Oceanside Family Therapy - & Assessments
Adolescent Therapy

Adolescence can be a turbulent time as a growing child faces increasing responsibilities and pressures to perform from parents/teachers and to be accepted by peers.  

Without adequate experience and coping skills, certain symptoms can develop; such as depressed mood, withdrawal, anxiety, anger outbursts, attachment issues and forms of self harm including drug use, risky behaviors and eating disorders.

Eating Disorders

We specialize in treating not only the eating disorder but the individual as a whole, unique being and often the family system, when applicable. We also consult with the client's physician or psychiatrist as part of treatment. Types of eating disorders include:

  • Anorexia Nervosa
  • Bulimia
  • Binge Eating Disorder (BED)
  • Emotional Eating
  • Compulsive Exercise
  • Comorbid Medical and Psychiatric Issues
  • Adolescent Self-Harming

Adolescent Self-Harming

By definition, self-harm or self-mutilation refers to hurting oneself to relieve emotional pain or distress. The most common forms of this behavior are cutting and burning. The least common forms of self-harm include pulling out bodily hairs, punching walls, and ingesting toxic substances or sharp objects.

Many adolescents today are struggling to cope with extreme levels of stress in school, in their families, and in their peer relationships. Some of these youth are being hurried through their adolescent years by parents and peers alike.

Adolescent girls are constantly being bombarded by images in the media about how they should look and act. Especially for young women, failure to live up to these idealized images can lead to developing an eating disorder and/or engaging in self-harming behavior as a form of self-punishment.  Cutting is done to increase a sense of personal control and to cope with painful emotions.

What Causes Adolescent Self-Harming Behavior?

Like substance abuse, adolescent self-harming behavior has no one single cause. It cuts across all cultural and socioeconomic levels. We do know, however, that more adolescent females engage in this behavior than males, and that self-harming adolescents are rarely suicidal. Most of these adolescents are seeking quick relief from emotional distress.

One major reason why adolescents gravitate towards self-harming behaviors is the endorphin effect. When adolescents cut or burn themselves, endorphins are quickly secreted into their bloodstreams and they experience a numbing or pleasurable sensation. For some of these youth, cutting or burning themselves numbs away unpleasant thoughts and feelings or they feel "high" from the experience. Like addiction to a particular drug, the endorphin "high" provides fast-acting relief for adolescents from their emotional distress and other stressors in their lives.

Other important reasons as to why teens engage in self-harm may include:

  • Feeling emotionally disconnected from or invalidated by parents or peers
  • Bullying by peers at school or online
  • Not feeling accepted for who they really are (including sexual orientation)
  • Feeling emotionally detached, abandoned or invisible to key figures. (Self-harm can increase a sense of feeling alive and helps confirm existence in reality)
  • Trauma, abuse, incest or rape
  • For girls, self-harm may be used as a coping strategy with overly demanding parents, especially in situations where the father is the dominant voice when it comes to discipline and decision-making
  • Unrealistic body image pressures
  • General lack of power or control in one's life

Prevalence

A study by Ross and Health, 2002, found that nearly 14% of high school students reported engaging in self-mutilative behavior.  Girls reported higher rates of self-mutilation than boys (64% girls vs. 36% boys), 25% reported starting self-harming behaviors during 6th grade or earlier.

A majority of the students who self-mutilated described their feelings before and during self-mutilation with words like “lonely,” “sad,” and “alone.”  The person who cuts will do so in order to escape from feeling trapped in an intolerable psychological and emotional situation that they can’t control or cope with.

Cutting provides temporary relief from anxiety and agitation, or provides stimulation out of “downer” states such as depression, emotional numbness, hopelessness and apathy toward life.
One must also consider that those who self-harm can also have suicidal ideation, which can lead to suicidal behavior.

How Do You Know When to Seek Help?

Since adolescents often engage in self-harming behaviors in privacy or with their friends, parents may not be aware that this problem exists. In addition, parents also need to be aware that there is a big difference between self-decorating and self-harming behavior.

 It is a popular fad among youth today to body pierce and tattoo as a form of self-decorating. Teens who self-harm are seeking relief from emotional distress, they are not self-decorating.
Here are some signs that might indicate that a teen has a problem with self-harming behavior:

  • Cut or burn marks on their arms, legs, and abdomens
  • Finding knives, razor blades, box cutters, and other sharp objects hidden in the teen's bedroom
  • Regularly locking herself or himself up in the bedroom or bathroom following a bad day at school, negative encounters with peers, and family conflicts for lengthy periods of time
  • The family physician, a teacher, or other adult observes cut or burn marks
  • The teen's peers cut or burn themselves.
  • Reports from a sibling indicating that he or she found blood encrusted razors or caught the teen in the act of self-injuring

What Kinds of Treatments Work?

By far, the most effective treatment for adolescent self-harming problems is family therapy. A skilled family therapist will be able to help improve family communication, teach conflict-resolution and problem-solving skills, and help foster more meaningful and closer relationships between parents and teens.

Skill-building groups can be helpful to self-harming adolescents as well. A good group should teach teens effective tools for managing their moods, challenging unhelpful thinking, visualization and meditation skills, and healthy activities to better manage stress.

How Can Adolescent Self-Harm be Prevented?

Parents play an integral role in preventing their teens from engaging in self-harming behaviors. At home, parents can make spending time together as a family a priority. Parents can put the teen in charge of selecting and planning a weekly family outing. The family mood needs to be more calm and inviting for the teen. When conflicts do erupt or crises occur, family members should work together as a team to solve these situations.

Teenagers need to feel a sense of place in the hearts and minds of their parents. They need to feel appreciated and know that their parents will be there for them unconditionally. It is the parents' responsibility to create firm boundaries between their work and family lives.

One way to help foster more meaningful connections between parents and teens is to share family stories. Parents should share with their kids what their struggles and high points were in adolescence. They can also share with their teens any important words of wisdom and stories that their own parents shared with them when they were growing up.
Self-harming behavior can be dangerous, particularly if the youth is abusing alcohol and other drugs. Parents need to take a firm stance and set consistent limits with these behaviors. Parents also need to model for their teens' responsible use of alcohol and healthy ways to manage stress.

Should a parent discover that their teen is engaging in risky and dangerous behavior such as self-harm, they should rest assured that a family therapist will be able to skillfully assist the family and teen with this serious issue.

This article was adapted from an excerpt from aamft.org

Nicole Story, Ed.S, M.Ed, LMFT, LMHC, is a licensed family therapist and licensed mental health counselor, who has been working with adolescents and families for over 15 years.
The past Clinical Director of an adolescent inpatient program, and President Emeritus of NEFAMFT, Nicole is often quoted and interviewed by the media as an expert in the field.  She works with adolescents individually and/or in family therapy in a supportive and non-judgmental therapeutic environment.  

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