A Silent But Growing Problem

It’s practically impossible to say how many teenage girls are self-harming. This is because very few teenagers tell anyone what’s going on, so it’s incredibly difficult to keep records or have an accurate idea of the scale of the problem.

But according to a recent survey, up to 30 percent of teenage girls in some parts of the United States say they have intentionally injured themselves without aiming to commit suicide, researchers have found.

About one in four adolescent girls deliberately harmed herself in the previous year alone, often by cutting or burning, compared to about one in 10 boys. The overall prevalence of self-harm was almost 18 percent.

“These numbers are very high for both genders — that surprised me,” said Martin A. Monto, a sociologist at the University of Portland and lead author of the new research.

And the pandemic has added a toxic ingredient to the mix. Private healthcare claim records in the United States for intentional self-harm as a percentage of all medical claim reports in the 13 to 18 age group increased 99.8% during March and April 2020.

What is Self-Harm and When to be Concerned?

Self-harm, formally referred to as non-suicidal self-injury, is the intentional act of causing physical pain to oneself without the intent of committing suicide. Cutting, burning, headbanging, and wound picking are common methods of self-harm behavior.

This behavior is commonly associated with eating disorders, borderline personality disorder, substance abuse disorders, and severe-profound autism.

It can be difficult to determine if someone is self-harming. But these signs may provide valuable clues:

  • Isolation or withdrawal from daily activities

  • Signs of depression such as lack of motivation or a low mood

  • Changes in sleeping or eating habits

  • Talking about self-harming or suicide

  • Alcohol or drug abuse

  • Risky behaviors

  • Unexplained cuts, bruises, or marks

  • Covering up all the time even when the weather is hot

While these signs could indicate self-harming, they are not necessarily conclusive. On the other hand, self-harming may not be preceded by any sign at all. Keep in mind that, if you suspect your child or someone you know is self-harming, it is important to ask about it honestly and openly.

Why Do They Do It?

1. Feel Pain

Many teenage girls engage in self-harm behaviors as a way to experience physical pain when they feel that they are otherwise emotionally numb from trauma or abuse that they have experienced.

These girls find that the pain inflicted by self-harm is preferable to the numbness and emptiness that it replaces. Experiencing something rather than nothing is a welcome reminder that one is still able to feel; that one is still alive.

For other girls, the pain of self-harm merely replaces other emotional pain that they can neither understand nor control and just won’t go away.

2. Induce Punishment

Those teenage girls who engage in self-harm behavior often have a deep sense of guilt or unworthiness. This low self-worth may be based on past experiences such as bullying, abandonment, trauma, or loneliness. As a result, these girls feel that they aren’t good enough to belong and they are to blame for their misfortune.

Those who are struggling with any type of disorder, whether it is eating, substance use, or mental health may carry burdensome guilt because of the disorder itself,  especially if these disorders are not properly treated. Self-harm becomes a “quick” way to relieve these girls from their “guilt.”

3. Avoid Unwanted Feelings

Many teenage girls who engage in self-harm have intense and impulsive urges to cut, as a way to avoid their painful internal feelings. By harming themselves they are able to distract themselves from their anxiety, sadness, loneliness, anger, and other negative unwanted feelings.

And self-harm can be an easy distraction from painful memories and flashbacks, and keep those painful emotions from bubbling to the surface.

4. Regulate Internal Emotions

Self-harm behaviors can be used as a way to regulate internal emotions. They provide a temporary outlet for teenage girls who are unable or unwilling to cope with the emotional pain that they are experiencing. By inflicting physical pain they are actually escaping their reality by choosing a fleeting way to escape their emotions.

It has been discovered that self-harm releases a surge of endorphins, which create a sense of euphoria and relaxation. However, this temporary “high” is followed quickly by feelings of guilt and shame. Often, the unfortunate result is even more negative internal emotions, which only reinforces the downward spiral of self-harm.

A Novel Perspective: The Self-Harming Brain

At a conference on teen suicide and self-harm, Christian Schmahl shared his team’s research on the neurobiology of self-harm. Schmahl showed that self-harming adolescents have a distinctive brain and physiological activity when responding to pain and to the sight of their blood.

