Why Do Some Teens Repeatedly Harm Themselves

A variation on suicidal behavior (sometimes termed "parasuicidal behavior" or "suicidal gestures") occurs in teens who harm themselves repeatedly in ways unlikely to cause death. Common examples include superficial cutting of the forearms or other areas of the body, self-inflicted cigarette burns, hitting oneself with a fist or an object, or hitting one's head against a wall or hard object. It used to be thought that these displays represented part of an emerging personality disorder, but recent studies have shown that this is not always the case. Other reasons for such behavior can include:
• The teen has feelings of guilt or worthlessness that are part of depression.
• The teen is trying to regulate unpleasant feelings (see below).
• The teen is expressing anger or desire for someone's attention (for example, from a parent or a boyfriend).

Some teens engage in these behaviors only in the midst of a depressive episode, as in the example below.

1. Brian: Brian was deeply depressed, but determined to continue attending school. He was suspended after repeatedly gouging his face with scissors. The teachers felt they could not monitor him closely enough to ensure his safety, and other students were very disturbed by witnessing his self-mutilation. Interestingly, Brian engaged in no self-harm at all after his mood improved with antidepressant medication. He went back to his fellow students and explained the nature of depression and how it affected him in a class presentation. He explained his previous self-harm behavior by saying, "At the time, I felt I deserved to be punished. I felt less guilty after I punished myself." The following year, he graduated as class valedictorian.

For other teens, self-harm behavior represents a way of regulating unpleasant feelings. When the body is physically injured, endorphins are released. These are brain chemicals that are natural pain-killers, but they also have a mood-elevating effect. Thus, by inflicting physical pain on themselves, these teens numb their emotional pain. Some claim to eventually not feel the physical pain at all. For these teens, self-harm behavior can be decreased by helping them use alternative mood regulation strategies, such as those described earlier. Incidentally, regular physical exercise releases endorphins too, so encouraging a sports activity can also be helpful.

Finally, some teens harm themselves to demonstrate anger or gain attention. This is especially likely in those who engage in self-harm in front of other people (usually family most often during or after an argument). These teens often benefit from all of the strategies discussed in the chapter on anger. They usually need more consistent limits and a parent who can remain calm and not be drawn into arguments. It is important not to allow threats of self-harm to change your parenting decisions. This would simply reinforce your teen's negative behaviors. The exception would be if your teen was threatening serious self-harm in front of you (for example, brandishing a knife or firearm), in which case a call to emergency services would be indicated.



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