Self-harm includes any behavior designed to provide relief from emotional pain through self-inflicted physical pain. Many young people with self-harm issues have experienced some form of past trauma resulting in ongoing emotional distress. Instead of expressing this pain in productive ways-for instance by talking about it-many adolescents and young adults repress it and don’t experience it openly. Repressing intense emotions for extended periods of time can cause emotional numbness. In the past, they may have needed to temporarily repress their emotions in order to cope with the trauma, but this coping strategy can have a long-term cost. After conditioning themselves not to feel, a young person can find it difficult to reawaken their emotions. They have difficulty feeling anything. So, to feel, they cut. One reason teens may turn to physical pain as a coping strategy is that they are terrified of emotional pain; as a result they seek out physical pain instead of engaging their emotions.
Others who self-harm do not repress their emotions. Instead, they experience the full intensity of painful emotions but have difficulty managing them. They may self-harm in order to redirect their attention to a more manageable, controllable type of pain. This redirection allows them to temporarily disconnect from the emotional pain and achieve a sense of relief and mastery.
Biologically speaking, cutting the skin releases “feel good” chemicals called endorphins. These chemicals give the cutter a sense of relief. The young person feels better for a time after cutting, but the chemical release wears off. When a person needs to cut deeper and more frequently to experience the same emotional relief, self-harm can become an addiction.
Usually self-harm is not suicidal behavior, although it can appear as such. Many who engage in self-harm do not want to kill themselves; they just want relief from their pain. Sometimes the reasons behind self-harm can cause an individual to spiral into depression, which may develop into suicidal ideation. In some instances, a careless act of self-harm can appear to be a suicide attempt. For some, dissociation is a part of the cutting process; in such cases the individual may not realize the extent of the harm that they are inflicting until afterwards. Dissociative self-harm can be dangerous as the cutter’s ability to manage the degree of harm inflicted is compromised.
Young people Who Are at Higher Risk for Self-harm
Although it is difficult to say what makes one person self-harm and another not, some youth are at higher risk for developing self-harm behaviors than others.
Risk factors include:
- Being female (although young men also engage in self-harm behavior)
- Having a mental disorder, such as depression
- Having a personality disorder, such as borderline personality disorder
- Experiencing low self-esteem
- Being a high achiever or perfectionist who finds it difficult time living up to a perceived standard
- Difficulty expressing feelings
- Family issues and lack of emotional support from family
- Lack of healthy coping strategies
Most people who self-harm start at around age 14. Some continue to self-harm into their twenties. While self-harm behavior may work as a coping strategy during the teen years, some young people find that it is not as helpful or as socially acceptable when they get older and so they abandon the behavior. Unfortunately, abandoning the behavior does not necessarily resolve the underlying problem. If an individual does not resolve the issues behind the self-harm behavior, then self-harm behavior may morph into other addictive behaviors, such as drug and alcohol abuse or promiscuity.
Treatment of Self-harm
The best treatment for self-harm behaviors is helping the individual express and talk about their pain. As they talk about their pain, they are able to gain perspective and understanding of it. Those who find talk therapy or verbal expression difficult can often release their pain through writing, drawing, painting, and other forms of expression. The important thing is for them to release their pain in a healthy way.
Since self-harm behavior can be similar to an addiction, many young people have intense urges to return to self-harm even as they try to recover. Helping young people deal with these urges is important in their treatment. It can be helpful to offer alternatives to the self-harming behavior such as using a stress ball, exercising, talking, finding a distraction, and seeking out the company of positive peers or adults.
Self-harm is unhealthy coping strategy that some young people use when dealing with emotional pain. Its causes can include past trauma and pain, difficulty expressing oneself, and a lack of healthy coping strategies. There are many types of self-harm, although cutting is the most common. Being an adolescent female with a mental disorder puts one at a much higher risk for self-harm. Treatment includes teaching and encouraging the young person to engage forms of healthy self-expression. This work can take time and is most effective in the context of a safe, trusting therapeutic relationship. Although self-harm is difficult to overcome, it is possible with effective treatment. With proper treatment, many of these young people live the rest of their lives free of self-harm.
Janette Davenport, MS, LPC, is a therapist at New Haven Residential Treatment Center, part of the InnerChange family of therapeutic programs.