Self-Harm in Adolescents: A Guide for Parents

One of the most shattering moments a parent can face is noticing marks on their child's arm. The first reaction is usually panic, followed by guilt and helplessness: "How did I not see this?"

Self-harm is more common in adolescence than is generally assumed, and it usually serves a different function from a suicide attempt. Understanding that distinction is decisive in enabling families to respond appropriately.

This article covers why the behaviour arises, how it can be recognised, how the first conversation should be handled, and which situations require emergency assessment. No details of methods are included; the aim is recognition and appropriate referral.

Key Points

• In most cases self-harm does not carry an intention to die; it is an attempt to regulate an unbearable emotion.
• Nonetheless, the behaviour itself is among the strongest predictors of later suicide attempt and must never be minimised.
• Reactions involving panic, anger or punishment lead the young person to conceal the behaviour; concealed behaviour carries greater risk.
• The behaviour is usually a marker of underlying depression, an anxiety disorder, a history of trauma or difficulty with emotion regulation.
• Marked improvement is achieved with appropriate treatment; self-harm is not a fixed trait but a coping method, and other methods can be taught in its place.

What Is Self-Harm?

Defined in the clinical literature as non-suicidal self-injury, this behaviour involves deliberately harming one's own body without an intention to die. It most often begins in adolescence, typically between the ages of twelve and fifteen.

What parents find hardest is that the behaviour has no rational explanation. Yet it does have a function, and seen through the young person's eyes it is coherent.

How Common Is It?

International studies indicate that approximately fifteen to twenty per cent of adolescents engage in self-harm at some point. Reported rates are higher among girls; this difference may partly reflect boys disclosing the behaviour less often.

This prevalence shows two things. First, families are not as alone as they assume. Second, being common does not make the behaviour unimportant; it is among the most frequently encountered serious signs in adolescent mental health.

The Function of the Behaviour

Self-harm usually serves one of the following functions:

• Emotional release: Temporarily reducing an unbearably intense emotion, anger or anxiety.
• Breaking through numbness: Dispelling the numbness and disconnection that arise particularly after trauma, confirming that one still feels.
• Punishment: A young person who feels guilty or worthless directing that feeling at the body.
• A sense of control: A young person who feels they have no control over most areas of their life seeing the body as the one area they can control.

Once these functions are understood, the direction of intervention becomes clear: not prohibiting the behaviour but teaching healthier methods that serve the same function.

How It Differs from a Suicide Attempt

These are different behaviours, but they are not entirely independent of one another.

Self-harm generally carries no intention to die, is repetitive and aims to regulate emotion. A suicide attempt is made with the intention of ending life.

However, research shows that the risk of a later suicide attempt is markedly increased in adolescents with a history of self-harm. The interpretation "they don't want to die, so it isn't dangerous" is therefore mistaken and delays assessment.

Why Does It Arise?

Difficulty with Emotion Regulation

The principal factor is insufficient capacity to cope with intense emotions. During adolescence the intensity of emotional responses increases while the cognitive control systems that balance them have not yet matured. This imbalance creates the ground for impulsive coping methods.

Co-occurring Mental Health Conditions

Self-harm is not a diagnosis in itself but a symptom. It frequently accompanies depression, anxiety disorders, post-traumatic stress disorder, eating disorders, and attention deficit hyperactivity disorder.

The most important part of assessment is identifying the underlying condition, because the treatment plan is built on it.

Trauma and Adverse Experiences

Neglect, abuse, bereavement, peer bullying and witnessing violence at home markedly increase risk. Prolonged peer bullying in particular shows a strong association with self-harm in adolescents.

Peer Influence and the Digital Environment

Among adolescents the behaviour can spread through peer groups and online content. Exposure to material that normalises or glamorises self-harm on social media is a risk factor. This does not mean the young person is imitating for effect; exposure only gives form to a strain that already exists.

Why Is It Concealed?

Most young people conceal the behaviour for months. The main reasons are shame, fear of the family's reaction and the expectation of not being understood.

Another reason is that the young person sees the behaviour as a coping method that works. The fear of having it taken away is experienced like the fear of losing a support. For this reason, rather than conveying "you will stop this immediately" in the first conversation, it is more useful to say that what will replace it is what will be discussed.

