Understanding Teen Self-Harm - What to Do When Your Child is Self-Harming

Written by Rach Littley Cert. Arts (psych), B. Couns (hons), Dip.MSBR

Self Harm - A Deeper Look.

A quick Psychoeducation for parents/guardians and those working with rangatahi to help understand teen self-harm.

Research suggests that between 7% and 47% of teens self-harm. The likelihood that an average New Zealand teenager has deliberately self-harmed, based on this study*, is estimated to be about 23%.

Some important information to remember as we discuss this handout: Not all deliberate self-harm is suicidal or pre-suicidal behaviour. Non-suicidal Self-Injury (NSSI) is defined as deliberate self-inflicted harm to oneself without suicidal intent. However, Kids and teens who self-harm do need attention, empathy and support to access interventions that focus on stabilisation, recovery and mana-manaaki. Self-harm at any level should not be dismissed.

It is also crucial to understand that there is a lot of stigma around self-harming. Sadly, there remains a degree of whakama and judgement towards individuals who engage in self-harming, which is often misperceived as “attention seeking” behaviour. On the contrary, NSSI or deliberate self-harm is a key indicator of a dysregulated individual.

Emerging brain science describes deliberate self-harm amongst teens as a complex coping mechanism from neurodevelopment, emotional struggles, and social influences. A primary understanding of this is due to the developmental stage of this age group where the prefrontal cortex (responsible for impulse control, decision making, etc) is still developing, while the limbic system (which processes emotions) is most active in adolescents. This neurobiological imbalance makes teens more susceptible to emotional dysregulation and impulsive behaviour. Self-harm can trigger a release of endorphins and other neurotransmitters like dopamine, creating a sense of relief and/or a temporary reduction in emotional pain. This can then create a reinforcing loop where self-harm becomes a maladaptive way of coping with stress or negative emotions.

Reasons* why your kid or teen might be self-harming:

• To cope with difficult feelings (distress, stress, anxiety, sadness)

• They feel an overwhelming emotion that they cannot place

• A way to express themselves

• Avoidant behaviours (i.e. avoiding acting on suicidal thoughts/urges)

• Self-Punishment

• Gaining control

• To feel or end a sense of numbness and/or disconnect.

These are some of the most common reasons for NSSI among teens, as indicated by NZ research, showing that the primary function of NSSI is to gain control and manage emotions. By understanding we can offer better support and facilitate open conversations that mana-manaaki the teen.

*This is not an exhaustive list.

Teen Self Harm - How to Respond.

A quick resource for parents/guardians and those working with rangatahi.

Please note that whilst this resource is written with teens as the focus, self-harm can and does occur throughout one’s lifespan; which requires, and is worthy of, supportive, empathetic care, across all life stages.

1. Don’t panic - Be empathetic.

Stay calm. Don’t Shame. Be Kind. 

It’s natural that upon discovering something as scary as your teen self-harming that you would feel upset and emotional. It’s okay to feel this way. It’s also okay to share how you are feeling with your teen. However, it’s important to avoid letting your teen see you panic. 

This inadvertently puts the teen into the role of providing care for you, and that can be really confusing for them. It can also potentially create a cycle in which self-harm reoccurs because the teen doesn’t know other ways to cope with the confusing dynamics; and/or make the teen withdraw more. 

It’s okay to assess the situation and - if there is no immediate danger - press pause so that you are able to collect your thoughts and regulate. 

You might say something like, “You aren’t in trouble, I am just really concerned. I want to talk with you about this because it’s important, I just need a moment to wrap my head around it”. This can help delay the conversation until you feel like you are in a space where you can engage, while also demonstrating the importance of prioritisting self-care in tough situations. 

I absolutely encourage you to watch this little clip by Brene Brown: Empathy Vs. Sympathy

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 to care in the form of first-aid is a tangible act of kindness. This kindness is a physical demonstration to your teen that they deserve care and that you are available and willing to give it to them. These two factors alone can be contributors to reduce self-harm episodes in the future as they build on empathetic connections, vulnerability from both parties, and deepen their sense of belonging.

3. Open Door & Spaces for Safe Communication

Significant research supports a relational approach when responding to self-harm. All humans, and especially those experiencing urges to harm, need connection to others.

Don’t demand a long talk or a talk that turns (from the teen’s perspective) into an inquisition.  Instead, invite the conversation to happen. Let them know that you’re there to listen to their experience with an open ear when they are ready, and avoid the temptation to fix it. 

One key feedback from the kids and teens I’ve worked with in my career is that they often feel that their parents are disappointed with them for self-harming, this fear of judgement in turn invites the feeling of shame to visit them. It’s important to let them know that you love them and respond with a non-judgemental attitude.

Safe communication is where as adults we help put more control around the talking in the hands of the teen, and take the role of the naive inquirer - someone who is listening to really understand what the person is saying and not listening to form a response. Someone who is validating what the teen is feeling and going through by trying to understand it from the teen’s perspective. 

4. Pay Attention - All Behaviour is Communication

All behaviour is a form of communication. Whether consciously or subconsciously there is always a root cause and/or an unmet need to a behaviour. How we respond to that behaviour is everything. 

When we adapt this perspective around behaviours, it provides us with a wider lens on what the behaviour is trying to tell us. What role might the self-harm be serving? 

5. Check-In with Yourself

Being a good parent, caregiver, or friend to someone who is self-harming requires taking good care of yourself. 

When we take care of ourselves, we are then better equipped to empathetically care and support others. Seeking support around this issue can be a little sticky, because we also want to honour the teen’s right to their privacy around the matter. 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 your own counselling so you can better support your teen. Research indicates that parents who attend their own counselling develop enhanced coping skills and strategies, which can improve their interactions with their children and lead to better emotional regulation at home.

6. Don’t Punish

Mental health struggles cannot be remedied through discipline. Read that line one more time.  

Transgenerational learning puts us adults at a disadvantage where our initial reaction might be to create some form of consequence for self-harm such as no phones, increased curfews, and/or forced proximity (i.e. not allowed to be in their room) under the guise of safety. 

Instead, process why it’s happening, practice harm reduction, and review alternate behaviours. Then and only then, with the support of a counsellor or another mental health professional, collaborate with your teen on how consequences might benefit and/or support them in making choices that make them safe.

7. Harm Reduction.

Harm reduction is a way of validating your teen, acknowledging their current regulation skills, and helping them expand on this in a manageable way. 

Harm reduction looks like when they feel the need to cut, agreeing to try one or two of the safer alternatives (attached) from the list beforehand.

Research shows that a “zero tolerance approach” to self-harm generally does more harm than good with more frequent relapses and increased secrecy. Harm reduction on the other hand is endorsed as the recommended treatment for NSSI. Why? Research, like this study,  is increasingly evident that even though abstaining from harmful behaviours is the end goal, it is not a realistic expectation. Whereas this strategy focuses on reducing the frequency and severity of NSSI whilst also expanding the teens emotional resilience with more coping strategies and increased autonomy. 

8. Patience

Lastly, remember that the journey away from self-harm can be slow and non-linear, especially when the behaviour has formed to be habitual. Refer to #5 for extra support with this. Keep in mind that progress is possible. Many teens who self-harm find healthier coping strategies and develop stronger emotional resilience over time. Celebrate the small victories along the way, and know that with patience, understanding, and support, positive change can and does happen.