Treatment for Teens Who Engage in Self-Injury But Aren’t Suicidal

When parents discover their teen engages in the maladaptive pattern of behavior mental health professionals call non-suicidal self-injury (NSSI), the first question most ask themselves is why. That’s after the initial shock fades, of course. Learning their teenage child intentionally harms themselves can be confusing and difficult to understand. The next thing they worry about is whether their teen is on the verge of committing suicide – and that’s a logical concern. However, parents of teens who self-harm need to know that while a teen who engages in self-harm is at increased risk of both suicidal ideation (SI) and suicide attempts (SA), people who engage in NSSI rarely do so with the intention to die.

That’s why we wrote this article. We’ll give parents of non-suicidal teens who engage in self-injury the following:

1. An overview of self-injury
2. A list of self-injury warning signs
3. A list of teens at-risk of self-injury
4. The prevalence of self-injury among teens
5. A list of the various types of self-injury
6. An explanation of why teens engage in self-injury
7. An example of an evidence-based treatment approach proven effective for non-suicidal teens who engage in self-injury

If you’ve recently discovered your teen engages in self-injury – but isn’t suicidal – this article will help you expand your understanding about NSSI and learn about the latest self-injury treatment programs for non-suicidal teens.

First, we’ll define what we mean when we say NSSI, self-injury, or self-harm.

What is Self-Injury?

The behavior itself is known by several names aside from its clinical designation, NSSI. You may hear it called or see it written as self-harm, self-injury, or self-mutilation. You may also encounter names that describe the specific method of NSSI, such as cutting, burning, branding, carving, scratching, and others. People often substitute these methods for the name of the behavior.

For instance, when you hear a parent say my teen is cutting/my teen is a cutter what they mean is my teen engages in non-suicidal self-injury.

Here’s how the  American Psychological Association (APA) defines self-harm:

“The condition – clinically known as non-suicidal self-injury or NSSI — is characterized by deliberate self-inflicted harm that isn’t intended to be suicidal. People who self-harm may carve or cut their skin, burn themselves, bang or punch objects or themselves, embed objects under their skin, or engage in myriad other behaviors that are intended to cause themselves pain but not end their lives.”

The primary takeaway for you is that if your teen engages in self-injury, it’s likely they do not engage in the behavior with the intent to die. In the context of a difficult situation, that can be a relief – but that doesn’t mean you should take it lightly.

NSSI is a serious behavior that reveals significant emotional issues – and any teen who engages in NSSI needs a full evaluation performed by a fully licensed and qualified mental health professional.

Self-Injury in Teens: Warning Signs and Risk Factors

If you think your teen engages in self-harm, here are six warning signs to watch for:

1. Covering their arms and legs all the time, even during hot weather
2. Bruises, cuts, or burns on their body they can’t explain or don’t have a reasonable explanation for.
3. Spending time with friends, acquaintances, or peers who self-injure
4. The absence of patches of hair, including eyelashes or eyebrows, with no explanation or no reasonable explanation.
5. Sharp objects in their room or backpack, with no explanation or no reasonable explanation.
6. Hiding in/retreating to their room during times of stress or conflict.

Please read our short article Self-Harming Behavior: Nine Warning Signs for a full list of self-injury warning signs.

If your teen engages in any of the behaviors listed above, your first step should be arranging a comprehensive evaluation with a fully licensed and qualified mental health professional. This is important, especially if your teen is considered at-risk of self-injury.

The latest research indicates the following groups are at-risk for engaging in self-injury:

• Teenagers
• Females
• Teens with friends who engage in self-injury
• Young adults
• Teens who see examples of self-injury online/on social media
• Teens with a history of early trauma

In addition, strong evidence associates the following factors with an elevated risk of self-injury:

• Diagnosis of a mental health or behavioral disorder
• Prior instances of self-injury
• Prior suicide attempts
• History of suicidal ideation
• Self-injury or suicidal behavior the family
• History of suicide in the family
• Victim of in-person or online (cyber) bullying
• Identification as LGBTQI +/non-binary/gender non-conforming

There are also specific mental health disorders commonly associated with self-injury or NSSI.

Mental Illness and Self-Injury: Common Diagnoses

• Depressive disorders
• Anxiety disorders
• Borderline personality disorder (BPD)
• Post-traumatic stress disorder (PTSD)
• Alcohol use disorder (AUD)
• Substance use disorder (SUD)
• Eating disorders
• Childhood trauma
• Physical neglect or abuse
• Emotional neglect or abuse
• Sexual abuse

Finally, here’s a list of the most common forms of self-injury:

• Cutting
• Skin carving
• Burning
• Severe abrading (scraping)
• Scratching
• Punching or hitting
• Bone breaking
• Biting
• Pinching
• Interfering with wound healing

Those are the warning signs, risk factors, and different types of self-injury. According to the most recent available data, the groups most at-risk of engaging in self-injury are teenagers (boys and girls), teenage girls, teens with a previous history of the mental illnesses identified above, and teenage girls who identify as bisexual. In fact, a comprehensive review of self-injury among college students showed that around 47 percent of college-age women who identify as bisexual report they engage in self-injury.

Now let’s take a look at how many teens in the U.S. engage in self-injury.

