Teen Self-Harm: How to Have “the Talk”

Dr. Tanya Spencer

Over time and in different locations, the way people express distress differs and changes.  Self-harm (often referred to as “cutting”) seems to be gaining prominence among teens and young adults.  This naturally sparks a strong gut reaction, particularly for people who aren’t very familiar with it or why someone would turn to self-harm.

We all remember times we shielded our parents from upsetting or raunchy material, thinking that it was too intense or embarrassing for them or us.  Self-harm might fall into this category.  Although best estimates figure that only about 10% of youth use self-harm routinely, 80% of youth know someone who has tried it.  50% of kids have tried it.
(CASE study, over 30,000 youth surveyed in 7 countries).  Likely, today’s teens know more about it or realize it is rather widespread compared to their parent’s generation.  Self-harm is not an end in itself – most experts agree that other emotional problems (not all of which are considered diagnosable mental illness) are what drives this sort of coping.  No parent wants to imagine their child hurting themselves – we spend most of our efforts trying to protect them!  And how on earth could someone possibly think that injuring themselves is a good idea?

In the past ten years, researchers and helpers working with youth who self-harm have discovered some very consistent findings:

  • Self-harm is a way to cope with feelings that youth can’t bear to endure or can’t identify
  • It is very effective initially to soothe distress but those who use it habitually get trapped in a cycle they increasingly can’t control
  • Most self-harmers are either completely overwhelmed with feeling or feel numb or empty – both feel intolerable
  • Most self-harmers lack “emotional literacy”
  • They either never learned how to identify and express their feelings or they feel like others are denying their experience
  • Most self-harmers are intensely private about their self-injury – they avoid discovery and, after the initial rush of relief, they feel very ashamed, crazy, and embarrassed
  • Very few report wanting attention, though this is the #1 reason people around
    self-harmers jump to when trying to explain it
  • Most self-harm is directed at feeling alive, not wanting to die
  • Some use self-harm to stave off suicidal impulses
  • Self-harm doesn’t feel painful – it offers profound relief and a sense that the youth can carry on, at least at first
  • Self-harm affects both females and males
  • Although “cutting” is most common, anything that would ordinarily produce pain can be used
  • About ½ of self-harmers don’t seek help from anyone
  • Only 1 in 3 turn to friends or family
  • Only 1 in 5 turn to formal medical care
  • Formal medical caregivers are, unfortunately, notorious for punitive and rejecting responses, driving self-harmers underground and confirming their worst fears, which perpetuates the self-harm further

What are the best way to deal with the possibility of self-harm?

  • Be the first to mention the topic – even if your child seems “fine,” they likely know someone who self-harms
  • Youth go to great lengths to hide it, so often it is the one you least suspect
  • Asking about it won’t “put ideas in their head” or increase the urge to self-harm
  • Chances are, they will be relieved that someone cares and they aren’t as scary or dangerous as they feared
  • Be patient – some youth will reject early attempts at conversation, especially if
    they fear being discovered
  • Don’t ask someone who uses self-harm to stop
  • They lack healthy coping mechanisms, so taking this one away, as damaging and shocking as it seems, will likely only worsen their emotional distress and urge to
  • Keep your emotional reactions in check
  • Kids who receive calm and compassionate responses and offers of support (emotional and practical) stop self-harming sooner
  • Offer alternatives to self-harm
  • Distraction, other methods of emotional expression, stimulation (for those who are numbed out) or relaxation (for those who are overwhelmed emotionally
  • Enlist professional help
  • One person can rarely be both an emotional and practical support
  • A professional can tease out the “real” issues and screen for diagnosable mental illness, associated learning problems, or dysfunction in the youth’s broader social system
  • A professional can help sort out whether to involve other family or the school

ARCH’s self-harm tool-kit for parents and teachers (click on Resources) discusses these issues in more depth and offers concrete guidance to help you reflect on your reactions to self-harm, encourage compassion from caregivers, and on-the-spot access to 24-hour resources.


  • What is your family’s emotional literacy?
  • Why do I feel the way I do about self-harm?
  • How to plan “the talk” with your kids
  • How to relax – for adults or teens to relieve stress
  • What to ask when seeking professional services
  • How to contract with youth who self-harm
  • Where to turn for more information or instant help

Our team has extensive experience with youth mental health  and self-harm.  We use best practices and an holistic approach to provide  comprehensive and effective care.  Call or e-mail us to find out how we  personalize our services to fit your unique situation.  Individual and  family sessions, along with case consultation to schools and treatment
settings, are available.

Once we understand the “why” of self-harm, the healing can start.

About tanya.spencer

Dr. Spencer has worked with families, schools, and residential treatment settings using an evidence-based framework and cognitive-behavioural perspective. She specializes in learning problems, attachment, mood disorders, teen self-harm and the autism and fetal alcohol spectra.
This entry was posted in Adolescence, Mental Health and tagged , , , , , , . Bookmark the permalink.

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