Self-harm in teenagers: what parents need to know

Self-harm is the act of deliberately injuring oneself as a way of managing overwhelming emotional distress. It is not, in most cases, a suicide attempt. This distinction matters because confusing the two leads to responses (panic, hospitalisation, punishment) that frequently make things worse. Self-harm is estimated to affect between 13 and 20 per cent of adolescents in the UK at some point, with rates highest among girls aged 13 to 17. It is not confined to any social group, academic background, or family type. It is a coping strategy, a maladaptive one, but a coping strategy nonetheless, and it needs to be understood as such.

Why young people self-harm

Young people who self-harm typically describe a state of emotional overwhelm that they cannot articulate or regulate in any other way. Self-harm may temporarily reduce the intensity of that feeling. For some, it creates a feeling where numbness had been. For others, it provides a sense of control at a time when everything else feels out of control. Some young people describe it as self-punishment; others as the only way they know of communicating the depth of their suffering. What almost all have in common is that they have not yet developed the internal resources or external support to manage extreme emotional states differently. The self-harm is a symptom, not the problem.

How to respond when you discover your teenager is self-harming

The first instinct of most parents is to express shock, distress, or anger. These responses are understandable but they almost always cause the young person to shut down and conceal future self-harm more carefully. The most important thing you can do in the first conversation is to stay calm, not to react with horror, and to communicate that you are not angry and that you want to understand. Saying something like 'I'm worried about you, and I want to understand what's been going on. You're not in trouble' creates the conditions for honesty. Demanding that the teenager stop, removing sharp objects, or punishing the behaviour treats the symptom while closing off the communication that makes treatment possible.

Signs that self-harm may be happening

Many young people who self-harm do so on areas of the body concealed by clothing: inner arms, thighs, stomach. Wearing long sleeves in warm weather, flinching when touched, or wearing sleeves that cover the wrists to bed are sometimes indicators. Other signs include finding blood on clothing, tissues, or bed sheets; discovering blades, pieces of glass, or other sharp objects; and withdrawal from activities that involve exposed skin such as swimming or sports. Persistent low mood, increased secrecy, changes in peer group, and declining school performance are not specific to self-harm but often co-occur. None of these signs in isolation constitutes evidence. They warrant a careful, calm conversation rather than a confrontation.

The relationship between self-harm and suicide

Self-harm without suicidal intent and suicidal self-harm exist on a continuum and distinguishing them is a clinical task, not something parents can reliably do alone. However, it is important to know that the majority of self-harm in adolescents does not involve a wish to die. Research indicates that approximately 12 to 15 per cent of young people who self-harm have concurrent suicidal ideation. Any disclosure of suicidal thoughts should be taken seriously and assessed by a clinician. If your teenager has told you directly that they want to die, or if the self-harm is escalating in frequency or severity, same-day clinical assessment is appropriate. In an acute crisis, contact a GP, call 111, or go to an emergency department.

What effective treatment involves

The evidence base for adolescent self-harm supports interventions that address the underlying emotional dysregulation rather than focusing on the self-harm directly. Dialectical behaviour therapy (DBT) is the most extensively researched treatment for self-harm in young people and was developed for this population. DBT teaches skills in distress tolerance, emotional regulation, mindfulness, and interpersonal effectiveness. It is structured, skills-based, and typically involves a combination of individual therapy and group skills training. Cognitive behavioural therapy is also used, particularly where depression, anxiety, or OCD are prominent. Family therapy is frequently an important component, particularly where family dynamics are contributing to the young person's emotional state.

What parents can do in the meantime

While waiting for assessment or therapy to begin, there are things that make a meaningful difference. Maintain regular, low-pressure contact with your teenager: shared meals, brief check-ins, activities that are not focused on mental health. Avoid making every conversation about the self-harm. Communicate clearly and repeatedly that you love them unconditionally and that they are not in trouble. Work with the school's pastoral team to ensure appropriate support is in place. Take care of your own emotional state, because parents carrying significant distress find it harder to respond calmly, and it is reasonable to seek your own support alongside your teenager's.