Self-Injury in Teens: Nationwide Prevalence

In a study published in 2018 that analyzed data from more than sixty thousand teens, scientists found that self-injury among teens is more common than most people realize. Here’s what the researchers found in their analysis:

• 17% of adolescents reported engaging in self-injury
• 11% of males reported engaging in self-injury
• 24% of females reported engaging in self-injury

A different study published in 2019 on adolescents receiving behavioral health treatment showed the following:

• 35-80% of teens in inpatient treatment reported self-injury
• 87% of teens who report self-injury had a psychiatric disorder
• Self-injury is associated with personality disorders, but not significantly associated with any specific personality disorder

We’ll translate the numbers in that first set of bullet points. Applying statistical analysis to the large sample size of sixty thousand teens allows us to make population-level estimates. By the numbers above, 17 percent of adolescents work out to around over four million teens, 11 percent of males work out over a million teen boys, and 24 percent of females work out to almost three million teen girls.

If you’re a parent reading this, what you can take away is that there are millions of families around the country who can relate – on a very real and practical level – to what you and your teen are going through.

Millions of teens engage in self-harm each year. That’s why we have the knowledge we share in the next section of this article.

Why Do Teens Engage in Self-Injury?

A study released recently called “A Meta-Analysis of The Prevalence of Different Functions of Non-Suicidal Self-Injury” offers the most up-to-date information on the reasons people engage in self-injury. This study is valuable because it’s the only meta-analysis to date that examines – from a quantitative perspective – the various reasons people who engage in self-injury say they self-injure.

Based on the data, researchers found two main reasons people engage in NSSI (self-cutting, self-harm, self-mutilation): intrapersonal and interpersonal.

Intrapersonal reasons mean a teen self-harms for reasons within themselves, while interpersonal reasons mean a teen self-harms for reasons related to other people.

Here’s what the results of this meta-analysis tell us:

Why Teens Self-injure

• 66-81% of teens self-injure for two primary intrapersonal reasons:
  • Reason 1: Emotional Regulation
    • Teens harm themselves to escape/reduce/mitigate negative emotions and thoughts
    • Teens harm themselves to induce positive emotions or thoughts
  • Reason 2: Self-punishment
    • Teens harm themselves because they believe they deserve a consequence for a behavior, thought, or emotion
  • 33-56% of teen self-injure for three primary interpersonal reasons:
    • Reason 1:
      • Teens harm themselves to communicate severe emotional and/or psychological distress
    • Reason 2:
      • Teens harm themselves to influence others to notice them, empathize with them, or take some type of action they need
    • Reason 3:
      • Teens harm themselves to punish others for perceived wrongs

This research teaches us something essential: self-injury has more to do with emotional regulation and communication of emotional distress – or communication of emotion in general – than it has to do with wanting to die.

That’s one reason clinicians think that a type of therapy designed to help teens with overwhelming, distressing, and life-interrupting emotions and patterns of thought is recognized as the most effective treatment for non-suicidal teens who self-injure.

The therapeutic approach research proves effective for non-suicidal teens who engage in self-injury is dialectical behavior therapy, known as DBT.

DBT for Teens Who Self-Injure is More Effective Than Typical Treatment

A recent study shows that the therapeutic approach known as DBT is an effective treatment for teens who self-harm. If you’re looking for a self-injury treatment program for your teen, we recommend finding a treatment center that offers DBT.

The latest study on this topic, published in January 2020, offers a strong case that any treatment center you seek for your teen should include DBT.

In comparison to a typical treatment approach, teens who received DBT showed five significant and positive outcomes:

1. They spent less time in treatment
2. When in treatment during crises, they spent less time in restraints
3. They attempted suicide less often
4. They engaged in self-harm less often
5. When in treatment, they spent less time under self-harm watch/monitoring

If you’re the parent of a teen who engages in self-injury, this information might be a game-changer. This research proves there’s an approach to self-injury that’s proven effective for teens. But why is DBT so effective for adolescents?

DBT for teens includes five core modules:

1. Mindfulness

Mindfulness helps teens be present in and accept reality as is, without judgment

2. Emotion Regulation

Learning to regulate emotions helps teens manage the rollercoaster of emotions that characterize adolescence

3. Interpersonal Effectiveness

Clinicians help teens learn how to form and maintain healthy, positive relationships

4. Distress tolerance

Clinicians teach teens the skills they need to process stress and uncomfortable emotions without maladaptive coping mechanisms such as self-injury

The Middle Path

When teens learn to walk the middle path, they understand how to find a balance between extremes, especially with regard to patterns of emotion, thought, and behavior.

DBT treatment programs are most effective for teens who need to learn to process overwhelming emotions and reduce impulsivity – two things that teens who engage in self-injury need in order to grow and heal.

The most important thing for you, as a parent, to understand is that treatment for self-injury works. Your teen can learn the skills they need to manage their emotions without harming themselves – and your family can begin to move forward with hope.

To learn more about self-harm among teens, please read this article:

Why Is My Daughter Cutting Herself? A Guide to Causes and Treatment

To learn more about adolescent mental health treatment in general, please read this article:

Choosing the Right Behavioral Health Program for Your Teen: Psychiatric Hospital, Inpatient, Residential, or Outpatient Treatment

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.