What is self-harm and how can parents spot the signs?

The dangerous practice of self-harm is something teens might be more familiar with than parents at this point. That’s due in part to a flurry of recent depictions in the media, including on streaming shows Euphoria, Dead to Me and Ginny & Georgia, on which the teen main character, who burns her skin with a flame when life gets too stressful, chillingly explains, “Of course I hurt myself. When you don’t have a voice, you have to scream somehow.”

And then there’s social media — particularly Twitter, filled with triggering images, and TikTok, which, a recent report found, has an algorithm that appears to push self-harm (and eating disorder) content to 13-year-olds within a half hour of their accounts being launched. (Though, TikTok notes, “We do not allow content depicting, promoting, normalizing or glorifying activities that could lead to suicide or self-harm … We will not show self-harm related content when searching related terms.”)

“There have been quite a few of our clients who comment on the impact of social media,” says Leigh McInnis, a licensed professional counselor and the executive director for the Virginia location of Newport Healthcare, a teen mental-health in-patient treatment program. “Especially when you’re in a negative state of mind and you see these little 15-second clips where someone is actively self-harming or talking about scars… Even if they’re recovering, there’s still this fantasy around it: ‘This worked for them … How can I be like them?’”

Says psychologist Barent Walsh, a pioneer in the field of treating self-harm, “I think it has been going on for centuries, but social media and other media has publicized and, in some ways, sensationalized self-injury, and because of that, more people learn about it and some experiment.” Some of this publicizing tends to “glorify, encourage and post incredibly triggering content, such as photographs or videos,” he says, and “one of the reasons it’s an epidemic in the U.S. and other countries is certainly social media and other media.”

And self-harm is an epidemic, Walsh tells Yahoo Life, pointing to 2018 data which found that over 30,000 adolescents had self-injured at least once in the past year; prevalence was higher among girls, with rates of at least 17% and up to 30%. An older review, of three dozen surveys from a dozen countries including the U.S., found that about one in five adolescents reported having self-harmed to ease emotional pain at least once.

“A key moment is if someone tries it,” says Walsh. “If it relieves emotions, they say, ‘Oh wow, that works,’ or they say, ‘that hurts,’ and they don’t do it again.”

Who self-harms and why?

Self-harm, known by clinicians as non-suicidal self-injury (NSSI), and sometimes diagnosed as non-suicidal self-injury disorder, it is the “intentional hurting of one’s self for a function other than ending one’s life,” McInnis tells Yahoo Life. It can take many forms, including cutting, burning, scratching, biting and picking at hair or skin, with the behavior largely seen in females and non-Hispanic white individuals, with the highest risk present in ninth grade.

But anyone of any age can self-harm, says Walsh, who notes that it is typically a person 12 or older, and that “the younger it starts, usually the more ominous the course.”

As a practitioner, Walsh says he first encountered self-harm in adults, in 1975, when he worked at a state hospital. “I was encountering people with a much greater level of disturbance,” he recalls of this early experience, and he became haunted by a question: “Why would somebody deliberately cause themselves bodily harm when we are wired to be self-protective?”

The answers are varied and complex, but are most often about the self-regulation of emotions, he says, referring to what psychologist Joseph Franklin calls “pain offset relief.” The area of the brain that manages physical pain, Walsh explains, “overlaps considerably with the area that manages emotional pain. When you physically hurt yourself and then stop, the brain is tricked, and it relieves emotional pain at the same time.”

So, people who do this “aren’t crazy,” he says, but are “using something that works to reduce emotional pain, but comes with wounds, scarring and people’s reactions.”

McInnis cites various other reasons that can be behind self-harm, including to “relieve numb or empty feelings, as a lot of people who struggle with depression or dissociation may create a sense of pain to counter that numbness.” Self-injury maybe also “gives a sense of control,” she says, can be a form of “self-punishment” or could be a way “to protect from suicidal thoughts — because maybe they have ideation but utilize self-harm to prevent taking it to the extreme.”

Finally, “there’s a stigma where people will assume there’s an attention-seeking function,” and that’s often not the case; but even when it is, she says, “that’s valid.” To that end, causing self-injury could be used to avoid social interaction or punishment or school, or in place of clearly “communicating the need to receive support or attention,” says McInnis, who stresses, “It is an act of desperation.”

What are signs of self-harm that parents should look out for?

In Ginny & Georgia, there is a moment when Ginny’s mom finds out that she’s been self-harming, and cries, “I’m so sorry I missed this!” But, says McInnis, “It is easy to miss.”

She explains, “When you are in your day-to-day with your family and your child, this happens, typically, as a process. It might start as intentional behavior, but it might also start as accident — they might skin their knee and, in that moment, they might get a reaction of sympathy or support or even anger, or it might distract them from something, and they associate the function with the injury and continue.” It’s a gradual progression a lot of times, she adds, “so you might not notice it as it gets worse. I definitely don’t think parents should beat themselves up over it.” Especially since kids will often go to great lengths to hide it.

As for signs, Walsh says, “It’s about tissue damage,” so parents should beware if they “start seeing, on their child, unexplained cuts, burns, abrasions, scrapes or gouges … People have accidents, and the first time, there’s a logical explanation. But if you keep seeing it, the explanation probably isn’t legitimate.”

McInnis adds that other tip-offs may include a child asking for a lot of bandages or wearing long sleeves or pants or multiple layers, even when it’s warm outside — and even to the beach.

What should a parent do if they discover their child is self-harming?

It’s important to strive for an “open and honest conversation” with your teen, says McInnis, rather than have them rely on peers or social media for information and support. “And it’s OK to ask,” flat-out, if they are harming themselves.

Then, depending on the severity of the behavior, she says, “I would definitely seek mental health support so they can have neutral party they can talk,” adding that “it’s OK to ask the therapist if they have experience” treating patients who self-harm. Goal-oriented cognitive behavioral therapy (CBT), she says, and its subset dialectical behavioral therapy (DBT), are “evidence-based approaches” to dealing with self-injurious patients.

Walsh advises, “Don’t panic about the behavior … The appropriate thing to do is to respond with a low-key, dispassionate demeanor, take your child to a professional and tell them, ‘We’ll work on this together.’ Don’t judge or yell; teach them skills or tools to manage their emotions in different ways rather than causing tissue damage.” He adds that a “key point” to remembers is that self-harm “is not about suicide, but emotional regulation … almost nobody dies from cutting.”

Finally, parents may want to pay close attention to what sort of media their kids are consuming, especially on social media but also when it comes to streaming shows, like those mentioned above. That’s because, with self-harm, notes McInnis, “There’s a huge element of social contagion.”

And so even when shows like Ginny & Georgia present “a very honest portrayal of teens looking like they are functioning well on the outside … when there’s this kind of hidden suffering,” she says, “I have a lot of concerns about people accessing that imagery without safeguards in place — without a therapist they can call if they are triggered, without a safe person they can watch with to kind of counter some of the questions that might come up. It’s just a little scary for me.”

If your or someone you know is struggling with self-harm, call or text the National Alliance on Mental Illness hotline (NAMI) at 800-950-6264 or call or text 988.

Wellness, parenting, body image and more: Get to know the who behind the hoo with Yahoo Life's newsletter. Sign up here.