What’s driving the teenage self-harm epidemic?

A 14-year-old girl feels so overwhelmed by thoughts and feelings about her father’s sudden death that she starts to cut her arms with a pair of scissors. Why? Because each cut brings an instant but temporary relief from her heart-shattering grief. It may be difficult to understand, but this teenager’s behaviour is far from unique. More young people than ever before are turning to self-harm: intentionally damaging or injuring their bodies by cutting, burning, strangulation, head-banging, skin-picking, hair-pulling and self-poisoning as a way of dealing with the unique stresses of 21st-century life.

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Secondary schools have witnessed a surge in cases, with 70,000 incidents estimated in the past year alone, and NHS England figures show that the number of girls treated as hospital inpatients after cutting themselves quadrupled between 2005 and 2015, while the number of boys admitted had more than doubled. These figures are shocking. And yet they show how more and more young people – typically adolescents, and three times more girls than boys – are turning to self-harm as a coping mechanism. Dangerous though it is, it can bring a sense of relief or control to a situation (internal or external) that feels confusing, overwhelming and beyond control.

So why do people deliberately harm themselves? We all do things that damage us, from smoking and drinking too much to binge-eating. We humans sometimes choose things we know aren’t good for us to bring temporary relief to the thoughts and feelings inside ourselves. Psychiatrist Armando Favazza describes self-harm as a ‘morbid form of self-help’. Studies tend to confirm this: that the main reason people report engaging in self-harm is to reduce emotional distress. Another common reason is self-punishment, although either motivation can lead to a temporary sense of relief.

“Schools have witnessed a surge in cases, with 70,000 incidents estimated in the past year alone”

One of the most incredible recent neuroscience discoveries was that we experience physical pain and the emotional pain of social rejection in the same parts of the brain, including the anterior cingulate, a hook-shaped piece lying an inch behind the forehead. Paracetamol was proven in a similar study to relieve the pain of social rejection, and it seems, from the clients I have worked with, that self-harm can also provide this kind of emotional ‘pain relief’. There is some evidence that after self-harming, endorphins are released which create a mini-euphoric state. This explains why some adolescents self-harm at the end of a stressful day. These discoveries challenge the idea that self-harm is just attention-seeking behaviour.
A client of mine started self-harming – first with nail scissors, then burning herself with a lighter – when she was 11 years old as a way to cope when her parents were fighting. Self-harming, she said, was a way of ‘anchoring’ her inner turmoil. She showed me a graphic novel about a lesbian girl who self-harmed, with a brilliant depiction of the girl before and after she had cut herself. The ‘before’ image was captioned: ‘difficult to understand’, next to the ‘after’ image, of the girl’s cut arms. were the words: ‘easy to understand’. The complex inner world of a teenager takes time, patience and compassion to understand. Sadly, young people often don’t have access to these things and so they find their own ways to make their inner turmoil tangible, understandable.

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Although self-harm can bring relief and a sense of control in the short-term, it can very quickly become compulsive. The deep sense of shame soon overrides the release it brings, and then the young person can find themselves looking for a quick way to bring relief to the shame. The constricting grip of this negative feedback loop is well known to drug addicts. Additionally, people who self-harm are more likely to try to take their own life, but equally most self-harm does not end in suicide.

So why are we seeing such an alarming rise in self-harm among our youth? Young people seem to have it better than ever before, yet the rise in social media use and the ‘attention economy’ have a significant role to play. I run a social enterprise called Bounce Works (bounce.works) that uses digital technology to improve young people’s mental health. However, we are competing for their attention with powerful corporations such as Facebook, Instagram and Snapchat that use slot-machine psychology to hijack our attention and dopamine reward system, targeting our base instincts, especially emotions such as fear, envy and outrage. The computer scientist and philosopher Jaron Lanier calls these companies ‘behaviour modification empires’.

