First of all, I’m going to say that focusing on the why this behavior occurs is probably not the most effective approach to addressing adolescent self-harm. I’ll give you some reasons why teenagers self-harm in a minute, but the one fallacy that people often have is that if they could explain why behavior occurs, then they would actually have the tools to fix or change it. More specifically, teenagers who may not understand the behavior themselves can often be put in an awkward situation in which they are forced to explain the unexplainable. If they don’t understand why the behavior is occurring in the first place, they may end up giving inaccurate reasons simply to appease their environment.
Self-harm behaviors likely have something to do with emotional pain. Possibilities include ways to control feelings, ways to control oneself or one’s behavior, ways to increase intensity of feeling (ie, the need to feel “real” or the need to feel “something”), or ways to decrease intensity of feeling (“If I didn’t cut I wouldn’t have been able to tolerate the situation”). Understanding how emotions work and what they do for people may is critical in understanding the role of self-harm behavior. For instance, feelings are functional in that they give useful information about what matters to us, communicate to ourselves and others, and help us become organized and prepare for action. Without feelings we just wouldn’t care.
In adolescence, self-harm behaviors may play a role in identity, communication, and intimacy. Self-harm may be kept very private or it may be made public. It may be an attempt at controlling one’s environment or letting someone else know that the person doing the self-harm cannot be controlled. The function of the behaviors may communicate to oneself (I know I matter, I know what I have to say is important, I can’t stand by and let nothing happen, I am not pleased by the situation, This is my way of making a statement), or to others (Back off, This is too much, I can control your reactions, I know you will be upset and freak out, There is nothing you can do about this, You can’t claim to know me, You think you know everything and you don’t).
Treatments for self-injury are not as simple as publicizing behavior (ie, making sure that others know about it), invading privacy by doing body checks, or just stopping doing it. If there was no benefit to doing it, no one would do it! That’s just simply how it works. Knowing the benefit can help someone to organize an effective solution. Teenagers who can obtain help in identifying, accurately labeling, understanding, and communicating their feelings effectively will have more options for what they can do when the urges to self harm show up. Increasing options, understanding the short and long term consequences of this behavior, and providing alternatives for how to tolerate intense, painful, and negative emotions is certainly one way to start.
It’s important to remember that teenagers also have their own feelings about this behavior. Some are opposed to changing it, some don’t want anyone to know about it, some want everyone to know about it, and some feel really hopeless that they can’t stop doing it. Most have some degree of mixed feelings. Assuming and communicating that a teenager simply doesn’t want to change is probably not going to help solve the situation. While it might be a likely, blaming a teenager for doing it usually only serves to communicate a parent’s frustration.
Similarly so, parents have their own feelings about it and may feel disgusted, hopeless, overwhelmed, inadequate, or guilty. How parents communicate and address painful emotion will also impact the situation; and thinking through the effectiveness and intensity of one’s own responses may be part of the work involved in addressing teen behavior.
I think it is important to consider that the problem of self-harm behavior has solutions. Sometimes providers, teachers, parents, and community react with an abject horror that stirs the pot, gets everyone all worked up, and in some cases emphasizes the solution (self-harm) and not the problem itself. Emotional problem solving is really just that- emotional problem solving. If a person can figure out how to problem solve (ie, address, tolerate, understand, deal with, validate, survive) painful emotions, then their way of solving problems (ie, self-harm) may decrease. Finding effective solutions means having an adequate way to assess and address these behaviors with a skilled professional who understands the role that these behaviors serve.