As a resource for parents and young adults, Shepherd’s Hill Academy values our partnerships in addition to the support that we provide. Preventing teen self-harm begins with talking to your teens and finding solutions to help guide these important ongoing conversations. We’ve asked our partners at The University of Southern California for their guidelines and advice for beginning these conversations, recognizing signs of self-harm, and the next steps should you and your teen require support. Shepherd’s Hill Academy offers therapeutic, faith-based solutions to support teens and their families.

Self-harm may be difficult for others to understand, but for the person engaging in these behaviors, it represents a way to cope. Those who struggle with mental health issues — including depression, addiction, and suicidal thoughts — may be at risk for self-injury.

Defining Self-Harm

In Preventing Self-Harm: What You Should Know if You Want to Offer Help, created by the online Master of Social Work program at the University of Southern California, adjunct professor Susan Lindau describes self-harm behaviors as a straightforward act to “find temporary relief from mental anguish.” Landau says that it decreases psychic pain through the tangible sight and feel of physical injury.

Authors reviewing about 20 studies on this subject identified four overarching functions of self-harm, as defined by the individuals engaging in these acts:

  • To obtain release or relief from a burden or intense feeling.
  • To gain control over and cope with difficult feelings.
  • To represent unaccepted feelings.
  • To connect with others.

Self-harm has been classified a number of ways, but many experts refer to it as nonsuicidal self-injury (NSSI), which means someone is deliberately injuring or damaging their body without intending to commit suicide. Common forms of NSSI include:

  • Cutting
  • Scratching
  • Burning
  • Biting
  • Carving
  • Hitting
  • Punching
  • Headbanging

People who engage in these behaviors may feel the same physical and psychological pull as those who have addictive behaviors toward substances such as drugs, alcohol, and food.

In a 2018 study, researchers used CDC data to examine NSSI among high school students in the United States found that about 18% of high school students engaged in NSSI in the past year, with the prevalence higher among girls (23.8%) than boys (11.3%). They also identified associations between NSSI and these specific health risks for high school students:

  • Drug and alcohol use
  • Fighting
  • Cyber-bullying
  • Being forced to have sex
  • Identifying as a sexual minority
  • Depression
  • Suicidal thoughts, making suicide plans and suicide attempts

Treatment Options

Fortunately, there are a variety of treatment options for those who are engaging in NSSI, which are based on understanding what function NSSI serves for the individual. For adolescents, there isn’t a one-size-fits-all approach, since treatment must be tailored to individual needs. The first step is to assess the underlying issues, address any mental health disorders that may be present and help individuals find healthier ways of coping. A common treatment option is some form of psychotherapy (i.e., “talk therapy or psychological counseling”), which can help an individual to do the following:

  • Identify and manage underlying issues that trigger self-injuring behavior.
  • Learn skills to better manage distress.
  • Learn how to regulate emotions.
  • Learn how to improve self-image.
  • Develop and improve relational skills.
  • Develop healthy skills for problem-solving.

The Mayo Clinic lists different types of individual psychotherapy that may be helpful, including:

  • Cognitive-behavioral therapy (CBT), which helps an individual identify and replace unhealthy beliefs and behaviors with those who are adaptive and support health.
  • Dialectical behavior therapy, which is a type of CBT that teaches behavioral skills to help someone better tolerate distress, manage emotions and improve relationships.
  • Mindfulness-based therapies, which help individuals live in the present to improve general well-being.

Family or group therapy is also an option. Medications may be prescribed, too, but usually only to treat an underlying mental health disorder. If someone is severely or repeatedly injuring themselves, psychiatric hospitalization may be recommended.

Another option may be a therapeutic residential care program, where individuals stay on-site and receive support and participate in various therapeutic modalities. An example of such a program is Shepherd’s Hill Academy, which is geared specifically for troubled teens and staffed by a variety of clinical experts. A program overview provides further details.

Shepherds Hill Academy offers a high-quality combination of strategies with our healing approach. Here’s a brief list of what Shepherds Hill Academy provides:

  • State-licensed therapeutic wilderness component.
  • One-on-one office therapy, group therapy, and equine therapy.
  • On-campus fully accredited academy, certified teachers and teacher’s aides.
  • 24/7 year-round care with a 5-to-1 student-to-staff ratio and an on-campus nurse during office hours.
  • Gender separated with gender-specific staff, classrooms and wilderness sites.

While the program structure is based on a Christian worldview, the directors underscore the fact that “every teen is loved and treated with equal respect and dignity—regardless of their faith.”

How You Can Help

Although self-harming behaviors require professional help, there are things you can do if you see or suspect that someone you care about is engaging in self-injury. Lindau recommends the following strategies:

Improve communication. 

  • Encourage the individual to talk with someone about what’s going on. That may be you, a therapist, an online resource or support hotline.
  • Pry if you’re a parent. Instead of ignoring your instincts, inquire without asking why, which usually puts someone on the defensive. Though a hostile response may be expected, Lindau recommends statements such as:
    • “I’m worried about you. Let’s talk about what’s going on.”
    • “I may be a worrywart. Tell me what’s going on.”
    • “You haven’t told me as much as you usually do.”
    • “Can you show me your arm? I am afraid you might hurt yourself.”

Provide a distraction.

  • Help them replace self-harming behaviors with physically healthy behaviors, such as a brisk run or intense 20-minute workout.
  • Encourage them to practice self-care, such as taking a bath, when the urge to self-harm rears up.
  • Talk to someone or have an accountability partner who they can contact during these moments and process the situation and their thoughts.

Teach STOP:

  • Stop what you’re doing.
  • Take a deep breath.
  • Observe what it felt like to take that deep breath.
  • Proceed with what you were doing.

Practice paced breathing together. 

  • Find a quiet place and focus on measured breathing and counting in and out for 10 minutes.
  • Lindau says results are common within three minutes.

Get help.

  • If the person is an adult and the urge is overwhelming, stay with them until the urge has passed; if the urge to hurt themselves does not go away after that time, think about seeking professional help.
  • If you see blood, take them to the doctor or your nearest urgent care facility or emergency room for professional help. Remember, if a person’s self-harming behaviors are escalating and have become life-threatening, supporting them at home isn’t enough.

For additional resources, visit Preventing Self-Harm: What You Should Know if You Want to Offer Help.

Sarah Chase Webber is a senior digital PR Coordinator for 2U, Inc. Sarah Chase supports community outreach for 2U’s education, social work, and library science programs.