Self-harming behaviours are common among adolescents, and particularly teenage girls. Self-harm is usually a way to try and manage intense and distressing feelings that can feel too much for a young person to handle. Self-harm should always be taken seriously and never minimised as a ‘phase’ or ‘attention-seeking’.
Sometimes, young people self-harm with the motivation of taking their own life. They may also experience suicidal thoughts or ideation without harming themselves. This is known as suicidality.
Sadly, self-harm is common among adolescent girls. But there is help and support available to help young people get through their challenges and feel better.
This blog offers some information about self-harm and suicidality and how to support a young person experiencing distress or suicidal thoughts.
What Is Self-Harm?
Self-harm is when a person intentionally harms themselves – through injuring their body or taking poisonous substances. Self-harm can have any motive and may or may not include suicidal intent.
Sometimes, researchers and medics refer to different types of self-harm, such as non-suicidal self-injury (NSSI). NSSI includes self-harm without any motivation to attempt suicide and excludes overdoses and other kinds of poisoning.
The amount of young people self-harming varies between countries and individual studies. However, many community-based studies show that around 10% of adolescents have self-harmed. They also consistently find that more teenage girls self-harm than teenage boys.
Only around 1 in 8 young people who self-harm go to the hospital, meaning that most self-harm incidents stay hidden from medical professionals.
Self-harm is more common in some groups of young people than others. Some groups that are at an increased risk for self-harm include:
- Female adolescents
- Adolescents from lower socio-economic backgrounds
- Autistic young people
- LGBTQI+ young people
Gender Differences in Self-Harm
Hospital visits for self-harm start to become more common from around the age of 12, particularly among girls. Between the ages of 12- 15, hospital visits for self-harm may be five to six times more common in girls than boys. As adolescents grow older, gender differences decrease again.
Why Do Rates of Self-Harm Increase So Quickly in the Early Teenage Years?
One important task for researchers is to understand why self-harm rates increase so fast in early teenage years, particularly among girls. Some research shows that self-harm rates are more connected to puberty than to age itself. Evidence suggests that self-harm becomes much more common when young people reach late puberty.
Self-harm is also linked to several factors that become more common in the early teenage years, such as depressive symptoms, alcohol misuse, and sexual activity. Experts think that self-harm may be one aspect of a period of vulnerability in early adolescence where young people are at an increased risk of emotional disorders and risky behaviours. This vulnerability may be linked to certain brain developments that take place after puberty.
Risk Factors Self-Harm
Self-harm among adolescents develops from a complex interplay of factors. These factors may be genetic, biological, psychiatric, psychological, social, and cultural.
They include:
- Biological differences, such as serotonin imbalances
- Personality characteristics, such as perfectionism and impulsivity
- Exposure to recent negative life events
- Difficult childhood experiences, including childhood abuse
- Family adversity and parental divorce
- Psychiatric disorders
Bullying, Social Difficulties, And Self Harm
Interpersonal difficulties during adolescence are a key risk factor for self-harm. This might include loneliness, isolation, or difficulty making friends. It may also involve arguments with adults in authority or young people of the same age.
Bullying is one of the most common types of interpersonal trauma experienced by young people. Bullying happens when one person or group deliberately and repeatedly harms another whom they have some form of power over. Experiences of bullying are common among adolescents: a UK Department of Education survey found that 40% of year 10 students had been bullied in the past year.
Bullying is linked to a range of mental health disorders, including self-harm. Research shows young people who have been bullied are at an increased risk of self-harm, including female and male adolescents.
Self-harm and Sexual Orientation
Research shows that among both teenage girls and boys, self-harm is associated with concerns about sexual orientation. Results from a meta-analysis suggest that LGB (lesbian, gay, and bisexual) individuals are over twice as likely to attempt suicide as heterosexual peers.
LGB people experience more bullying, victimisation, and social stress than heterosexual peers. They’re also more likely to have mood disorders (which may also be linked to oppression of their identities). Each of these factors may contribute to self-harming behaviours.
Experts also explain how LGB people have fewer ‘protective factors’ than heterosexual people. Protective factors are things that make it less likely a person will self-harm. One study found that LGB people experienced significantly less family connectedness, teacher caring, other adult caring, and school safety than heterosexual peers.
