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Self-Harm in Adolescents: Warning Signs, Factors, and Treatment

By February 19, 2020Blogs

Self-harm is a term used when someone intentionally causes injuries to their body, usually as a way of coping with overwhelming emotional distress. Some young people who self-harm may also have thoughts of suicide. More than half of the young people who commit suicide have had a history of self-harm.

Self-harming behaviors include:

  • Burning (with cigarettes, lighters, or matches)
  • Excessive rubbing (to create friction burns)
  • Pinching, picking skin, or biting
  • Substance abuse
  • Binge eating and/or avoiding eating
  • Excessive exercise
  • Persistent hair pulling (anywhere)
  • Strangulation

Identifying signs is important for effective treatment and some indicators include:

  • A child with unexplained cuts or bruises on their wrists, forearms, thighs, or chest
  • A child who appears low in mood, and lacks interest in activities they once enjoyed
  • A child who expresses a desire to take their own life
  • A child who keeps themselves fully covered despite warm weather
  • A child who appears withdrawn and isolates themselves from friends or family
  • A child who expresses self-loathing and the desire to hurt and punish themselves
  • A child who expresses low self-esteem and makes statements of hopelessness and worthlessness
  • A child who consistently blames themselves for problems that have occurred
  • A child uses drugs or alcohol
  • A child pulling out eyelashes, eyebrows, or hair
  • A child who has unusual weight loss or weight gain, or changes in eating habits.
    • They may try to hide changes in their weight by wearing loose clothing or being secretive about eating.

Causes of self-harm are bio-psychosocial and multifactorial. Several factors can contribute to increasing the likelihood of self-harm such as:

  • Family factors/ Parental mental health disorders
    • Difficulties in parent-child relationships, child and family adversity, maladaptive parenting, and parental divorce
    • Exposure to self-harm in the family
  • Childhood physical and sexual abuse
    • Research has found a strong correlation between sexual and physical abuse and self-harm.
  • Academic Settings
    • Bullying is one of the main precipitating factors for individuals who self-harm.
  • Life stressors
    • Stressful life events, such as socioeconomic difficulties, financial difficulties, peer-related stressors, social isolation, conflicts, and rejection.
  • Peer influence
    • Group self-harm behavior
    • Social media
  • Substance Abuse
  • Sexual orientation
    • Adolescents’ concerns regarding sexual orientation.

Common disorders associated with self-harm are the following:

  • Mood disorders
    • Depression is the most prevalent mental health disorder associated with adolescents who self-harm.
  • Bipolar disorder
    • Associated with increased rates of self-harm
  • Psychosis
    • Due to intrusive thoughts, or voices telling them to self-harm
  • Anxiety disorders
    • Anxiety disorders comorbid with depression have been identified as a risk factor for self-harm.
    • Panic attacks have been associated with an increased risk of self-harm in adolescents.
  • Eating disorders and body dysmorphic disorder
    •  Poor body image.
    • Diets can be considered a form of self-harm.
  • Conduct disorder
    • Antisocial behavior can be a risk factor for self-harm.

Identifying signs of self-harming is important. Remember that asking about self-harm will not increase the likelihood of self-harming behaviors. It is important to seek treatment for a comprehensive risk assessment, to understand the frequency and severity of the individual’s self-harming behavior, as well as understanding the function of the behavior.

Cognitive-behavior therapy (CBT) is the primary treatment for depression and affective disorders. CBT is based on the theory that thoughts, behaviors, emotions/moods, and some physical symptoms influence each other. Through CBT a person learns to challenge and modify their thoughts and behavior. CBT focuses on recognizing cognitive thoughts and learning skills to manage their depressive symptoms. CBT teaches individuals problem-solving skills, behavior activation, and emotional regulation.


Brunner, R., Parzer, P., Haffner, J., Steen, R., Roos, J., Klett, M., & Resch, F. (2007). Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents. Archives of pediatrics & adolescent medicine161(7), 641-649.

Hawton, K., Saunders, K. E., & O’Connor, R. C. (2012). Self-harm and suicide in adolescents. The Lancet379(9834), 2373-2382.

Laye-Gindhu, A., & Schonert-Reichl, K. A. (2005). Nonsuicidal self-harm among community adolescents: Understanding the “whats” and “whys” of self-harm. Journal of youth and Adolescence34(5), 447-457.

Slee, N., Garnefski, N., van der Leeden, R., Arensman, E., & Spinhoven, P. (2008). Cognitive-behavioural intervention for self-harm: randomised controlled trial. The British Journal of Psychiatry192(3), 202-211.

Ystgaard, M., Reinholdt, N. P., Husby, J., & Mehlum, L. (2003). Deliberate self harm in adolescents. Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke123(16), 2241-2245.