Self-harm in adolescents

The reasons why a teenager self-harms can be diverse and can change over time. Experts divide these motivations into interpersonal and intrapersonal. Interpersonal motivations relate to relationships with others (avoiding an unwanted social event, seeking help from a family member who is perceived as unaware of the distress, etc.). Intrapersonal motivations relate to managing one's own emotions or mental states (reducing anxiety, feeling alive, calming or counteracting feelings of guilt, etc.).

Introduction to self-harm in adolescents

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It's common for teenagers who self-harm to initially be reluctant to talk about it. In these cases, it's best to be patient and approach the issue indirectly, flexibly, and cautiously. If the teenager still refuses to talk, you can ask for help from a close family member she trusts, such as an aunt or an older cousin. If the problem is worsening and she continues to be unwilling to talk, then it's necessary to seek professional help.

Direct examination of the body to check for new self-injuries can be very intimidating or stressful for a teenager who self-harms. Sometimes it is necessary and unavoidable, such as when individuals who self-harm are hospitalized or receiving care in a clinical setting. These observations fall under the umbrella of nursing care and are carried out by healthcare professionals.

At home, parents can ask their children to show them if they suspect new injuries, but always based on trust and the child's voluntary cooperation . If parents observe very obvious signs of self-harm (such as bloodstains on clothing or sheets), then it would be essential to ask them to show the wounds or even take the child to a health center for treatment and to assess their severity.

Discovering that your child is self-harming can be very difficult to process and understand. When talking about it, it's advisable to explain how it makes you feel, doing so as calmly as possible (try not to argue or blame), and to try to understand how your child feels about the self-harm (how they feel before and after). Self-harm can often stem from underlying emotional distress or difficulties , so it's important to let them know they are not alone . It's also recommended that you gather reliable information about self-harm (the more you know, the better you can support them), including how to seek professional help.

If a friend tells you she has self-harmed, it's a sign of trust, so you should use that to encourage her to tell her parents or another adult who can help her. Sometimes it's easier to start by telling a school counselor, tutor, or educational psychologist, and then this professional can help her tell her parents, who should always be informed, even if they aren't always the first to know.

We know that there are different types of self-harm. Some are more severe than others. Some studies indicate that girls self-harm more frequently (especially in clinical settings), use a wider variety of methods, and are more likely to use cutting as a method of self-harm. Boys self-harm less frequently and use other methods more often. Therefore, there are some differences between boys and girls.

Trichotillomania , although it can lead to physical harm, is not considered self-harm. Trichotillomania typically involves a compulsive component, and in most cases, this behavior is carried out with little to no awareness of it. Self-harm is a distinct phenomenon, and it is important to differentiate it from other similar behaviors, as the treatment is different.

It is important to understand in detail what triggers the idea of self-harm and what the consequences of this behavior are for each individual. Most young people explain that they self-harm to "relieve" an unpleasant emotion, thought, or feeling. Although it may be difficult to understand, self-harm can provide short-term relief, and therefore is more likely to be repeated in the future.

Describing the negative medium- to long-term consequences of self-harm (e.g., shame, family concern) can help the person begin to see it as something they need to fight against. Often, professional help can be beneficial in this regard, contributing to the development of alternative strategies to self-harm that improve distress tolerance and emotional regulation.

To access the services of a clinical psychologist within the public healthcare system, you must first consult your pediatrician or family doctor, who will then refer you to specialized mental health services (child and adolescent mental health centers). Sometimes, depending on the region, it is possible to receive care from a clinical psychologist at the primary care center itself. In Catalonia, this is done through the Primary Care Support Program (PSP), which is staffed by mental health professionals who advise and collaborate with pediatricians on secondary prevention.

Therapeutic processes usually take time (at least a few months), and relapses are not uncommon. It is important that, along with the professional and the affected person, the parents collaborate in identifying and, if possible, modifying the factors or variables that influence these relapses; this is an integral part of the therapy process itself.

No, self-harm is self-inflicted bodily injury, specifically damage to the body's surface. This usually includes cuts, burns, scratching that causes lesions, picking at scabs, or preventing wounds from healing, burns, bruises, etc. In the case presented, it is true that this behavior can be harmful to health and is carried out to avoid a feared or anxiety-provoking situation (and in this respect, it would be similar to non-suicidal self-harm), but it is not considered self-harm according to current definitions.

Self-harm typically occurs on the arms. This is the most common location for cuts (on the forearms). However, cuts are also frequent on the legs and abdomen. It can be detected through unusual behaviors such as wearing long sleeves or excessively covering the body in summer, avoiding going to the pool or gym, or not changing clothes in locker rooms. Additionally, bloodstains are often found on clothing, towels, or sheets.

