Shedding Light on a Silent Struggle: Self-harm and Teens

Search a keyword like “self-harm” or “cutting” on Instagram or TikTok, and you’re redirected to a list of crisis support resources. The feature is new since the summer of 2023, added in response to calls for social media companies to do more to protect mental health — especially among teens.

When it comes to self-harm, research shows an increase in rates among teens that correlates with the rise of smartphones and social media use. A study in 2015 from the American Psychological Association found that about 17% of teenagers engage in self-harm at least once. However, rates of self-harm among adolescents have increased since then, especially during the pandemic.

In late January, the heads of Meta, Discord, TikTok, X and Snapchat were called to the latest Congressional hearing on how social media affects teen mental health. The executives were greeted by scores of parents sharing photos of their children they say have been harmed by the apps.

Whether the apps are partially to blame for the increase in self-harm among teens, it’s essential for parents and those who work with teens to recognize the signs of self-harm.

Social media serves up a deluge of social modeling on self-harm 

Even with crisis support tips now on the major platforms, social media users are still served up potentially harmful content on restricted dieting and other forms of self-harm. Teens susceptible to self-harming behaviors need little imagination to find ways to injure themselves in their social media “For you” feeds.

Social modeling is well established in psychology, says Edward Suarez, PsyD. A well-known psychologist in the 1960s, Albert Bandura, conducted experiments on observational learning showing that children acquire social behavior by observation. 

Social media algorithms are designed to send users down rabbit holes of content based on what they search and watch. For teens predisposed to self-harm, social media may make self-injurious behavior even worse. This underscores the importance of recognizing signs of self-harm and knowing how to respond, says Dr. Suarez.

Recognizing the signs and symptoms of self-harm

Self-harm shows up in ways that aren’t always obvious. It can include behaviors like hitting, biting, scratching, cutting, restrictive dieting, overeating or self-neglect.

Signs and symptoms of self-harm

• Frequent, unexplained cuts, bruises and burns
• Wearing long sleeves and pants in warm weather to hide injuries
• Scars or marks on the body that appear to be intentionally inflicted
• Withdrawal from social activities 
• Isolating oneself
• Sudden mood changes, such as being more withdrawn, irritable or anxious
• Feelings of despair
• Self-neglect
• Lack of appetite 
• Oversleeping

While some of the above are typical teen behaviors, such as oversleeping and moodiness, any sudden changes from routine behavior are an indicator of self-harm.

Self-harm is a way to express pain and release tension, says Dr. Suarez. “To these individuals, self-inflicted pain produces euphoria. It has the paradoxical effect of making them feel better by hurting themselves.” 

Nonsuicidal self-injury (NSSI), as self-harm is called, is often accompanied by other mental health issues such as depression and anxiety. 

Therapeutic treatment for self-harm

Nonsuicidal self-injury results from intrusive thoughts to endure physical pain to mask emotional pain, says Dr. Suarez. “To prevent self-harm, my goal is to teach someone to allow the intrusive thoughts to pass. It’s about redirecting and reframing your thoughts,” he says.

Managing and redirecting intrusive thoughts of self-harm comes with therapy and practice. Therapists typically use cognitive behavioral therapy (CBT) to help patients change a behavior like self-harm. CBT is a structured, goal-focused form of therapy that helps a person identify the underlying issues of self-harm and develop healthier ways to cope.

Another similar method of treatment for self-harm is dialectical behavior therapy (DBT), which is a form of CBT adapted for people who feel emotions very intensely. With practice, the STOP skill from DBT can help redirect harmful behavior with the steps in this acronym:

• Stop! Do not move a muscle
• Take a step back
• Observe the situation
• Participate in a healthy activity

Treatment for self-harm takes time and practice, especially for teens, whose prefrontal cortex that controls executive functioning is not fully developed. “You have to work a little harder as the therapist to get teens behaviorally conditioned not to hurt themselves,” says Dr. Suarez.

The goal, he says, is to get individuals to learn that pain is unavoidable. “You cannot stop a thought. You can only redirect thoughts, reframe them and manage them. We must accept that this is how we feel and allow the opportunity to pass.”

Talking to a teen about self-harm

Raising awareness about self-harm can help to mitigate it. Parents, teachers, guidance counselors, coaches and other teens are in the position to recognize the signs early and help prevent escalation.

If you suspect someone you know is harming their body, Dr. Suarez recommends listening and alerting someone who can help. “As shocked as you might be, you have to try to express empathy and concern without giving too much advice,” he says.

With time and support from qualified providers, a teen who is engaging in self-harm can learn to replace the injurious behavior with healthy behaviors, like listening to music, exercising, taking a walk or even punching a pillow. 

Wendy Margolin is a contributor for UHealth’s news service.

Tags: Dr. Edward Suarez, mental health counseling, pain relief, teens and mental health