Rethinking Self Harm

A new CDC report raises urgency about a generation of struggling youth. CDC data on American teens released in February 2023 reported that “almost all indicators of health and well-being including experiences of violence, mental health, and suicidal thoughts and behaviors worsened significantly.” Clinicians who work with young people tell us that self-harming can be one sign that a teen is struggling—but what does it mean, and what can we do to help?

It’s scary when a loved one self-harms. It can be easy to jump to the conclusion that your loved one may be considering suicide. But that may not be the case, says Dr. Jeff LaPratt, senior psychologist at The Retreat by Sheppard Pratt. “Someone self-harming does not mean they are suicidal; one does not equal the other.” 

Why do people self-harm? Who is most at risk for self-harm?

Clinicians see self-harm across all age groups, but the largest percentage of those who self-harm are teens and young adults. “During the teenage years, the brain is still developing. Emotions are experienced in a heightened way. Social pressures and pains have a higher degree of influence,” LaPratt says. Because teens feel emotional highs and lows with such intensity, self-harming behaviors can act on regulating these emotions in the absence of healthy regulating skills. 

“On top of age,” LaPratt continued, “depression, anxiety, trauma, and social rejection can be risk factors. The first step in treatment is to understand what factors are leading to the impulse and behavior.” The function of self-harm can differ depending on what someone is going through. 

Common reasons people self-harm

• To manage unbearable emotions—physical pain can distract from emotional pain
• To help regain a sense of feeling—for those experiencing numbness
• To relieve stress and pressure
• To feel in control
• To ground oneself when experiencing dissociation—a temporary feeling of separation from your thoughts, actions, surroundings, and even memories
• An attempt to cope with trauma
• A lack of healthy emotional understanding and regulatory skills

Treatment for people who self-harm

“The core of treatment is creating a safe, supportive environment where a person can express their feelings without adverse consequences. I, as a clinician, want to form an alliance with my patient,” LaPratt explained. 

Clinical therapies might include:

• Cognitive behavioral therapy (CBT), where a clinician focuses on helping a patient recognize negative thoughts, emotions, and behaviors in order to increase coping skills
• Dialectical behavior therapy (DBT), where a clinician teaches a patient that life does not exist in black and white and helps them learn new ways of thinking and behaving
• Psychodynamic psychotherapy, where a clinician helps a patient identify how negative behaviors began and how to stop them by addressing their root causes 

As a specialist in DBT, Dr. LaPratt often begins by understanding behaviors with a behavioral chain analysis: “We don’t just assume that we know the motivation for the behavior. We seek to break down the behavior and understand what the triggering event was. If we then understand the chain, we can treat what is happening at every link in that chain. We want to find ways for the person to get what they are seeking—relief, distraction, feeling, etc.—from healthy habits and coping skills.”

DBT, LaPratt continues, is an especially effective treatment for individuals who self-harm. “It asks, how do we accept that we have difficult emotions sometimes, and change the way we respond to them?” 

The skills of DBT include:

• Mindfulness, which teaches acceptance and changes how we relate to thoughts and emotions
• Distress tolerance, which helps us tolerate intense emotions when we are in crisis
• Emotional regulation, which helps us change unwanted or ineffective emotions, and 
• Interpersonal effectiveness skills, which help us communicate our feelings, wants, and needs

What does society need to recognize about self-harm? 

Self-harm is sometimes judged as a way to gain attention. While this isn’t always the case, Dr. LaPratt emphasized that not everyone knows how to ask for help or believes they deserve help. Seeking attention is not a bad thing, he says; “It is a human need. We have to not stigmatize or judge that but teach healthy and effective skills for doing so.” 

Self-harm can be difficult to see. It can cause shame and guilt. “There is often a desire to hide the behavior—and to hide mental health concerns in general. Being open and nonjudgmental, having curiosity for how someone is feeling, will help someone who is self-harming feel they can be honest about their struggles.” 

If you are concerned about someone in your life who may be engaging in self-harm, begin by taking the focus off the behavior itself. Shift your focus to understanding the experience that person is having. Create a safe space where someone can speak freely without fear of negative consequences. And then just listen, LaPratt says. Reach out for help. And take care of yourself as well: “Having a child going through this is extremely difficult for the caregiver too. There can be a lot of blame that goes around. We need to let go of the blame ,” he says.

Self-harm does not exist in a vacuum. If we reserve judgement and work to destigmatize the behavior itself, we can help those who are suffering to reach out for help. “There are a lot of really great therapists out there who know what to do, who can and want to help,” LaPratt says. “There is hope.”

If you or someone you know is struggling with self-harm, visit our Psychiatric Urgent Care or call Sheppard Pratt’s care navigators at 410-938-5000.