Helping Adolescents who Self Harm

I have been asked to work with a group of teachers to help them better understand self harm among adolescents. Currently there is limited research in this area. Self harm is a growing problem among adolescents. It is estimated that between 1-2 million adolescents engage in some form of self harm. Self-harm includes; cutting, burning, head banging, bruising, etc. While this behavior has historically been seen in upper middle class teen girls, it appears to be crossing gender, racial, and economic lines. It appears that more teens are exposed to self harm as a coping strategy on the internet and teen social networks. There is some debate about whether it is a precursor to, or a form of, suicidal ideation. Parents, teachers, and other adults working with children can get overwhelmed when they discover a teen they care about engaging in this behavior. I often hear something like, “I want to help him, but I don’t understand why she/he is doing this”.

Signs

The classic sign is a teen who is wearing long sleeves/pants in warm weather to cover up their scars. They sometimes have excuses for their injuries (fell in some bushes, clumsy with a knife, etc). I have known teens who want to shock adults and wear tank tops or shorts so that there wounds are visible.

Causes

While the causes of this type of behavior continue to be researched, it seems fairly clear that self-harm is used as a coping strategy to deal with intense emotional stress. Usually this stress has its roots in family/social history. There can also be a significant social influence, as teens are often exposed to self-harm from peers. Like other addictive behavior there can be a change in brain chemistry that does can produce a stress relief/euphoria that reinforces the behavior. Self harm can escalate quickly, and can spread in peer groups and across schools.
In explaining this and other problem behaviors to caring adults, I use the formula “H+E=B” . Where

• H is an individual’s personal family/social/developmental/school, “history”
• E is the personal/family/social/school/etc “environmental stress”
• B is the problem coping “behavior”

How to help

Addressing this behavior is often difficult. Preferred treatment usually includes a primary care doctor, psychiatrist, and a mental health professional (social worker, psychologist, licensed professional counselor). Often there is work with the family to address any family stressors. Individual therapy usually focuses on developing alternative coping strategies and self soothing strategies. Supportive adults and peers at school may be included in a network of support for the student. Schools also should be alert for a contagion effect with other students who may be engaging in the behavior.
When talking with caring adults, I try to emphasize how important healthy supportive relationships are for any problem behavior. People can be uncomfortable with a teen that is cutting or burning. Particularly if the wounds are visible. The important thing to remember is that it is a symptom of someone who is hurting more inside and needs help and support.