Understanding self-harm: How to support teens in crisis

Adolescence is a time of profound change, growth, and self-discovery, but it can also bring intense emotional challenges. For some teens, the struggle to manage their overwhelming feelings can result in self-harming behaviours.

Self-harm is difficult to address, but understanding its complexities and adopting a supportive approach can make a crucial difference, guiding teens in crisis towards recovery and a more hopeful future.

This article explores why teens self-harm, the signs to look out for, how to offer effective support, and the critical role of GPs in addressing the issue.

Why do teens self-harm?

Adolescence is a period of intense change and development, both physically and emotionally, and some teens may feel unprepared to manage these challenges. For these teens, self-harm can provide a temporary way to release emotional pain or regain a sense of control when their lives feel chaotic.

Mental health conditions such as depression, anxiety, or post-traumatic stress disorder (PTSD), can also play a role in self-harming behaviours. Additionally, teens who experience bullying, abuse, neglect, or other traumatic events may turn to self-harm as a means of coping.

It’s important to know that while self-harm isn’t always an indicator of suicidal intent, it can increase the risk of suicide over time, making early intervention essential.

What are the signs of self-harm in a teen?

Recognising self-harm in teenagers can be difficult, as they often try to hide their actions. Physical signs may include unexplained cuts, burns, or bruises, typically on areas that are easy to conceal, such as the arms, thighs, or abdomen.

Self-harm can also be accompanied by emotional and behavioural changes. Teens may experience sudden mood swings, become more withdrawn from family and friends, or become unusually secretive about their activities. A decline in academic performance, a loss of interest in hobbies, or changes in eating and sleeping habits can further signal their distress.

Parents should be attentive to statements that reflect self-criticism, hopelessness, or guilt, as these feelings are often linked to self-harm. Identifying these signs early and responding with care can make a difference in a teen’s path to recovery.

How can I provide support to a teen who self-harms?

Supporting a teen who self-harms requires empathy, patience, and a non-judgmental attitude. It’s crucial to create an environment where the teen feels safe to open up without fear of punishment or dismissal. Start by gently initiating conversations, for example, by saying “I’ve noticed some changes and just want to check in to make sure you’re okay.”

Listening attentively, without interrupting or rushing to offer solution, is essential. Acknowledge their pain and validate their feelings by saying something like, “I’m really sorry you’re feeling this way. It’s okay to feel overwhelmed sometimes.” Avoid minimising their experiences or reacting with anger, as this can push them further into isolation.

Encourage the teen to seek professional support, reassuring them that asking for help is a sign of strength, not weakness. In the meantime, suggest healthier coping strategies like journaling, drawing, or engaging in physical activities to help them manage their emotions.

What immediate steps should a GP take if a teen discloses self-harm?

GPs play a vital role in ensuring a teen’s safety and supporting their recovery. The first step is conducting a comprehensive assessment of the situation, which includes understanding the frequency and severity of the self-harm, identifying any underlying mental health conditions, and assessing the risk of suicide.

GPs should provide immediate care for any physical injuries caused by self-harm. Beyond addressing physical health, offering a safe and non-judgmental space for the teen to share their feelings is essential. Validating their distress and reassuring them that help is available can make a significant difference.

Referrals to mental health services is a key aspect of the GP’s response. Evidence-based therapies, such as cognitive behavioural therapy (CBT) and dialectical behaviour therapy (DBT), are highly effective in helping teens build healthier coping mechanisms and address the root causes of self-harm. In certain situations, family therapy may also be helpful.

In cases where the teen’s self-harming behaviour presents an immediate risk to their safety, GPs should work with emergency mental health services to provide urgent intervention. Developing a safety plan that identifies triggers and lists emergency contacts can reduce the risk of future harm.