“Every time a young person scrolls through a social media feed, it’s a bit like self-harming”

I can’t help but feel that every time a young person scrolls through a social media feed, it’s a bit like self-harming. Looking at how beautiful and successful everyone else is feels like injecting a repeated dose of envy, social rejection or the fear of missing out, mainlining straight into their deepest sense of unworthiness. This also helps to explain why self-harm is so much more common among girls. Girls growing up in a ‘selfie’ world become image-conscious at a much earlier age. According to one recent study, a third of seven- to ten-year-old girls believe that they are judged on their appearance and a quarter feel the need to be perfect. Eating disorders are a type of self-harm more common to teenage girls, and the two co-exist in about 25 per cent of cases. For some, self-harm can replace an eating disorder and vice versa, especially if the crutch of the self-harm method is taken away from that person when they aren’t psychologically ready.

There are other aspects to the online world that are troubling. Georgia, 16, told me that it’s impossible to switch off after school: ‘I don’t have the ability to be on my own; I am constantly in contact with my friends. I can always see where my friends are, as everyone posts wherever they go…I know instantly if haven’t been invited.’ She would regularly wake up in the middle of the night to check her phone to see if she had missed out on any conversations or events. Young people are more connected than ever before, but they are, as US professor Sherry Turkle brilliantly put it, ‘alone together’.

Humans are social animals: we have a biological need to connect with others, but it’s only really those warm, face-to-face connections that help us to feel safe. One of my clients, who spent a lot of time on online multiplayer video games, once told me that the previous night he had been playing a game and chatting with more than 100 friends from around the world: ‘But as soon as I turned off the game I felt lonelier than I’d ever felt before…and I don’t know why.’ Within the digital world lies a promise to us that we never need to deal with discomfort or boredom. The bus ride or queue, the silent moments in conversation – all can be filled with entertainment or productivity. But discomfort is a part of life that we can and should learn to be with. For our young people, the idea of spending time in solitude or self-reflection is increasingly triggering huge levels of anxiety. Yet the more time they spend inhabiting the disembodied, online, Photoshopped version of themselves, the more disconnected they become from their own bodies and their authentic self. Self-harm is a way of bringing yourself sharply and swiftly back into your body when you are feeling overwhelmed.

Young people also feel pressure to succeed at a young age, from their families and from the education system, which is still based on the Industrial-era factory model, and overly focused on teaching things that can be measured or tested. I’ve worked with a number of clients who started their self-harming journey around the time of their GCSEs. Children who are overscheduled or from broken families can turn to self-harm at times of increased pressure as it provides a private form of release that, unlike teen drug and alcohol use (which tends to be more social), doesn’t require flexibility of schedule. It’s easy to self-harm on your own using things you may already have in your bedroom.

The rise in self-harm comes hand-in-hand with an equally worrying rise in anxiety and depression. According to one government-funded study, one in four girls aged 14, and roughly one in ten boys the same age in the UK are depressed – double the rates observed a decade earlier. It’s even more concerning, because we know that self-harm is highest among young people who also display symptoms of anxiety and depression.

“Although self-harm can bring a relief and a sense of control in the short term, it can very quickly become compulsive”

How are these challenging emotions underlying self-harm spreading so fast? One cause is ‘emotional contagion’, the phenomenon of one person’s behaviour or feelings spreading to another. Facebook demonstrated in 2012 precisely how emotional contagion works in our networked age when it ran a secret experiment to see if it could manipulate people’s emotions on a mass scale by tweaking their newsfeeds. Facebook’s own report concluded that ‘emotional states can be transferred to others via emotional contagion, leading people to experience the same emotions without their awareness’, and that emotional contagion can be achieved without ‘direct interaction between people’. Given that over a third of 15-year-olds in the UK are ‘extreme internet users’, online for at least six hours a day at the weekend, we can safely assume that emotional contagion is at work here.

