According to one researcher, self-harming adolescents are doing all the wrong things for the right reasons...
I work as a psychologist for an adolescent mental health team in the public mental health system. Our service provides mental health care for young people who are identified as “too complex”, “too acute” and “too risky” to be seen by private psychologists. As such, it could be said that I work at the coalface of teenage mental health issues.
While I’ve been working in this capacity, I’ve noticed an increase in the number of young people engaging in self-harming behaviours such as cutting, scratching, overdosing on medication, burning and self-hitting. In many cases self-harm is not intended to be fatal and there is now a general consensus among clinicians and researchers that these types of behaviours represent a distinct type of self-harm termed 'non-suicidal self-injury' (NSSI).
It is difficult to estimate the rate of NSSI, as evidence suggests that only 10% of young people who self-harm present for hospital treatment. According to a study conducted in 2004, 6-7% of young Australians engage in NSSI in any 12-month period and lifetime prevalence rates are higher, with 17% of females and 12% of males aged 15-19 reporting NSSI at some point in their life. It is likely that these rates have increased over the last decade (De Leo & Heller, 2004).
Currently, approximately 75% of the young people I see in our service engage in NSSI. Of these, most are young women (mostly aged 13-17 years), although more young men are beginning to engage in self-harm. By far the most preferred method of NSSI among young people is cutting.
The question needs to be asked: Why are so many of our young people engaging in this behaviour?
The ‘experts’ who provide the most truthful answers to this apparently perplexing issue are the young people themselves.
Most of the young people I speak with indicate that the major reason they self-harm is because NSSI is an effective strategy for getting quick relief from emotional pain, tension and distress. If it is done regularly and over a reasonable length of time, self-harm also has an addictive quality and demonstrates all the hallmarks of substance dependency such as:
- Initial effectiveness
- Compulsion to use
- Lessening effectiveness over time (i.e., tolerance)
- Loss of control
- Continued use despite serious consequences
- Difficulty abstaining
- A withdrawal syndrome if abstinence is achieved
In this light, on a physical level, NSSI can be understood as a form of self-medication.
NSSI triggers multiple neurochemical responses (such as the release of endorphins) that provide a short-lived relief from the emotional pain. As one researcher on NSSI puts it: “The brain serves as a 24-hour pharmacy.” (Plante, 2007, p. 104) and many young people have figured this out! They have learned to regulate their neurochemistry without needing anything outside themselves except a blade or another type of sharp implement.
Because cutting and the associated blood-letting and scarification has a certain ‘shock value’, it is understandable that many people (especially parents) react with confusion and horror to the subject of self-harm and to those who engage in it. It is important to remember, however, that NSSI is simply another form of self-medication.
In this way, it is no different from other behaviours commonly associated with adolescence such as:
If this is truly understood, the focus automatically shifts from the behaviour itself back to the reasons why young people are using it as an effective but short-lived form of relief.
According to Plante (2007), self-harming adolescents are “doing all the wrong things for the right reasons” (p. 3). Every young person I work with who uses self-harm talks about similar underlying issues.
These young people struggle with:
- Not being truly seen or met by their parents and teachers
- 'Toxic' home environments that involve alcohol and drug use
- Domestic violence
- Physical, emotional, sexual and psychological abuse, neglect, etc
- 'Toxic' school environments that involve academic pressure, difficult peer relations, bullying, etc
- 'Toxic' social environments that involve alcohol, drugs, ‘partying’, sexual harassment, reckless and coerced sexual behaviours
- Harmful engagement with social media sites
Although it is true to say that the majority of young people today are being affected by these environments, those who present to our service seem to be particularly sensitive and especially prone to 'taking on' these various forms of toxicity. Because of their sensitivity, these young people experience intense awareness of the unpleasantness within their bodies (as a result of what they’ve taken on) and the pressing need to alleviate this intensity.
In essence, these young people know what they feel, but lack the knowledge of what to do with what they feel.
If you know someone who is struggling with self-harm, the key is to not react but to talk with them about what they are experiencing and feeling. Helping young people identify how they take on other people’s stuff will support them to return to an understanding of who they truly are, as distinct from what is going on around them.
Once this return is made, young people will be truly empowered to make more loving choices about what to do with what they feel.
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De Leo, D., & Heller, T. S. (2004). Who are the kids who self-harm? An Australian self-report school survey. Medical Journal of Australia, 181(3), 140-144.
Plante, L. G. (2007). Bleeding to ease the pain: Cutting, self-injury, and the adolescent search for self. Westport, CT: Praegar.