Ask an expert: Self-harm in teenagers

This video and article discuss self-harm. If you feel like your teen or another young person in your life is at risk of serious harm, call 000. For other crisis support services that are available to them, visit our urgent help page.

If your teen is self-harming, or you’re worried that they are, it can be really difficult to process. You might feel overwhelmed, unsure of what to do or afraid that you’ll say the wrong thing. 

Understanding what self-harm is and why teenagers turn to it is a good first step. From there, you can explore practical ways to support your teen while also looking after yourself. 

To help, we spoke with clinical psychologist Nasalifya Namwinga, who shares her expert insights and advice.

Video transcript.

What is self-harm?

Self-harm is when someone intentionally physically hurts themselves, but without wanting to end their life. For most teens, it’s a way to cope with really painful or difficult emotions and feelings. 

Self-harm can take many forms, such as:

• cutting, scratching, burning, biting or picking at the skin

• hitting oneself and/or pulling out hair

• using drugs or alcohol in a way that causes harm to the body

• deliberately fasting or bingeing to cause harm to the body.

Why do young people self-harm?

Teens might self-harm for a range of reasons, and it’s different for everyone. As Nasalifya says, it’s often a way for them to cope with or to express intense feelings and emotions such as anger, guilt, sadness, shame or self-hatred. 

Teens may also self-harm as a way to:

• communicate a need for support

• seek immediate relief 

• regain a sense of control when things feel overwhelming

• prove to themselves that they aren’t invisible

• punish themselves for feelings of shame or guilt

• feel something when they’re emotionally numb.

While self-harming behaviour doesn’t have a single cause, it’s often linked to common underlying issues such as:

• bullying in or out of school

• mental health challenges

• relationship issues or breakdowns

• study stress or performance stress

• past experiences of trauma or abuse.

A common misconception is that teens who self-harm want to end their life. While some teens may have thoughts of suicide alongside their self-harming behaviour, it’s not the same as a suicide attempt. However, it can still put them at risk of causing serious harm.

Is self-harm just a way to seek attention?

A common myth is that teens self-harm just to get attention, but this isn’t true. Self-harm is often a deeply private way of coping with overwhelming feelings and emotions, and many teens go to great lengths to keep it hidden. 

Even if a teen does want someone else to notice, this usually means they're struggling, need support or don't know how else to ask for help. So, instead of assuming it’s attention-seeking, it’s important to approach them with empathy and understanding. 

What are the signs my teen is self-harming?

Because teens often keep their self-harming behaviour hidden, it’s not always easy to spot. You might notice physical and emotional signs, but it’s more likely that you’ll see changes in their behaviour.

Physical and emotional signs of self-harm

• Frequent, unexplained injuries (cuts, sores, bruises, burns)

• Feeling sad, angry or irritable

• Feeling frequently sick or unwell

• Feeling guilty or ashamed

• Being less energetic

• Appearing pallid

• Putting less effort into their hygiene or appearance

Behavioural signs of self-harm

• Wearing long-sleeved clothes, even in hot weather

• Hiding clothes or washing them separately from the family’s wash

• Being secretive about their room or possessions

• Creating unusual excuses for injuries

• Withdrawing from friends, family and social events

• Losing interest in school, hobbies or activities

• Avoiding swimming or other activities where their skin is exposed

• Changing their eating, sleeping or communication habits

What can I do if my teen is self-harming?

Nasalifya suggests four key steps in supporting your teen.

1. Start with communication

Create a safe space where your teen feels comfortable opening up, without fear of being judged, ridiculed or told what to do. Let them know they’re not in trouble, and that you’re not angry with them or ashamed of them – you’re simply there to listen and to support them. Nasalifya suggests a few helpful conversation starters:

• Lead with empathy. ‘I can imagine this isn’t easy for you to talk about right now, so thank you for telling me.’

• Seek understanding. ‘I want to understand what it means to you and what I can do to support you through this.’

• Check in. ‘How do you feel talking about this?’

• Follow up. ‘When we talk next time about how you’re doing, is there anything I can do to make the conversation easier?’

If your teen is resistant to speak about what’s going on with them, becomes emotional or switches off from the conversation, you could encourage them to speak with someone else they trust – whether that’s another family member, a teacher or a counsellor.

2. Seek professional support

The next step is to connect your teen with a GP or mental health professional. They can help your teen better understand why they’re self-harming and learn new skills, strategies and therapy approaches for managing their urges.

If your teen wants to talk to someone straight away (or prefers not to do so face-to-face), they could try calling a helpline or using an online chat support service. These services are free and confidential, and have trained people there to listen and help:

• Lifeline – call 13 11 14, text 0477 13 11 14 or use the Lifeline online chat.

• Kids Helpline – call 1800 55 1800 or use the Kids Helpline online chat.

• 13YARN (for Aboriginal and Torres Strait Islander people) – call 13 92 76 or visit the 13YARN website.

3. Encourage positive coping strategies 

Nasalifya suggests encouraging your teen to use distraction activities. The idea is that these can provide your teen with an alternative activity to focus on until their self-harm urges become less intense and are easier to resist. 

Examples include activities such as gaming, watching movies, playing music, creating art, journalling, or whatever else interests them. If your teen feels unsure, you can even try some activities together to find something that works.

Learn about more coping strategies for avoiding self-harm. And remember, working with a professional is a great way for your teen to build strategies that work best for them. 

4. Seek emergency support if needed

You may find yourself in a situation where you need to access emergency or crisis support. In this case, it’s best to approach the situation as calmly as possible. Ensure that you don’t come across to your teen as angry or frightened. Provide first aid if needed and seek additional medical care when necessary.

How do I look after myself during this process?

Supporting a teen through self-harm is important, but you can’t pour from an empty cup. Taking care of yourself matters too. Here’s what Nasalifya suggests:

• Acknowledge your feelings. It’s completely normal to feel upset, scared or unsure of what to do. Recognising your feelings can help you to process them in a healthy way.

• Set boundaries. You don’t need to have all the answers or to ‘fix’ everything right away. Be patient and give yourself permission to take breaks when things feel overwhelming. 

• Prioritise self-care. Whether it's going for a walk, journalling or catching up with friends, take time out for self-care activities that help you to feel recharged and more prepared to support your teen.

• Build your team. You don’t have to do this alone. Reach out to people who can support, guide and encourage both you and your teen – good friends, family members, people from your community, or professionals such as a GP or counsellor.