Most people have awful feelings when they experience physical pain or look at their wounds. That pain intensifies sadness, anger, and frustration. When we stub a toe or bang our head, we instinctively unleash a resounding “ouch” of anger and frustration. But those who engage in self-harm have quite a different experience.

Instead of finding pain to be unsettling or painful, they find it to be calming. Cutting their body or pressing a hot match to the inner arm dissipates their anger, sadness, or frustration. The pain induces a flood of relief, which makes them happier, more content, and satisfied. Their primary incentive to self-harm is emotional regulation.

Those teenage girls who go on to be self-harmers find that pain and the sight of their blood calm the amygdala (that part of the brain where the most reactive feelings are experienced).

This neurobiological model, which needs more research, may indicate that the distinctive brain response of being calmed by pain and seeing injury is the true underlying cause of self-harm.

Reducing Self-Harm

1. Safety

Before proceeding with any active intervention, the teenage girl’s physical and emotional safety must be ensured. Foremost she needs to be extricated from a relationship that includes abuse or neglect. If this is problematic, the parent, therapist, friend, or caregiver should report the situation to the relevant authorities to assure that this will be resolved.

Even though you can’t remove every sharp object, it’s important to take them away for a different reason. By removing away easily accessible sharp objects, parents and caregivers are sending a lesson of love and concern as well. They are conveying a full commitment to the healing process and modeling a safe environment.

2. Avoiding Shame

Understandably, parents become very frightened by their adolescent’s self-harm. But the reaction could make things get better or worse. If the parent’s reflexive reaction is to cause the child shame for their self-harm, then it is likely that the child will be driven to self-harm even more. It’s just feeding the fire.

Instead, the parent needs to be in control and behave counterintuitively by “taking it in stride.” Often, shame is generating self-harm, and the parent must do everything possible to protect the child from further shame. Rather, the parent needs to open the doors of trust and understanding, which is what this child so desperately needs.

3. Connection

For some teenage girls, self-harm is the call for someone to show them compassion. Psychotherapist and author Steven Levenkron writes, “talk, trust, healthy attachment, intimacy, and secure communication are the necessary building blocks for change.”

“The prerequisite for the helper is to develop influence with the self-mutilator, and that influence comes from experiencing a trusting, safe relationship.” This is the foundation that must be laid before the healing begins.

But there is another reason that human connection is important, especially for “self-harmers.” The connection itself with other people is a primary way for teenage girls to reduce their shame, feel valued, and fill their time constructively.

4. Re-Engage Core Identity

It isn’t uncommon for someone who is suffering deep emotional pain to begin to identify with the pain. It’s as if that person isn’t just experiencing the pain, but rather “is the pain itself.” Adolescents are even more vulnerable than others because their pain is being felt within the background of the struggle to find their individual identity.

It is important for anyone working with the teenage girl, be it a parent, therapist, or friend, to be aware of this. Helping the adolescent to solve this fundamental issue of identity can help the adolescent to see himself/herself as something distinct and far more than pain; as a valuable human being going through something very difficult.

5. The Power of Free Choice

Contrary to what some parents may believe, they have no control over their adolescents. What they do have is the possibility of an authentic relationship and the power of persuasion that can be exercised within it. Parent-child relationships are ultimately about the alliance, not compliance.

The anxiety that a parent feels about the safety of a child who is self-harming tends to cause the parent to try to prevent the child from making choices, hoping to reduce their anxiety about the child’s safety. While this may seem noble and necessary, it won’t work. Because the moment the child steps away from the parent, the control is gone.

The more effective route is to invest in building the relationship, and then leverage the influence and persuasion that it affords to impact the child’s choices. While there is nothing easy about this, in the end, the parent really has no other option.


Parents feel anxious, hurt, and confused to see their teenage daughter, who they love so deeply and in whom they have invested so much, willfully damage the body that they have been entrusted to protect. And psychologists are concerned because self-harm carries with it a higher risk of suicide and adult anxiety disorders.

However, once the root causes and dynamics of self-harm are properly understood, the effective methods mentioned above can be marshaled to arrest this terrible epidemic. Then there is considerable reason to hope that these girls can be helped to desist from their destructive behavior and be guided to live happy and successful lives.