The Role of Social Influence
Adolescents who are exposed to self-harm and suicide by others are more likely to self-harm. While the underlying mechanisms are not certain, it’s likely that self-harm by others provides a behavioural model for vulnerable young people, making it more likely that they will engage in self-harming behaviours.
Other theories point to the shared stressful experiences of family members and social groups. Young people are likely to experience some of the same distressing conditions, memories, or events as those around them, especially if vulnerable young people tend to group together. Self-harm, then, is a common response to shared distress (rather than a behaviour that is ‘transmitted’ from one person to another).
So-called ‘social transmission’ is particularly strong among female adolescents. One study found that among adolescent girls, the risk factors for deliberate self-harm included recent self-harm by friends, self-harm by family members, drug misuse, depression, anxiety, impulsivity, and low self-esteem. On the other hand, the risk factors for adolescent boys were suicidal behaviour in friends and family members, drug use, and low self-esteem.
Is Self-Harm Among Adolescents Becoming More Common?
Statistics from hospitals show that self-harm has become much more common in the past decades. There was a big rise in hospital visits in self-harm in the 60s and 70s and another rise among female adolescents in the 90s.
It’s still not clear exactly what contributed to these trends. It’s possible that easier accessibility to medication made substance overdoses more common. Experts also point to the increased stress placed upon adolescents at school and a greater consumption of alcohol and drugs in general.
The ‘social transmission’ of behaviours – where young people may be more likely to self-harm when their friends or peers self-harm – may also play a role. This includes exposure to self-harming behaviours in the media, especially social media.
Suicidality Among Teenage Girls
Globally, suicide is common among teenage girls. It’s the second most common cause of death among young people aged 10-24 and the most common cause of death among female adolescents aged 15-19.
Suicide attempts are a type of self-harm when a person deliberately attempts to take their own life.
In most regions of the world, adolescent boys are more likely to die by suicide than adolescent girls. But in some Asian countries, including China, more suicides are recorded in young females than males.
Suicidality in Self-Harming Behaviours
Most young people who attempt suicide have previously engaged in non-suicidal self-injury (self-injury without any suicidal motivation). Previous self-harm also increases the risk of suicide attempts. However, some young people who self-harm don’t develop suicidal motivations.
As part of suicide prevention practices, it’s important to identify when a young person who self-harms is likely to also make suicide attempts. Research suggests that when self-harm is accompanied by suicidal ideation, hopelessness, and fewer reasons for living, young people may be at a greater risk of suicide.
What Are the Risk Factors for Suicidal Behaviours Among Teenage Girls?
The risk factors for suicidal behaviours among teenage girls are similar to those for self-harm in general. They include parental separation, family history of suicide, low educational achievement, and co-occurring mental health disorders. Social transmission also seems to play a role.
Difficult family relationships may also make suicide attempts more likely, as well as shared genetic traits such as aggression and impulsivity.
Among adolescents, interpersonal factors – particularly relationship problems with peers, partners, or family members – often precede suicide attempts. This is especially true for young people below the age of 14, who are less likely to have a diagnosed mental health disorder. In these cases, suicide attempts may follow a short period of distress centred around social relationships.
Preventing Self-Harm and Suicide Among Teenage Girls
Many individuals, families, and communities are affected by self-harm and suicide among young people. Self-harm and suicide are a source of pain, grief, distress and worry for those affected, and suicide is a tragic event in every case.
Prevention of self-harm and suicide among adolescents is as urgent now as it’s ever been. Prevention strategies tend to fall into two types: those that address the population as a whole and those that target groups of young people at a particularly high risk.
These prevention approaches may include:
- addressing bullying among young people
- addressing the ‘social transmission’ of self-harm
- supporting LGBTQI+ young people and challenging stigma
- encouraging young people to seek help
- building self-esteem and resilience among young people
- school-based psychological well-being and skills training programs that teach adults and peers to recognise warning signs of suicide and self-harm
For young people at a higher risk of self-harm or suicide (for example, those with co-occurring mental health conditions or those who have previously self-harmed), therapeutic approaches can help improve their mental health and prevent self-harm and suicide. Social interventions that address family and community relationships or distressing life events may also reduce the risk of self-harm.
