Bleeding Away the Pain: the Ins and Outs of Self-Harm

Self-harm is a means in which adolescents seek refuge from their emotional pain through the infliction of bodily harm. The physical wounds of self-harm often result in permanent scarring – both psychologically and physically. For most, it's hard to understand what would lead adolescents to take such drastic measures and deliberately harm themselves. Unfortunately, there is no universal answer; rather, it's a means to cope. And that coping behavior can become habitual and addictive. Teens who self-harm often lack healthy coping skills, so their inner turmoil becomes an external branding. In essence, they seek to bleed away their pain.

Self-harm typically begins mid-adolescence. Adolescence is a time when youth seek autonomy and peer acceptance, all while trying to cope with the ever-increasing pressures of everyday life. According to the data, the worldwide prevalence of self-injury in adolescents is about 17 percent; 13 percent among young adults; and 6 percent among adults. Studies in the U.S. indicate the lifetime prevalence of self-harm ranges from 12 to 37 percent in secondary school populations and 12 to 20 percent in young adult populations. Research also indicates that females are about three times more likely to engage in self-injurious behavior compared to their male counterparts. Sadly, the data may not paint an accurate picture, as self-harm often goes unreported and undetected.

Self-harm is often a symptom of underlying psychiatric disorders, such as depression, anxiety, obsessive compulsive disorders and eating disorders. These are serious mental health conditions that warrant professional attention and can improve with treatment. It's important to note that self-harm frequently gets linked with suicidal intent. While there's an association between suicide and self-harm, not all teens who self-harm wants to die; they just want to find a temporary escape from their psychological suffering. However, the correlation between self-harm and suicide should not go unnoticed either, as some teens may use self-harm as a cry for help.

Research reports several risk factors associated with self-harm and suicide, and these include: problematic behavior at school, history of parental mental health problems, dysfunctional relationships with parents and peers, traumatic life events like sexual trauma, angry and aggressive behavior, depression, impulsivity, anxiety and substance abuse. While addressing self-harm can seem like an overwhelming obstacle for parents, educators and helping professionals, there is light at the end of the tunnel. Teens can learn more constructive and healthy ways to cope, but they are going to need our help. In order to help these troubled youth, we must first educate ourselves on the "ins and outs" of self-injurious behavior.

In What Ways Do Teens Engage in Self-harm?

There are many ways teens harm themselves. The following are some of the most commonly reported:

1. Cutting or carving into the skin with objects such as scissors or razors, which draws and leaves scars on the skin.
2. Burning oneself with hot objects (blistering) or even rubbing the skin with items such as erasers (creating a skin abrasion) and/or salt and ice (freezing skin tissue) to produce a skin irritation.
3. Scratching or pinching with fingernails or objects to the point of bleeding or leaving marks on the skin.
4. Interfering with healing of wounds by continuously pulling off scabs or re-opening wounds.
5. Banging or punching oneself or objects (some teens beat their heads with their fists or against a hard surface) to induce pain.
6. Breaking bones by slamming objects, like a hammer, on fingers or toes, or trying to snap or fracture bones.
7. Ingesting toxic substances or swallowing objects, like overdosing on prescribed or over-the-counter medication or ingesting foreign bodies such as batteries or pen parts.

What Are the Signs?

Teens are often secretive and try to conceal the self-injurious marks. As a result, they may never tell a trusted adult about their "secret," but the following are some self-harming warning signs:

• Having many cuts/burns on the wrists, arms, legs, back, hips or stomach.
• Wearing baggy or loose clothes (e.g., wearing hoodies or long sleeves during hot days to conceal the wounds).
• Making excuses for having cuts, marks or wounds on the body.
• Finding razors, scissors, lighters or knives in strange places (i.e., the nightstand drawer, under the bed or tucked away in socks).
• Spending long periods of time locked in a bedroom or bathroom.
• Avoiding and isolating oneself from others.
• Expressing self-anger or self-disgust.
• Having fresh wounds or lots of unexplainable bruises.

Why Do Teens Self-Harm?

Some of the reasons teens self-harm include:

1. To cope with and manage distressing thoughts and emotions. Many teens report self-harming is a way to cope with emotions such as anger, anxiety and depression. Fifty percent of youth who self-harm say they did it because they wanted to get their mind off their problems, and 45 percent of teens claimed it helped them release tension or stress and relax. Troubled teens may resort to self-harm to help them stop and avoid negative thoughts and emotions.

2. For the rush and release. Some teens engage in self-harm to get a rush of endorphins and adrenaline. Almost like a drug rush, cutting can release a sensation of a high, followed by a surge of release, like a natural painkiller after the injury has occurred. Unfortunately, this behavior can become habit forming and addictive, which can result in more extreme and frequent injuries.

3. To drown suicidal thoughts. Not every teen who self-harms has suicidal ideations, but there is a significant risk of suicide and suicide attempts among teens that engage in self-harm. One study reported that 70 percent of teens engaging in self-harm had made at least one suicide. Studies have shown that among depressed adolescents, self-injury is a strong predictor of suicide attempts; and many youths who attempt suicide also engage in self-injurious behaviors. Because self-injurious behavior is often liked with mental health issues, it is extremely important to recognize that this is a serious condition that requires professional help.

4. To reconnect with feeling. Teens who self-harm may feel numb or empty. To "feel" again, they may induce physical pain. Self-injury can provide a sense of control and focus, as it takes teens' minds off whatever is bothering them and they become pre-occupied with the self-harming behavior. These adolescents are trying to find a way to reconnect and make the numbness go away. Many teens who self-harm aren't trying to make their lives worse; they're trying to make it better. They don't like feeling the way they do, they just don't know how to make themselves feel better.

5. To get help. Teens who self-harm often have difficulty expressing and communicating how they are feeling. As a result, they keep their emotions bottled up, leading to isolation and feeling disconnected from others. Many don't like hurting themselves and desire to stop, only the behavior has become addictive and it's the only way they know to cope. After injuring themselves, they may experience a surge of guilt and shame. They may even vow to never do it again, but when faced with another life stressor, return to their destructive behavior. Guilt and shame may cause teens to feel embarrassed about their "secret," so they may not ask for help. Help is the one thing they desire most, only they don't know how to ask for it.

What You Need to Know

Self-harm is a dangerous coping skill that can leave permanent scars, or worse yet, fatality. Undoubtedly, adolescence is a hard transition for many teens (and parents). As a parent, once you think you have something figured out, your child undergoes another change and you're back at square one. If you find out your teen is engaging in self-harming behavior, it's normal to go on a roller coaster of emotions, but don't let your distress keep you from getting your teen the help he or she needs. If you're an educator or helping professional, know the signs of self-harm and reach out to troubled youth. Often, these teens want to be noticed and cared about. If you personally know of a teen who is engaging in self-harming behaviors, please seek professional help immediately.

If you are reading this and are engaging in self-harming, please know people care about you and want to help. There are alternative healthy ways you can cope with your pain and suffering. You don't have to bottle up your feelings, and most importantly, you don't have to try to bleed away the pain.