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Why do adolescents and young people harm themselves?

About 18% of adolescents in Western countries inflict non-suicidal self-harm at some point in their lives

Self-inflicted injuries are a public health problem
Self-inflicted injuries are a public health problem. Fabian Sommer (Picture Alliance/Getty Images)
Enrique Echeburúa

It is disconcerting that many adolescents, particularly girls, inflict self-harm repeatedly without any explicit intent to commit suicide. The most common methods involve using blades or scissors to cut their arms, wrists and thighs, lighters to burn themselves, or their fingernails to make deep scratches. Some may sometimes bang their heads or fists against walls hard enough to cause extensive bruising. Most of this happens in the privacy of their bedrooms. Girls are more likely to create surface wounds on their legs and arms, while boys are more apt to engage in aggressive acts, like burning and beating themselves.

During the developmental years of adolescents in Western nations, approximately 18% intentionally harm themselves without having suicidal ideations. In countries like Spain, this has become a pressing public health concern. According to the Ministry of Health, hospitalizations resulting from self-harm among 10 to 24-year-olds have more than tripled over the past two decades, reaching 4,048 in 2020, up from 1,270 in 2000.

Explaining why people engage in non-suicidal self-harm can be difficult. Those who engage in this behavior often seek relief from negative emotions like anxiety or anguish, or simply to experience something new. It’s a pathology of self-harm used to regulate emotional pain. Adolescents may do this to express emotions such as rage, anger, guilt, or loneliness. These emotions are typically triggered by hostile or negative thoughts, followed by physical symptoms such as an increased heart rate and an impulse to self-harm.

The underlying reason for self-harm in adolescents is often a feeling of loneliness and helplessness. They feel their emotional struggles and daily problems are not being taken seriously by those closest to them. The pain they inflict on themselves is a way to express their psychological suffering. It can also be a form of self-punishment, for instance, because of a poor body image and low self-esteem. It may be an attempt to atone for perceived wrongdoing. Self-harm offers temporary relief and the illusion of control over emotions, but it’s a desperate plea for urgent help and support from family or society.

It’s alarming that certain young individuals, while in a dissociative state, don’t feel physical pain but find self-harm pleasurable. Unfortunately, this aberrant mode of self-regulatory behavior can become addictive, leading to an escalation in intensity and frequency. In severe cases, they’ll experience irresistible urges to hurt themselves and increase the severity to achieve the same relief. The addictive components of self-injury and the clinical damage it causes are indicators of addiction severity.

There are often specific reasons causing this type of behavior. Adolescents with eating disorders may be doing it to mitigate feelings of guilt for overeating or for the suffering they cause their parents. Other young people, especially those who have suffered traumatic events, may feel an existential emptiness and hurt themselves just to feel alive.

“Stressful situations can trigger youths with emotional instability.”

Self-harm in adolescents may stem from a desire for attention, often when their family lives are unhappy, or to cope with stress from bullying and online game addictions. Emotional instability leads to harmful acts that provide temporary stress relief. Mental health struggles can stubbornly persist until comprehensive help is sought.

Self-harming behavior emerges more frequently among adolescents struggling with low self-esteem or underlying clinical conditions like borderline personality disorders, eating disorders, autism and substance abuse. Furthermore, feelings of loneliness or a perceived lack of support may also act as catalysts for this behavior. In short, stressful situations can trigger youths with emotional instability.

The rise in self-harm among vulnerable adolescents is partly due to the unrestrained use of the internet, specifically the sharing of explicit images on Instagram and other social media networks. This type of content can have a contagious effect, prompting others to replicate the behavior they saw on the internet. When young people, particularly those with large followings, cut themselves and share the photos or videos on social media, it motivates others to copy them.

Although self-harm and suicidal gestures can often be confused, they are two different things. Self-harm is a coping mechanism in response to emotional turmoil such as anger and despair. Suicidal gestures, on the other hand, stem from repeated suicidal ideation, overwhelming feelings of hopelessness and a persistent desire to die. Self-harm methods are usually less severe and not typically fatal.

While self-harm isn’t inherently intentional, it can be a precursor to suicide. This is especially true for individuals with depression, or a family history of psychiatric problems and suicide. Psychological help can offer tools for coping with stress, emotional regulation, and problem-solving. It’s also important to cultivate healthy habits and establish a strong family and social support network. Ultimately, the key is identifying sources of stress and using adaptive psychological resources to overcome emotional struggles.

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