Self-Harm in adolescents

Assessment and Treatment of Self-harm in Adolescents 

Self-harm is said to occur in 7-14% adolescents at some point in their life. It is commoner in girls than boys. 

What constitutes self harm? 

Any harm caused without the intention to end one's life could be self harm. The commonest behaviours seen are superficial cutting and medication overdoses (e.g. paracetamol), however self-harm may manifest as scratching, biting, cigarette burns.....

Function of self harm: This can be varied, self-harm may be - 

  • A way of communicating distress to others around 
  • Punishment of self or others 
  • Anger expressed toward self when it can't be expressed outwardly in a safe manner
  • Replacement of emotional pain with something more tangible / physical 
  • Unlike emotional pain, an act of self-harm can be concrete and gives a sense of control 

Does it work? 

A lot of people come to rely on this and deem it their coping method (albeit it a maladaptive one). It works for them when one of the above functions is served. Biologically, an injury to the body also leads to a gush of stress hormones in the system - opiates/steroids in the body which also produce a sense of relief rather quickly. 

Causes: This usually is a stressful life event causing distress, such as - 

  • parental separation
  • illness in the family 
  • bullying at school
  • relationship issues 

Are people who self harm mentally ill? 

Usually self harm is transient, teenagers would learn better coping methods and move on. Not all self harm is associated with / caused by mental illness. It is important though to have considered this and where needed seek expert help to tease this out as self harm can be one among many other symptoms of an underlying psychiatric disorder such as - 
  • Depression 
  • Post Traumatic Stress Disorder
  • Abuse (emotional, physical, sexual, neglect)
  • Psychosis 
  • Emerging Personality Disorders such as borderline and emotionally unstable personality traits 
  • Chronic but problematic family disputes  

Is self-harm same as suicidal ideation? 

Self harm needs to be distinguished from suicidal ideation or acts of attempted suicide where the intent is to die. At times adolescents who self harm, especially when there is an underlying / associated mental health condition may simultaneously have suicidal thoughts. Repeated self-harm tends to lead to suicidal ideation for a proportion of people as very likely the underlying causal factors perpetuate the difficulties.

Management / treatment:  

  • Parents / adults - it helps to not react with alarm and distress on finding out your child is self harming. Remember self harm has a function, a means to an end and you need to work with the young person to help them find an alternative way of coping. 
  • Intervene to remove the stress factors (i.e. abuse, family disputes, bullying)
  • Reduce harm - remove or limit access to sharps, pills / medication
  • Helping children, adolescents to develop positive coping strategies rather than relying on self-harm. 
  • Treat the underlying psychological / psychiatric disorder - Cognitive Behaviour Therapy (CBT), use of medication or both may be needed. Specialist approaches such as Dialectical behaviour Therapy (DBT) or trauma work at times may be needed. 
  • Get expert help through your GP, school counsellors especially if you doubt whether there are associated suicidal ideas/thoughts or acts.