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There has also been a marked increase in the past decade in references to self-harm in movies, songs and on social media. But before we blame these people or the sites that host this content, in my experience, a young person would only ever ‘imitate’ what they see in these media if they feel distressed already and therefore identify with the underlying message. One of my clients with a history of self-harm told me she couldn’t let herself watch 13 Reasons Why (the controversial Netflix show about a teenage suicide) as she knew that she would be triggered, but her non self-harming friends could watch the show and actually enjoy it. We should be wary when we hear about schools reporting that ‘copying peers’ is the most common reason for the rise in self-harm. It feels to me there is judgment in this, that their pain is somehow not real. Why do some young people self-harm and others don’t? Why are some more vulnerable to emotional contagion and others less so? Young people self-harm when they are distressed, when they feel under too much pressure, when they don’t have time or space, when they don’t feel safe.

The dramatic rise in self-harm is a mass cry for help from a generation in distress. But there is hope. In the UK, more schools are now practising value-based education, which is less about competition and more about building honesty, cooperation and compassion into the curriculum. Schools are also becoming more responsive to mental health issues, many introducing lessons on emotional resilience and mindfulness from a young age. We have to be careful, though, that mindfulness isn’t being used like medication, dosing kids up so that the school keeps its spot in the league table.

There is also a growing interest in self-compassion, which is about learning to be a good friend to ourselves – it’s the ideal antidote to self-harm in an age in which young people, girls especially, have become hypercritical of themselves. The good news is that the teenage brain is also very ‘plastic’, which means with the right input it has a high chance of changing for the better.

Mostly, though, the clients I’ve worked with give me hope. Recovery from a pattern of self-harming is not only possible, but likely, given the right support. One client I worked with started pulling out her hair during her GCSEs in response to huge pressure from her parents and school to achieve. In the evenings, in the privacy of her bedroom, she would tear out big clumps as a way to reassert a sense of agency, and also to punish herself for not being ‘enough’. In our sessions, she figured out that the strongest act of self-compassion she could do was to stand up for herself, to say ‘no!’ So she did, telling her parents and her teachers that she needed them to back off. The next week I heard that she had stopped pulling out her hair for the first time in two years.

What can parents do?

  • Pay Attention: Is your child showing signs of distress? Are they withdrawing into themselves? It can be easy to dismiss your teenager’s behaviour as ‘hormonal’.
  • Listen: Check in with them; say that you’ve noticed they seem more upset. Be curious.
    If they don’t want to talk, suggest texting or emailing you if that’s easier.
  • Stay calm: This is essential for them to open up. Young people are secretive about their self-harm as they fear their parents’ anger and punishment. Create a ‘safe space’ for these discussions. Say, ‘I’m so sorry to hear how much pain you are in. I’m here for you if you want to talk.’ Don’t bombard them with questions.
  • Validate: Name the emotion you see in your child, for instance saying: ‘It seems like you are really angry with me. I’m sorry about that.’ Having our feelings validated helps us to feel anchored. When someone tries to fix us, it can make us feel as though our feelings aren’t valid.
  • Triggers: Help them write down some of the triggers that create the urge to self-harm.
  • Alternatives: Think together of other ways to cope with strong feelings. Direct substitutes include using an ice cube or flicking a rubber band on the skin. Then talk to your child about reducing the risk, eg, by removing blades or medication.
  • Get help: If you’re worried about your child and self-harming, speak to your partner or a friend. Get professional help if needed. Ask your GPGP for a referral, look for help privately or find help online (see below).
  • Internet boundaries: Discuss the potential harm of internet use with your child. Create a healthy boundary together, such as no internet in the bedrooms.
  • Love: All children need to know that they are loved, regardless of how well they do in their exams or how many likes they get on Instagram. Show your love by being fully present with them at least once a day, with no devices and no distractions.

For more information on self-harm, and to get help go to samaritans.org, youngminds.org.uk, childline.org.uk and read healthtalk.org’s self-harm guide. 

Louis Weinstock is a psychotherapist, coach and meditation teacher who specialises in working with children and families. For more information, visit louisweinstock.com