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Self-Harm During Adolescence: Understanding and Addressing the Challenges

Writer's picture: dr.ssa Elizabeth Mooredr.ssa Elizabeth Moore

Adolescente triste che si guarda allo specchio, riflettendo su se stessa, con espressione pensierosa e malinconica. La scena evoca un senso di solitudine e introspezione, rappresentando un momento di vulnerabilità emotiva

Adolescence is a period of significant emotional, physical, and psychological changes. It is a transitional phase where individuals explore their identities, experience intense emotions, and seek to balance independence with relationships. During this time, some adolescents engage in self-harming behaviors as a way to cope with emotional pain and psychological challenges. Self-harm during adolescence is a phenomenon that can have serious consequences and requires a careful and targeted approach.


Diagnosis and the DSM

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), self-harm is often categorized under Non-Suicidal Self-Injury (NSSI). This disorder is characterized by the intentional infliction of harm on one’s body without suicidal intent, typically as a means to cope with painful emotions or situations. Common forms of self-harm include cutting, burning, and head-banging.


Causes of Self-Harm

The causes of self-harm in adolescence are complex and vary from person to person. Generally, these behaviors are an attempt to manage or express overwhelming emotions that cannot be processed in a healthy way. Key contributing factors include:

  1. Emotional Stress and Anxiety: Difficulty managing emotions such as anger, sadness, loneliness, or frustration.

  2. Relational Problems: Struggles in family, school, or peer relationships can intensify the desire to self-harm.

  3. Trauma and Abuse: Experiences of physical, emotional, or sexual abuse may lead adolescents to self-harm to “feel alive” or as a form of self-punishment.


Why Do Adolescents Engage in Self-Harm?

Self-harm manifests in various ways and for different reasons:

  • As a Form of Punishment: Adolescents may use self-harm to punish themselves for perceived mistakes or failures.

  • To Seek Attention: In some cases, self-harm is a way to attract attention or provoke a reaction from others, hoping for support or understanding.

  • To Escape Emotional Pain: Physical pain can serve as a distraction from psychological distress.

  • To Feel Alive: Self-harm can help overcome feelings of emptiness or emotional disconnection, allowing adolescents to experience intense sensations.


Risk Factors

Several factors increase the risk of developing self-harming behaviors:

  1. Dysfunctional Family Dynamics: Family conflict, separations, or lack of emotional support can contribute to self-harm.

  2. Shyness and Social Difficulties: Adolescents with social anxiety, loneliness, or low self-esteem are more vulnerable.

  3. Bullying and Discrimination: Being a victim of bullying or other forms of psychological or physical abuse heightens the risk.

  4. Psychiatric Disorders: Conditions such as depression, anxiety disorders, eating disorders, or borderline personality disorder are often associated with self-harm.


The Adolescent’s Perspective on Self-Harm

Adolescents often have an ambivalent relationship with self-harm. On one hand, they may feel shame about their behaviors and attempt to hide the wounds or scars to protect their privacy and image. On the other hand, some may intentionally display their injuries as a way to seek recognition or help, drawing attention to their struggles.


The Parental Perspective on Self-Harm

Parents discovering their child’s self-harming behaviors often experience guilt, confusion, and frustration. They may feel helpless when faced with a behavior they struggle to understand, worrying about their child’s safety and well-being. Some parents react with anger or denial, while others seek professional help to address the situation.


Self-Harm and Suicidal Behavior

While self-harm is not inherently a suicidal act, there is a correlation between self-harming behaviors and the risk of suicidal tendencies. Adolescents who self-harm are more likely to develop suicidal thoughts or attempt suicide, especially if they do not receive adequate treatment. The line between self-harm and suicide attempts can be thin, and the risk increases if emotional pain is not effectively addressed.


Treating Self-Harm

The treatment of self-harm in adolescence is complex and multifaceted. Key approaches include:

  1. Cognitive Behavioral Therapy (CBT): Helps adolescents identify and modify dysfunctional thoughts and emotions that trigger self-harm.

  2. Dialectical Behavior Therapy (DBT): Focuses on improving emotional regulation and interpersonal skills.

  3. Family and School Support: Involving the family and school ensures a supportive and understanding environment.

  4. Psychoeducational Interventions: Teaching adolescents alternative coping strategies for managing emotional pain in a healthier way.


Conclusion

Self-harm in adolescence is a complex phenomenon reflecting an internal struggle with difficult emotions and painful life situations. Although self-harm is not suicidal behavior, it is important to recognize its close relationship with the risk of suicidal tendencies. Early and targeted intervention involving the adolescent, their family, and their school environment is essential to help young individuals develop healthier coping strategies. Adequate psychotherapeutic support, such as CBT or DBT, can play a crucial role in improving emotional well-being and reducing self-harming behaviors. Awareness and open dialogue among adolescents, parents, and professionals are fundamental to effectively prevent and address this behavior.




 Written by

Dr Elizabeth Moore, Psychologist

(consultation only in Italian)

 

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Bibliography


  • L'adolescente e il dolore psichico: Comprendere e affrontare il malessere psicologico dei giovani, di Massimo Ammaniti

  • Il dolore invisibile: Adolescenti, autolesionismo e disturbi emotivi, di Anna Maria Giannini

  • Quando il dolore diventa gesto: L'autolesionismo tra adolescenza e giovinezza, di Gabriella Fabbri


External resources

If you wish to explore the topic of psychological manipulation further and find relevant articles and studies, consider these important academic and institutional resour


  1. Mind – UK

    Mind è una delle principali organizzazioni di supporto per la salute mentale nel Regno Unito. Offre risorse educative, supporto psicologico e informazioni per chi è coinvolto in comportamenti autolesionistici.


  2. National Self-Harm Network (NSHN)

    Un'importante rete di supporto per chi affronta l'autolesionismo, che fornisce risorse, linee guida e consigli pratici per le persone che si autolesionano e per i professionisti che le supportano.


  3. Associazione Italiana Disturbi del Comportamento Alimentare (AIDCA)

    Sebbene si concentri principalmente sui disturbi alimentari, l'AIDCA offre risorse utili anche per chi si occupa di autolesionismo e altre problematiche psicologiche in adolescenza.


  4. Ospedale Bambino Gesù - Autolesionismo e adolescenza

    L'Ospedale Bambino Gesù di Roma offre articoli e risorse specifiche per genitori e professionisti sulla gestione dell'autolesionismo in adolescenza, con un focus sui trattamenti e sulle terapie psicologiche.


  5. Ministero della Salute - Salute mentale adolescenziale

    Il sito del Ministero della Salute italiano fornisce informazioni e risorse per comprendere e trattare i disturbi psicologici degli adolescenti, inclusi i comportamenti autolesionisti.

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