Warning Signs: How Is It Recognised?

The behaviour is usually carefully hidden. The following signs should draw attention:

• Clothing inappropriate to the season; insisting on long sleeves in hot weather
• Unexplained marks, burns or scratches on the arms, legs or abdomen
• Frequently repeated and inconsistent explanations of accidents
• Sharp objects found in the bedroom, or long periods alone in the bathroom
• Locking doors, a marked increase in demands for privacy
• Mood fluctuation, withdrawal, pulling back from friendships
• Changes in sleep and appetite
• Expressions of worthlessness, guilt or hopelessness

Any one of these alone does not establish the behaviour; but several occurring together call for opening a conversation.

How Should the First Conversation Go?

The family's first reaction is the single most important factor determining whether the young person will accept help.

What to Do

• Stay calm. A panicked response increases the young person's guilt and leads them to conceal the behaviour more deeply.
• Ask directly and without judgement. "I think you have been hurting yourself, and I want to talk about it" is more useful than indirect hints.
• Accept the feeling. "I didn't know you were feeling this badly — would you like to tell me about it?" keeps the door open.
• Say clearly that you will seek help. This is a decision about support, not a punishment: "We cannot solve this on our own; we are going to see a specialist."
• Ensure safety. Quietly limit access to risky implements at home, without making it a point of conflict.

What to Avoid

• Punishment and threats: Confiscating a phone or imposing restrictions does not stop the behaviour; it only conceals it.
• Blame and shaming: "How could you do this to us?" adds to the young person's burden.
• Extracting promises: Asking for a promise never to do it again usually cannot be kept and creates a sense of failure.
• Ignoring it: "They are doing it for attention; it will pass if we don't respond" is dangerous. Even where attention is sought, this does not mean the need is not real.
• Promising secrecy: Promising confidentiality to win trust leaves the parent trapped when safety requires action.

Situations Requiring Emergency Assessment

An emergency health service should be contacted without delay in the following situations:

• The wound is deep, bleeding cannot be controlled, or medical treatment is required
• The young person expresses a wish to die or speaks of a plan
• There are behaviours resembling farewells: giving away possessions, writing messages that read like goodbyes
• The frequency or severity of the behaviour is increasing rapidly
• Alcohol or substance use has entered the picture
• The young person says they do not feel safe

In these situations one does not wait for an appointment; emergency services are contacted. In Ankara the nearest hospital emergency department or the 112 emergency line can be reached, and the young person should not be left alone during this time.

Treatment Approaches

Psychotherapy

Psychotherapy is the first-line approach. The method with the best demonstrated effectiveness for self-harm is dialectical behaviour therapy adapted for adolescents. It works on four core skill areas: distress tolerance, emotion regulation, interpersonal effectiveness and mindfulness.

Cognitive behavioural therapy and trauma-focused approaches are also used depending on the picture. The shared aim is not to prohibit the behaviour but to build alternative coping methods serving the same function.

The Safety Plan

Early in treatment a written safety plan is drawn up with the young person. It sets out the steps to follow when the urge arises: which signs serve as warnings, which alternative behaviours will be tried, whom to contact, and in what circumstances emergency help will be sought.

Writing the plan together with the young person is markedly more effective than imposing it.

Medication

In Assoc. Prof. Mehtap Eroglu's clinical approach, decisions about medication are based not on the behaviour itself but on the underlying condition. There is no medication specific to self-harm. Medication is planned for accompanying depression, anxiety disorder or other conditions and runs alongside psychotherapy.

The Family's Role

The family is not an observer outside treatment but part of it. Parents work on emotion regulation, communicating without escalating conflict, and how to respond during a crisis. A family's ability to manage its own anxiety directly affects the young person's recovery.

The School's Role

Adolescents spend most of their time at school, and the behaviour is often first noticed by a friend or teacher. With the family's consent, contact with the school counselling service is an important component of follow-up.

What matters here is that information is shared in a limited way that protects the young person's privacy. What the school needs to know is not the detail of any diagnosis but what to do in which circumstances: identifying someone the young person can approach when struggling, and clarifying how the family will be contacted in a crisis.

Discussing the behaviour in class, or the young person being associated with it in front of peers, must be avoided entirely.

