Self harming Teens – what’s it all about?

Teenagers who self harm typically describe either a surge of emotions which can be overwhelming or an absence of feeling, described as feeling “numb”.  Sometimes the behaviour can be viewed by others as a way of seeking attention, though for lots of people who self harm it is done in private and something that is covered and hidden.

Typically, the people that I see, have a background of extremes happening in their lives: at worst this may include domestic violence, sexual assault, being harassed or bullied at school or work, witnessing a trauma incident.

For others, there may not be a single actual event and it is more reflected by the person’s internal world.  Perhaps perpetuated by the feeling of being an “ugly duckling”, not fitting in, self loathing or a general belief that they are disgusting in some way and quite imperfect.

What does self harming give someone? 

This may seem like an odd thing question, in that clearly we don’t want anyone to self harm, so how could it be giving them something.  However, it can be helpful to explore with the person what does the behaviour give them, and they usually have some answer.

The aim is to help them use a replacement behaviour which is kinder or healthier than self harming.

Usually people who feel “too much” describe that self harming gives them something else to focus on.  While people who feel numb say that they wish to feel something.  Others say that they loathe themselves so much that they want to punish themselves by causing pain or harm to their body.

How does self-harming develop into a regular behaviour? 

Often self harming occurs during an extreme of emotions or extreme of numbness, and in the short term provides some relief of the feeling.  People then tend to do what kind of worked last time, so next time they are feeling that way, they do it again, until it gradually becomes the “go to” response forming an unconscious habitual behaviour.

What do Psychologists teach to change self harming behaviour?

Essentially we teach teens how to regulate their emotions.  This can involve:

  • Identifying and Expression of emotions – This involves firstly helping them to identify with words and maybe other forms of expression what they are feeling. By making sense and expression of how they are feeling, a person can develop some form of self awareness.
  • Validation and soothing of emotions – This involves helping people to accept and validate the feelings that they are experiencing and then using specific psychological strategies to soothe and calm their emotions.
  • Resilience building – This involves teaching what to do differently. Exploring and deciding on replacement behaviours, which may be a gradual change or simply a swap over.

Specific psychological strategies, may involve:

  • Cognitive behavioural therapy, essentially challenging unhelpful thinking that escalates emotions.
  • Mindfulness or hypnosis. Think of emotions as being like the ocean.  We often simply try to block or stop feelings telling ourselves that we are weak for feeling.  The problem with this is that there is no map for how to drive through or flow with them.  One metaphor may be to think about trying to stand tall when a surfing wave comes your way.  You will be dunked. Instead you need to change your strategy and learn surfing  or at the very least sit down on the bottom of the ocean until the wave passes.

Which ever strategies are used to address self harming, the self harming is a symptom of a bigger issue, like depression, anxiety or trauma related symptoms, and ultimately treating the bigger problem is essential for a long term change to self harming behaviour.

When to be concerned? Does it mean that the teenager is suicidal? 

Clearly self harming is not a good way of coping with emotions as we don’t want anyone to actually harm themselves, and we want to teach people how to treat themselves with compassion and kindness.

The good news – if we can see it that way, is that empirical research shows that in a majority of cases self harming behaviour does not mean that a person is suicidal.  However, I have spoken with people who have self harmed and accidentally cut deeper than they had intended to, which can be alarming and may require medical attention.

Nevertheless, it is worthwhile to undertake a risk assessment with the person to ensure their safety.  Depending on the person it may involve something like this flow chart:

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