If you have a teen who harms themselves intentionally – a behavior called non-suicidal self-injury (NSSI) by mental health professionals – you might feel confused, helpless, and hopeless. It’s disturbing to realize your adolescent is hurting themselves on purpose. It’s even more painful to realize there’s not much you can do to control it, short of placing them in a residential (RTC), partial hospitalization program (PHP) or intensive outpatient treatment program (IOP) for teens.

Research, however, shows their behavior may come from an unlikely source: their friends.

A paper published in 2013 in The Archives of Suicide Research –  “The Impact of Social Contagion in Non-Suicidal Self Injury: A Review of the Literature” – analyzed dozens of peer-reviewed journal studies to understand how adolescents influence each other to engage in self-harming behavior. The researchers found that, like suicide, adolescents who self-harm tend to do so if those in their peer group are doing it. This is called the social learning or imitation theory.

Understanding this theory can help parents understand – intellectually if not emotionally – some of the reasons teens may begin to harm themselves.

Why do Teens Self-Injure?

In the words of the study authors:

“Although the maintenance of NSSI is most likely due to reinforcement contingencies that develop over time…the initial engagement in NSSI may be particularly influenced by social contagion factors.”

In layman’s terms: the first time a teen cuts or harms themselves, they’re often mimicking what their peers are doing. They keep self-harming because it turns into a habit that feels good. Eventually, the behavior can turn into a chronic maladaptive coping mechanism that functions to release pain, alleviate stress, or distract from problems.

“Self-harming is not a natural thing to do,” adds Lisa Faguet, Clinical Program Director at Evolve Treatment Centers for teens in Agoura Hills, California. “It becomes a normalized behavior because they see so many of their friends doing it.”

The study found that teens learn self-harming behaviors from another source, aside from their friends: online media. Posts on social media and threads on online messaging boards like ASKfm or Reddit often glorify these maladaptive behaviors.

More Facts about Self-Harm Among Teens

Research over the last twenty years presents a disturbing picture: non-suicidal self-injury in the adolescent population appears to be increasing. Studies from 2000-2005 estimate the rate of NNSI among US teens at around 14%-20%. More recent research indicates that around 60% of teens in the US report at least one instance of NNSI, while around 50% report repetitive NNSI. This can include cutting, scratching, burning, or others form of self-harm.

Teens with the following disorders, and/or teens with the following experiences, are more likely to engage in NSSI:

• Depression
• Anxiety
• Emotional dysregulation
• Abuse
• Trauma
• Substance use disorder
• Eating disorder

Keep in mind that not all teens diagnosed with these disorders or have these experience will engage in NNSI.

What Should I do if my Teen is Self-Harming?

If your adolescent engages in NSSI, you need to get them help as soon as possible.

The first step is to see a mental health professional for a full assessment. After the assessment, the therapist or psychiatrist may recommend treatment in a residential treatment center (RTC), a partial hospitalization program (PHP), or an intensive outpatient program (PHP).

Residential treatment is for teens who need total immersion in a full-time treatment setting right away. In treatment language, RTCs are for high acuity teens. This means their condition is urgent, and if they don’t get help as soon as possible, it could escalate and lead to more dangerous patterns of behavior, including suicidal ideation (SI) or suicide attempts (SA).

Note: it’s important to understand that teens who engage in NSSI do not always escalate to suicidal ideation or suicide attempts. However, NSSI is a significant risk factor for both SI and SA.

In a residential treatment center, your adolescent will learn coping strategies and distress tolerance skills to replace their self-harming behavior. RTCs for teens provide 24/7 treatment and round-the-clock monitoring and support.

Partial hospitalization programs (PHP) or intensive outpatient programs (IOP) are appropriate for teens with lower acuity. That means they need help right away, but are stable enough to live at home with their parents. Teens in PHP and IOP programs learn the same coping skills and distress tolerance techniques that teens in RTCs do.  The real differences are the time spent per day receiving treatment and where they live. Teens in PHP or IOP live at home, whereas teens in RTC live at the treatment facility.

What if My Teen’s Friends are Self-Harming, Too?

The short answer: tell their parents and remove your teen from that particular peer group. Whether they return to that peer group depends on what happens during treatment.

The longer answer: when you look for support for your teen, make sure you find a mental health treatment program that offers strong discharge planning and a solid, realistic aftercare program. Effective discharge planning reduces the likelihood of relapse – in this case, relapse means a return to self-harming behavior.

During the discharge planning process, your child’s therapist will discuss with your teen what their social network will look like once they return home. Since research shows friends can influence teens to engage in maladaptive behavior like NSSI, your teen’s therapist will teach ways for your teen to distance themselves from their old peer group and make new friends that don’t engage in or encourage maladaptive behavior.

That way, when your teen returns home or finishes their PHP or IOP program, they’ll have the tools to live life on their own terms.