teens that self-injure are perfectionists and are their own worst critics, there is no shortage of reminders from peers about perceived appearance defects.

Bullying is one factor that may play a role in self-injury. The National Institute of Child Health and Development conducted a large survey of sixth through 10th graders in 2009. They found that 37 percent had been victims of verbal harassment and 32 percent had been subjected to rumor spreading. Bullying is often centered on the teen’s physical self. In another study, 41 percent of students identified being overweight as the primary reason that students are bullied, followed by sexual orientation, intelligence and ability at school, and race and ethnicity. With texting, social media and other online media, teens often cannot escape bullying. Teens experience bullying in a very intense and personal way, and it can shake self-esteem tremendously. While it may seem contradictory, some teens see self-harm as way to gain a sense of control. Other traumas that may precede self-injury include premature sexual experiences, abuse or family issues such as a separation or divorce.

Adolescent self-injurers are often perfectionists who have difficulty managing intense feelings or expressing emotions verbally, and who dislike themselves and their bodies. They may use self-injury as a way to express their feelings and emotions visually, or as a way to punish themselves. Following an act of self-injury, the person usually is left with a feeling of calm. The relief is temporary, however, and until the teen begins to address underlying issues and finds healthier ways to cope, the behaviors will continue.

If your teen is self-injuring, it is important to seek help. This is not something that parents should handle without support. While the goal of treatment is that the child stops the self-injury, self-injury is a sign of a deeper problem. Treatment will allow you and your child to determine what that problem is, while concurrently focusing on coping and communication skills. Some self-injury dos and don’ts are provided on page 18.

Alternatives to Self-Injury 

What are some alternatives to self-injury? Many teens have resources they don’t realize they have (support people, skills, ideas). Often identifying what has helped in the past can generate ideas about what might help in the future. When teens share that they have had a difficult situation and have not self-injured, focus on how positive this is. What did they do instead? Did they take a risk by communicating in a more direct way? Did they distract themselves or soothe emotions in a healthier way?

Other alternatives to self-injury include expressing and sharing feelings with others, deep breathing, having a special something (stuffed animal, photo of someone they love) to look at or hold for comfort. Distraction techniques, such as watching TV, making a phone call or waiting five more minutes before self-injuring also are helpful. Some alternatives to release tension include wrapping oneself tightly in a blanket, taking a warm bath or shower and listening to soothing audiotapes, such as nature sounds or favorite music.

It’s important to recognize that treatment takes patience. Self-injurious behavior generally does not go away after a few therapy sessions and, depending on the underlying cause, could persist for some time. Treatment is not a straight path, and setbacks and relapses do occur. |

Heidi J. Dalzell, PsyD, is a licensed clinical psychologist in Newtown, Pa., specializing in the treatment of teens, including adolescent self-injury, eating disorders, post-traumatic stress and sexual abuse. She has worked in inpatient and outpatient treatment settings. She regularly blogs on topics of interest to those in the field of eating disorders. Heidi can be reached by e-mail at: