Why do adolescents and young people self-harm?

It is surprising that many adolescents, especially girls, deliberately and repeatedly inflict harm on themselves without explicit suicidal intent. The most frequently used means are blades or scissors to cause cuts on arms, wrists or thighs, lighters to produce burns or the nails themselves to make deep scratches. Sometimes these young people can hit their head or fist against a wall or other solid surface until they bruise. Most of the time these self-harms take place in the solitude of the room. Girls are more likely to have superficial wounds to the legs and arms, while boys more often resort to more violent methods, such as burns or beatings.

Self-inflicted injuries are a public health problem. Hospitalizations for self-harm in Spain in the population aged 10 to 24 have more than tripled in the last two decades: from 1,270 in 2000 to 4,048 in 2020, according to data from the Ministry of Health. About 18% of adolescents in Western countries inflict self-harm with non-suicidal intentions at some point in their evolutionary development.

It is not easy to answer the question of why this type of behavior. Non-suicidal self-harm temporarily reduces negative emotions of anxiety and discomfort and can produce feelings of relief, making them easier to repeat. It is a pathology that consists of hurting yourself to regulate emotional pain or seek new exciting experiences. Affected teens do so to express emotions such as rage, anger, guilt, or loneliness. This emotional storm starts from a hostile or negative thought, followed by a psychophysiological activation, such as increased heart rate, and an impulse to self-injurious action.

More information: Teresa Sánchez, psychologist: "There is an alarming growth in both self-harm and suicidal practices among adolescents"

What underlies this behavior is a subjective sense of loneliness and helplessness, where adolescents feel that their emotions are not taken into account and their everyday problems are not properly perceived by their loved ones. You want to express psychological suffering through physical harm. It is also a way of punishing themselves, for example, for not liking their own body, the result of low self-esteem, or redeeming guilt for something bad they think they have done. Self-inflicted injury offers a temporary sense of control over disturbing emotions. It is, ultimately, to launch a cry for help to their closest family or social environment.

What is surprising is that some of these young people, in a dissociative state of mind, do not feel pain, but can experience self-harm as something even pleasurable. It is a self-regulatory behavior of maladaptive affects that can become addictive, with a tendency to increase intensity and frequency. In fact, some adolescents who resort to these behaviors show irresistible urges to harm themselves, as well as the need to increase the severity of self-harm to achieve the same relief effect (tolerance). The more addictive components the self-harm presents, the greater the clinical severity.

Sometimes there are specific reasons, of various kinds, that explain the involvement in this type of behavior. Thus, there are adolescents with problems in eating behavior who can carry them out to mitigate a feeling of guilt for having overeaten or for the suffering caused to their parents. Other young people, especially those who have suffered traumatic events, may show an existential emptiness and thus want to feel abnormally alive.

A stressful situation can be the trigger in young people with a precarious emotional balance"

Some teens who self-harm may seek social desirability, that is, to be talked about, even if it is in a worrisome tone. They may also want to escape painful situations, such as living with parents who have a conflictive relationship, or trying to cope with a situation of bullying or a dependence on online gambling. In sum, a high level of emotional distress usually precedes self-harm and is followed by a momentary reduction in stress. But this cycle repeats itself inexorably if the central problem is not adequately addressed.

These behaviors are more common in adolescents with low self-esteem or who suffer from other clinical problems, particularly borderline personality disorder, alterations in eating behavior, substance abuse, and autism. But also the feeling of loneliness or the perception of lack of support can set in motion these self-injurious behaviors. In short, a stressful situation can be the trigger in young people with a precarious emotional balance.

The increase in self-harm in vulnerable adolescents has contributed to the uncontrolled use of the internet and, in particular, the dissemination of explicit images on Instagram and other social networks, which can have a contagion effect. If young people, especially when they have a large following, cut themselves into a state of apparent placidity, photograph themselves, post it on Instagram and receive a like, they encourage other people to imitate their behavior.

However, there are differences between self-harm and suicidal gestures. Self-harm responds to emotional states of anger, deep discomfort, or distress, while suicidal gestures are usually associated with repeated suicidal ideation, deep feelings of hopelessness, and persistent desires to end life. Likewise, the methods used in self-harm are less severe and generally not dangerous enough to cause death.

Although there is no explicitly autolytic intention in self-harm, they constitute a future risk factor and can be a prelude to suicide, especially if there are depressive symptoms, family psychiatric problems or a history of suicide in the immediate environment. Therefore, it is important to seek psychological help to acquire emotional regulation and problem-solving strategies, deal with stress effectively, incorporate healthy habits and surround yourself with adequate family and social support. Ultimately, it is about detecting the sources of stress and facing emotional challenges with adaptive psychological resources.

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