Self-Harm in Adolescents

On several occasions I have met with adolescents referred to me for counseling services due to their self-harm behaviors.  Often times those adolescents do not share their self-harm behaviors with their family or teachers and the behavior is usually only revealed by accident.

Jackie is a 12-year-old female who recently started junior high and is trying to adapt to the new environment.  She is slightly overweight and has a hard time making new friends.  Within a few days of beginning junior high, several of the “popular” girls began whispering negative comments about Jackie’s physical appearance and quiet demeanor.  Several weeks into school many more students begin to make fun of Jackie and are much less discrete.

Jackie begins to feel alienated by her peers and is often alone during breaks and lunchtime.  She is beginning to feel sadness and helplessness, she is having difficulty sleeping, and she experiences anxiety before and during school.  Jackie finds it hard to talk to her mother (a single parent) about the problems she is having at school and due to her lack of social support she begins to cut her forearm with a razor blade.

Jackie soon experiences relief from the cutting behaviors and continues to cut her self on a regular basis as a way to cope with the bullying at school.

Jackie is a fictional character but is very much an example of the type of situation an adolescent could find himself or herself in that could lead to self-harm.

What constitutes self-harm behaviors?

Self-harm behaviors can present themselves in a variety of ways.  According to WebMD (Goldberg, Joseph. “Mental Health and Self-Injury.” http://www.webmd.com. WebMD, LLC. 30 January 2015.) the following can be considered ways an individuals may harm themselves:

·      Cutting

·      Burning (or "branding" with hot objects)

·      Excessive body piercing or tattooing

·      Picking at skin or re-opening wounds

·      Hair-pulling (trichotillomania)

·      Head-banging

·      Hitting (with hammer or other object)

·      Bone-breaking

In my work with adolescents I have become most familiar with the self-harm acts of cutting, burning and hitting.  Individuals, both adults and youth, are usually very private about their self harm behaviors and try to keep them hidden as much as possible.  Some adolescents wear long sleeve shirts and pants to hide their fresh or old cuts, even if the weather is hot.  I have learned from experience that once you have gained a rapport with an adolescent you may ask them if you can view their self-harm marks.  Many are often reluctant to do so because of shame or embarrassment, but are willing to in order to develop better coping skills.

Why self harm?

There is no one reason why an individual chooses to harm him or herself.  Self-harm is an inadequate coping skill that some adolescents resort to.  In my experience, an adolescent might harm themselves due to generalized anxiety, current or past experiences of abuse (physical, sexual, and/or emotional), self-loathing, relationship issues with family members or friends, bullying, academic pressure and/or life transitional stress, and many other, more hidden reasons.

The American Academy of Child & Adolescent Psychiatry (American Academy of Child & Adolescent Psychiatry. “Self-Injury in Adolescents.”  www.aacap.org. 30 January 2015.) states that, “Adolescents who have difficulty talking about their feelings may show their emotional tension, physical discomfort, pain and low self-esteem with self-injurious behaviors.”

Just because an adolescent may be experiencing one or some of these issues doesn’t necessarily mean they will resort to self-harm as a way of coping.

How can you intervene?

Once a parent, teacher, or friend has discovered an adolescent’s self-harm behaviors, that adolescent will more than likely feel embarrassment or shame.  It is important to address the issue in a safe and non-judgmental way.

Additionally, you should remove all dangerous objects from the adolescent’s environment which the adolescent is using or may use to self-harm.

Generally, self-harm behaviors do not mean that an individual is also suicidal.  However if you feel that the self-harm could lead to death or they talk about killing themselves you should take them to a nearby hospital or contact emergency services right away.

Next, individual and/or family counseling is highly recommended.  In order to help the adolescent process the negative feelings associated with the self-harm and to develop healthier coping skills it is important for them to talk to a mental health professional.

Thank you for reading my blog on “Self-Harm in Adolescents.”  I hope you gained more knowledge about this topic.  If you have any questions or comments you may contact me at Michele@ocfamilyhelp.com.  Additionally, I have office locations in Orange and Mission Viejo and would be happy to schedule a session.