Siblings and Other Family Members

Self-harm affects not only the young person but the whole family. Siblings usually know part of the situation, do not fully understand it and cannot voice their own anxieties. When all of the family's attention turns to the struggling young person, the sibling quietly withdraws.

An age-appropriate, honest and limited explanation to siblings is recommended: they need to know what is happening, not to feel guilty, and to have space to ask questions. Secrecy leads a sibling to construct worse scenarios.

Follow-Up and Recurrence

Treatment does not progress in a straight line. Recurrences may occur, particularly around examination periods, the ending of relationships and times of increased family tension.

Here again the family's response is decisive. A recurrence should be treated not as a collapse but as a point at which the plan needs review. What is monitored is not a single event but the overall trend in the frequency and severity of the behaviour.

Alternative Coping Methods

Building methods to replace the behaviour is central to treatment. These are chosen together with the young person; which one works varies from person to person.

• Intense sensory input: Holding ice or splashing the face with cold water can help get through the most intense minutes of an urge safely.
• Physical release: Brisk walking, running or hitting a pillow disperses accumulated tension.
• Writing: Putting the feeling into a notebook or phone is a non-bodily way of getting it out.
• The delay technique: Deciding to wait fifteen minutes when the urge arises. Urges come in waves and usually decrease in intensity within that time.
• Making contact: Messaging a previously agreed person, who need not be a family member.

None of these is sufficient on its own and none replaces treatment. Their function is to give the young person a set of tools to use in a crisis.

Expert Opinion

According to Assoc. Prof. Mehtap Eroglu, the most frequent misconception in self-harm referrals is families interpreting the behaviour as a phase of adolescence or an attempt to attract attention. This reading leads to assessment being postponed for months.

Clinical experience from consultations in Ankara shows that the family's first reaction determines the course of the process. After reactions involving panic and punishment, young people conceal the behaviour more deeply and become less likely to ask for help; a calm, non-judgemental response oriented towards seeking help markedly increases engagement with treatment.

Another important point is that recovery is not linear. Recurrences may occur during treatment, and this does not mean treatment has failed. What should be assessed is the overall trend in the frequency and severity of the behaviour.

Assoc. Prof. Mehtap Eroglu emphasises that seeing the young person alone for part of the consultation is particularly important in this picture, because the underlying difficulty often cannot be voiced in front of the family.

Assessment and Appointment Process in Ankara

A considerable proportion of self-harm referrals in Ankara occur after a family has noticed the behaviour by chance. Referrals from school counselling services in Ankara also account for a notable share. This does not mean the young person was not seeking help; more often it means they did not know how to ask.

At Assoc. Prof. Mehtap Eroglu's practice in Ankara, assessment begins with a review of the young person's safety. The frequency, duration and triggers of the behaviour, and whether thoughts of dying are present, are addressed directly and openly. Asking these questions does not increase risk; on the contrary, it opens a space in which the young person can speak.

Co-occurring conditions are then screened: depression, anxiety disorders, history of trauma and attention difficulties are each assessed. How the family is coping and the pattern of communication at home are also part of the process. In consultations conducted by Assoc. Prof. Mehtap Eroglu, parents are additionally given a concrete framework for how to act during a crisis; this is among the most effective steps in reducing a family's sense of helplessness.

Follow-up frequency in Ankara is determined by the level of risk; appointments are arranged more often early on and spaced out as the picture stabilises. Any previous assessment reports, a list of current medications and observations from the school counselling service should be brought to the appointment. It is ideal for the young person to attend willingly, but where there is a safety risk one should not wait.

If you would like to arrange an assessment for your young person in Ankara, you can review our adolescent psychiatry service and request an appointment.

In Summary

Self-harm is a coping method an adolescent turns to in order to regulate a feeling they find unbearable. It is not a fixed personality trait but a learned and changeable behaviour.

Although in most cases it carries no intention to die, it is a strong predictor of later suicide attempt, and no level of it should be minimised.

A calm, non-judgemental response oriented towards seeking help is the most important factor determining the young person's engagement with treatment. Marked improvement is achieved with appropriate psychotherapy and, where needed, treatment of accompanying conditions.

For the symptoms, risk factors and treatment approaches of adolescent depression, see our guide to adolescent depression.