Looking Out for The Signs of Self-Harm
If you’re worried that a young person may be self-harming, there are some signs to look out for. Aside from visible injuries, you may notice:
- unexplained burns, bite marks, cuts, bruises, or other marks on their body
- insistence on covering parts of their body with long clothes or other material
- feeling low, depressed, and withdrawing from relationships
- angry outbursts
- self-blame
Some young people may be self-harming without showing any signs. If you’re concerned about a young person, it’s important to contact a doctor or mental health professional for advice and support.
If You’re Worried About a Young Person Self-Harming…
If you’re worried a young person is self-harming, it can feel incredibly distressing. But it’s important to remember that many young people self-harm and recover again. You are not alone and there is support available.
There are many ways to support a young person, but among the most important is seeking professional help. You can usually access mental health support through a general doctor or GP, who may refer a young person to a child and adolescent mental health specialist. You can also contact mental health services directly, particularly those specialised in the care of young people.
Other ways to support a young person include:
- trying to start a conversation about their feelings and experiences without pressuring them to talk if they don’t want to
- letting them know you want to support them, and they can speak to you when they are ready
- spending quality time together
- creating spaces where they can feel safe
It’s important to remain open-minded and non-judgemental towards a young person, listening carefully and offering reassurance. Remember that they are not self-harming for attention. Be careful not to devalidate or minimise their experiences.
Recognising the Signs of Suicidal Thoughts
Many young people have suicidal thoughts at some point in their lives. While having suicidal thoughts doesn’t mean a person will attempt suicide, they should always be taken seriously.
If you think a young person may have thoughts about suicide, it can be incredibly distressing. It’s important to remember that there is support available and that young people can and do feel better again.
It’s not always easy to recognise when a young person is thinking about suicide. Sometimes, young people themselves will not be clear that they’re having suicidal thoughts. They may experience suicidal thoughts as sudden urges or more constantly.
That said, some warning signs can help you to recognise suicidal thoughts. These include:
- Expressing feelings of hopelessness, sadness, guilt, shame, or worthlessness
- Social withdrawal
- Losing interest in activities they used to enjoy
- Expressing ideas about death through speaking, drawing, or writing
- Giving away things that they own
- Self-harming
- Using drugs or alcohol as a coping mechanism
- Expressing ideas like ‘I can’t go on’ or ‘things would be better without me’
Speaking to a Young Person About Suicidal Thoughts
If you’re worried a young person may be having suicidal thoughts, it’s important to find out how they are feeling. While it can feel daunting to talk about suicide, it helps a young person feel less alone and know they have someone to turn to.
You might want to open the conversation gently by calmly asking what they’re experiencing. But at some point, you need to ask them directly whether they are thinking about suicide. Use language that refers explicitly to suicide, such as ‘having suicidal thoughts’ or ‘thinking about taking your own life’. Speaking about suicide doesn’t increase the risk of suicide attempts.
If a young person tells you that they are having suicidal thoughts, stay calm and take their feelings seriously. Thank them for telling you, and keep your voice and body language calm. Rather than seeking to ‘fix’ their feelings in one conversation, try to empathise with their experience and gently explore why they may be feeling this way.
If you’d like extra support before having a conversation about suicidal thoughts, organisations like Papyrus can provide tips and a helpline.
Accessing Support
If a young person shares with you that they’re having suicidal thoughts, it’s important to seek professional help immediately. You should speak with your GP, primary doctor, or another mental health professional.
You can also tell your young person about helplines they can access, such as Papyrus, Childline, Samaritans and Shout.
If you think a young person is at risk of serious harm, call the emergency services or visit an emergency room straight away.
The Wave Clinic: Specialist Mental Health Support for Young People
The Wave Clinic offers specialist mental health care for young people with eating disorders, borderline personality disorder, self-harming behaviours, and other mental health concerns. Our programs make a difference in the lives of young people, supporting them to grow in self-confidence, build support systems, develop life skills, and connect with their passions.
Our expert-led programs offer a diverse selection of evidence-based treatment approaches. We sensitively and carefully address past experiences of trauma that may shape present emotions and behaviours. Our residential programs provide 24-hour medical monitoring for young people at the highest risk.
If you’re interested in finding out more about our programs, get in touch today. We’re here to support you.