For a long time, in diagnostic classifications, self-harm only appeared as a symptom of borderline personality disorder (BPD). In the clinical context, the reality is that self-harm is a very common transdiagnostic phenomenon, present in different mental health problems (e.g., eating disorders, depressive disorders).

On the other hand, we also know that self-harm is very common in the general population and can occur without any other mental disorder. In fact, we know that approximately 30% of adolescents and young adults in the general population have self-harmed at some point in their lives. Recently, non-suicidal self-injury has been included in the DSM-5 (the reference clinical guide for the diagnosis of mental disorders) as a diagnostic category under study, which could help differentiate it from other mental health problems.

There are probably several reasons. One of them has to do with the way we relate to each other in recent decades. The use of social media as a tool for socialization may contribute to the spread of self-harm among young people. Also, in recent years, self-harm has become more prevalent in television series and songs aimed at young people, which may have contributed to a certain normalization of this type of behavior.

Social media can be a tool for the spread of self-harm. We know that there are pages and videos on social media that discuss self-harm. This makes it very likely that most young people are aware of what it is. However, social media also presents an opportunity to help young people who self-harm or are at risk of doing so. There are some websites with reliable information about self-harm, such as answers.cat. Exploring them could be helpful. Talking about it openly could also be beneficial.

Peer influence is very high at this age. For a teenager, social acceptance can be one of their primary needs. This is true for both overly dependent and non-dependent teenagers. Therefore, imitative behaviors are often observed.

To protect adolescent girls from this, the most important steps should be taken several years earlier, fostering an environment where the girl doesn't develop excessive interpersonal dependence or an excessive need for acceptance and support, and where she develops assertiveness, her own judgment, and a degree of independence. Even if this has already been achieved, there is still a risk of imitation as a way to gain acceptance within a group. In these cases, it's advisable to talk to the girl, perhaps even with the help of a professional, to help her gain perspective, or even to distance herself from peer pressure if it's very high.

Many young people explain that they self-harm to regulate a social situation (e.g., to avoid an argument, to get attention). Although this may seem like manipulation, it is preferable to assess the factors that triggered the self-harm and the short-term consequences (e.g., whether it reinforces the behavior) in each specific case. However, it is worth noting that most of the time, self-harm is related to a dysfunctional way of managing one's emotions.

There are various approaches to addressing self-harm, ranging from general to specialized. When the problem is detected and is not severe, more general approaches are recommended, which can be implemented in a non-clinical setting. In these cases, general support therapies such as anxiety reduction interventions, problem-solving skills training, and mindfulness techniques can be effective. In more complex cases, because the adolescent has been self-harming for a longer period, or because the self-harm is accompanied by other problems that may require clinical attention, then an evaluation by a mental health specialist is necessary, along with the application of more specific clinical interventions such as cognitive behavioral therapy, dialectical behavior therapy , or interventions based on these.

Many young people who self-harm repeatedly may feel alone, strange, or isolated. Being able to talk to them as calmly as possible can help with these feelings. To do this, it's important to have information about myths, characteristics, and treatment options. Helping the person understand the reasons behind their self-harm can motivate them to change.

We recommend the GRETA Group website , where there is information on self-harm designed by experts in the field.

Suicide and self-harm are distinct phenomena . Self-harm, by definition, implies the absence of suicidal intent. However, individuals who self-harm are more vulnerable to experiencing suicidal thoughts if this behavior persists.

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It is possible to stop self-harm . When the behavior is recurrent, it is advisable to consult a professional. Most people who undergo specific treatment for self-harm stop self-harming and improve their emotional well-being.

It is recommended that every school have a protocol for responding to cases of self-harm. This protocol should include guidelines on how to identify these cases, who should assess the student who has self-harmed and how, how and when to contact the parents, and how to prevent the spread of self-harm among other students.

Students who self-harm

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In these cases, it's understandable that the girls consider it normal, since something many people do tends to be seen as normal. However, even though there is a group, and a clear contagion effect, the cases should be treated individually.

Group interventions in this (school) context are not advisable, nor is it appropriate to treat everyone's problem in the same way. Individual cases can vary significantly in terms of personality, risk factors, co-occurrence of other psychological problems, family structure, etc. It would be beneficial to assess each case individually and inform the parents. Girls with fewer problems in addition to self-harm could receive support within the school setting (from a school counselor). In other cases where additional problems are identified besides self-harm, parents should be advised to seek help from the public healthcare system (pediatrician or primary care physician, and assessment of the need for referral to specialized care).