Some research shows that between 7% and 47% of teens self-harm, although the number of teens engaging in deliberate self-injury is, by some researcher estimates, about 23% and the likely hood that an average American teenager has deliberately self harmed in the previous year is, as of this 2019 study, about 18%.
In the past- and sadly to some degree still today- self-harm has had a reputation of being an “attention-seeking behavior,” but emerging brain science (like this 2018 study that used brain imaging to study the brains of girls who self-harmed) is now showing that for many teens, self-harm is actually an early warning sign of physical changes occurring in the brain. Kids and teens who self-harm DO need attention and support to access early interventions to help them recover and thrive. Thankfully teenage brains are resilient, and with early intervention, attention, and care, many can recover completely.
I wanted to create this handout for teachers, parents, peers, and anyone in a relationship with someone who is self-harming. This post is written with teens as the focus, but self-harm can and does occur throughout the lifespan are requires supportive, empathic care at all life stages.
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1. Don’t Panic
Stay calm. Don’t shame. Be kind.
The natural response to discovering something as shocking and scary as your teen self-harming is to feel upset and emotional. It’s okay to feel upset, it’s okay to tell your teen you are upset, but avoid letting your teen see you panic.
If you panic, you are likely to inadvertently put your self-harming teen into the role of providing care for you, and that can be confusing for a hurting teen. Additionally, it can potentially can create a cycle in which self-harm reoccurs because the teen doesn’t know other ways to cope with the confusing dynamics. If you feel like you cannot handle your emotions in the situation, it’s okay to assess the situation and- if there is no immediate danger- step out and take a moment to breathe.
You might say something like “You aren’t in trouble, but I’m really concerned. I want to talk with you about this, but I need a moment to process.” This can delay the conversation until you are in a space where you can actually engage and sets an example for self care in tough situations.
2. Assess Urgency
Whether you have discovered someone harming themselves or if someone disclosed their self-harm to you, offering care is the first concern.
Is an ER visit warranted? If not, is first-aid needed? Even if the wounds are very superficial, offering care in the form of first-aid is a tangible act of kindness. The process of cleaning and bandaging someone’s self-harm wounds is powerful gesture. It says, louder than words, “I’m here. I care. I’m not turning away from you.” That care can show the teen that they deserve care and that you are available to give it – two factors that might reduce self-harm episodes in the future.
Although you may want to wait until the initial shock wears off, don’t avoid talking about self-harm. The more of the topic is avoided, the more it is implicitly shamed, and the more likely it is that the shame of silence will fuel future, covert episodes of self-harm.
Don’t demand a long talk, especially with teens, but invite the conversation to happen. When it does, listen to the individual’s experience and avoid the temptation to fix.
You may want to talk with your teen about how to communicate around the issue. Let them know they can tell you about episodes of harm without judgment. See #7 and #8 for strategies to reduce the frequency.
Significant research supports a relational approach to responding. All people, and especially those experiencing urges to harm, need connection with others. When we’re working on connecting with someone who is is dealing with urges to harm themselves, responding with a non-judgmental attitude (it reduces stigma and shame), seeking to understand the full story (and offer ways to express the story besides just talking), working together to create a safety plan, and making sure you (the person helping) are maintaining your own self-care can help facilitate this connection point.
4. Check-In With Yourself
Being a good parent, caregiver, or friend to someone who is self-harming requires that you take good care of yourself. Seeking support around this issue can be tricky, as teens can rightfully feel like their privacy has been violated if a parent speaks too freely to others about their issue. Show discernment in who you choose to confide in for support, and identify one or two people who can support you through the experience. If you need more support, seek therapy yourself so you can be a better support to your teen.
5. Don’t Punish
Mental health struggles cannot be remedied through discipline. First, seek to understand.
Process why it’s happening, practice harm reduction, and review alternate behaviors. Then and only then, with the support of the therapist, collaborate with your teen on how consequences for continued self-harm episodes might help support them making choices that keep them safe.
6. Pay Attention
The majority of teens who self-harm indicate doing so brings relief- a clue to the changes that researchers have discovered occur in the brains of teens who cut. Self-injury is the second strongest predictor of suicide. (While the #1 predictor of death from suicide is a previous suicide attempt).
What if they are doing it for attention?
Many adults were raised in families that taught us to ignore behavior when we suspect someone is “doing something for attention,” but here’s the thing: all behavior is communication, and if we ignore that communication we risk losing trust.
One common myth about NSSI (non-suicidal self-injury) is that adolescents who self-injure will “grow” out of the behavior, as if it is a phase or a fad (Lewis, Mahdy, Michal, & Arbuthnott, 2014). On the contrary, research has suggested that NSSI often persists into adulthood and that many adults who engage in NSSI began self-injuring when they were teenagers (Klonsky, 2011). – Researcher Nicolas J. Westers
Next time you think someone is doing something for attention, think about the role the behavior is serving. What might it be saying? How might it be an attempt to access the resources the person needs in order to function?
7. Get Therapy
If your teen is cutting or self-harming, it’s time for therapy. Do not wait to see if it gets better. Find a good therapist by asking a guidance counselor, doctor, teacher, or religious leader for referrals.
Not every therapist is a good fit for every teen. Even if your pediatrician, who has never steered you wrong, swears a particular therapist is a miracle worker, that therapist might not be a good fit in personality or approach for your teen. So, while it’s okay to require your teen to show up to therapy, don’t make them continue to visit a therapist they don’t like. Instead, ask them to commit to three sessions with a therapist, and if they still dislike the therapist, to try three sessions with a new therapist, etc.
Consider family therapy. Self-harm in the family is disruptive and often the most natural responses (panic, punishment, etc) from loving parents can actually perpetuate the cycle of self-harm.
Don’t be afraid to lean on professionals to help guide you through this tough season of parenting. Kids and teens are often distressed by their acting out because they don’t know why they are doing it. The role of the therapist is often one of interpreting for the family: helping kids and parents understand what’s really happening, so the family can work with the underlying challenges instead of focusing on the behavior.
Leaning on a therapist as a sort of translator between parent and teen can reduces anxiety for both teens and parents. Good therapy gives kids a way to discover and then communicate their needs, which often resolves or reduces problem behavior.
8. Harm Reduction
Harm reduction is kind of new to mainstream mental health, but you might be surprised to learn that harm reduction is endorsed as the recommended treatment for non-suicidal self-injury by the National Institute of Health. Why? Research, like this study, is increasingly clear that even though abstaining from a harmful behavior, substance, etc would be best, it’s often not a realistic expectation. Emphasis on reducing the frequency and severity of a harmful behavior while also getting treatment for the underlying cause is far more effective. An example of harm reduction might be making list with your team of less harmful ways to “self-harm” (an example might be snapping a rubber band on their wrist, or squeezing an ice cube) and then agreeing that before the next time they cut they will try one to two things from the list. Self-harm recovery can be slow and non-linear, especially if the behavior has become a habit. Work with your teen and your therapist to develop ways to support recovery, which may include collaboratively creating a safety plan that helps define actions and goals a person can take when they feel the desire to harm themselves.
Download A Printable Crisis Plan
For more information on using this resource, read the article.
Want to share this as a printable with clients, students, or parents you work with? You can print this article or download a high-resolution PDF version of this handout.