Understanding Non-Suicidal Self-Injury in Adolescents: A Therapist’s Perspective
Non-suicidal self-injury (NSSI) is a deeply painful reality for many adolescents and their families. As a therapist who regularly works with individuals struggling with self-harm, I see how profoundly this behavior impacts individuals and those who love them. NSSI is often misunderstood, leading to judgment and shame that can exacerbate the cycle - often because the people who love these individuals are scared and unsure of how to respond. This blog post aims to shed light on why adolescents might engage in self-harm, highlight the importance of compassionate support, and offer strategies to promote recovery.
Why Do Adolescents Self-Injure?
Self-injury serves as a coping mechanism for overwhelming emotional pain. Adolescents may turn to self-harm to:
Regulate intense emotions: Self-injury can momentarily alleviate feelings of sadness, anger, or anxiety.
Express what cannot be said: For some, it’s a way to externalize inner turmoil when words feel inadequate.
Feel in control: In a world that can feel chaotic, self-harm might offer a sense of agency.
Combat numbness: Physical pain can provide a stark contrast to emotional emptiness or dissociation.
Seek validation or connection: While not always the case, some adolescents may hope their injuries signal to others the depth of their distress.
The Cycle of Self-Harming
NSSI often follows a cycle:
Trigger: An event or feeling triggers overwhelming emotions.
Build-up: Tension escalates, creating a sense of urgency to act.
Self-injury: The act temporarily alleviates distress or creates a sense of release.
Aftermath: Relief is short-lived, often replaced by guilt, shame, or self-recrimination.
Repetition: The cycle repeats as new emotional challenges arise.
Understanding this cycle helps caregivers approach the issue with empathy rather than judgment.
The Difficulty of Quitting
Many times, I will speak with parents or teachers and they will shared the same sentiment: “They should be able to just STOP”. It is hard at times from a caregivers’ lens to understand why someone would continue to harm themselves. The difficult piece of stopping self-harm is that, for adolescents, self-injury can feel like an "effective" way to manage emotions, which makes it very hard to stop. In many cases, it may serve as their primary (or only) coping tool, and quitting can also feel like losing a lifeline. That’s why harm reduction—not immediate cessation—is often a critical first step in therapy.
Harm Reduction Strategies
Identify safer alternatives: Encourage sensory-based replacements like squeezing ice, snapping a rubber band, or drawing on the skin with a marker.
Safety planning: Collaborate on a plan to address triggers and outline steps to take instead of self-harming.
Increase emotional literacy: Help adolescents identify and name their emotions, fostering self-awareness and developing a better understanding of what it actually is that they are feeling that is leading to self-harm.
Teach emotional regulation: DBT skills like distress tolerance, mindfulness, and emotional regulation can help.
Building a Safety Plan
You may also find benefit in building a safety plan with your child. A safety plan is a collaborative tool for navigating moments of crisis, and it is crucial that you build this plan not just for them, but WITH them. It might include:
A list of triggers and early warning signs.
Healthy alternatives to self-harm.
Emergency contacts, including trusted adults and crisis lines.
Steps to create a safe environment (e.g., reducing access to harmful tools).
How Parents and Caregivers Can Help
Parents and caregivers play a vital role in supporting adolescents who self-harm. Here’s how:
Name and validate emotions: Say things like, “I see you’re feeling really upset. That makes sense given what’s happening.” Validation helps adolescents feel understood and less alone.
Model regulation: Demonstrate calm responses to stress, showing healthy ways to manage emotions.
Stay curious, not critical: Often times, individuals hesitate to talk about self-harm because they fear criticism or shame from their loved ones. Instead of asking, “Why would you do this?” try, “Can you help me understand what you’re feeling when this happens?”.
Provide unconditional support: Let your child know they are loved no matter what, even in the face of self-injury.
Positive Relationships as a Foundation for Recovery
Healing from self-injury is painful for adolescents and their families, but it is possible. At the heart of recovery lies connection. Secure, supportive relationships help adolescents rebuild trust and develop healthier coping mechanisms. Family members, friends, teachers, and therapists can all contribute to this network of care.
Recovering from self-injury is a journey—one that requires patience, empathy, and collaboration. For adolescents, the path forward often begins with feeling seen and understood. For families, it’s about offering steady, compassionate support. Together, positive relationships and effective strategies can pave the way for healing and growth.
If your family is navigating this painful experience, know that you don’t have to face it alone. Consider reaching out to a therapist to guide you in building a plan for recovery.Professional support can be a game-changer. Therapy offers a safe space for adolescents to explore underlying issues, learn new skills, and build emotional resilience. Therapists can also help families strengthen their relationships and create a recovery-oriented environment. With time, support, and connection, healing is possible.