Deliberate Self-Harm And Teens

It is frightening when we see a teen who has cut, burned or otherwise intentionally hurt him or herself, but if we can focus on the fact that s/he is not trying to commit suicide, we may calm ourselves and be of real assistance. (For more on Teen Suicide, click here).

First, what is Deliberate Self-Harm (DSH), and why do some teens engage in such seemingly bizarre (to us) behavior?

DSH is an attempt to

• Alter a mood state by inflicting physical harm serious enough to cause tissue damage to one's body

• Punish oneself for being a "bad person," which is sometimes done to avert more serious harm that s/he believes s/he will receive from another person

• To alter a sense of internal "deadness." The sight of blood can serve as confirmation that the person is in fact a living, feeling human being

How many teens engage is such behavior? As hard as it is to believe, studies have shown that some 14-25% of students engage in some form of DSH. Among college students, the rate of DSH can range up to 35%. (Among prison populations the rate is sometimes as high as 48%).

One young person writing on an Internet blog described his feelings and the urge to harm himself, ending with the following: "If anyone has the time to try to distract me, I'd really appreciate it."

Teens engaging in DSH are in real pain, as was the person quoted above. They are not "faking," trying to manipulate others, and they are definitely not "crazy." Teens who hurt themselves often exhibit symptoms of other mental health disorders, particularly Depression, as you would expect, and often Substance Abuse.

Studies have shown that risk factors for DSH are:

• Sexual, Physical, and severe Emotional Abuse
• Emotional Neglect
• Early disruptions in bonding with the primary caregiver, through the absence or illness of the child or the caregiver

Most, but not all, teens who engage in DSH come from a home environment in which the expression of emotions is not allowed, and often where adults invalidate any attempt to express legitimate feelings. It may also be that the child's innate temperament does not allow for the easy regulation of emotions.

n other words, a temperamentally sensitive child who has difficulty controlling emotional states finds him or herself in an emotionally hostile environment, the combination of which results in intolerable feelings for the child and the subsequent development of pathological coping symptoms. (click here for more on Teen Temperament).

DSH should not be confused with body decoration, such as most piercings, tattoos, and the like, which are socially acceptable forms of expression within certain groups (whether we adults like it or not).

Can a child or teen who is deliberately harming him or herself be helped? Definitely. The goal of the therapy is to assist the teen to better understand why s/he feels compelled to harm him or herself, and to find other ways of expressing what seems unexpressable. It is often long and difficult work (for both the child or teen and the therapist), and depending on the severity of the case, may require in-patient treatment. But with the right help, healing can take place. Acting quickly and calmly can make it easier to help the teen, so if you suspect DSH, don't delay in seeking professional help.

Do you know of a child who is, or whom you believe to be, engaging in DSH behaviors? Do you have questions about what is serious and what is just a teen being a teen? Your questions and responses will be posted to this site (or answered in personal email, if you prefer). We hope you will share your experiences with us, or contact us with your concerns and questions.

Deliberate Self-Harm Resources and References

Resource

Levenkron, S. (1998). Cutting: Understanding and overcoming self-mutilation. New York: W. W. Norton & Co.

References

Favazza, A. (1996). Bodies Under Siege: Self-mutilation and body modification in culture and psychiatry. (2nd Ed.) Baltimore: Johns Hopkins University Press.

Gratz, K. L., (2006). Risk factors for deliberate self-harm among female college students: The role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity/reactivity. American Journal of Orthopsychiatry, 76/2, 238-250.

Gratz, K. L., & Chapman, A. L. (2007). The role of emotional responding and childhood maltreatment in the development and maintenance of deliberate self-harm among male undergraduates. Psychology of Men & Masculinity, 8/1, 1-14.

Whitlock, J. L., Powers, J. L., & Eckenrode, J. (2006). The virtual cutting edge: The Internet and adolescent self-injury. Developmental Psychology, 42/3, 407-417.