7 Ways to Support a Teen Struggling with Self-Harm
By Sunshine Loveland, MS, LPC
Content Warning: This article discusses suicide and self-harm, which may be distressing to some readers. This post is not a substitute for professional mental health support. Please prioritize your well-being. USA/Canada: Call or text 988 to reach the Suicide & Crisis Lifeline (24/7).
Today on the blog we want (okay, need) to talk to you about something hard but important: self-harm behaviors in teens. If you are a parent, friend or family member of a teen—OR you are a teen yourself, the following information is critical in understanding how to best help those at risk.
Self-harming behaviors are an ever-growing mental health concern, especially for teens. On average, recent research shows that non-suicidal self-injury (NSSI) prevalence rates are between 7.5 and 46.5% among youth across the U.S. The onset of NSSI behaviors occur at about age 12 and reach their height between the ages of 15-17. (Children (Basel). 2024 Apr 14;11(4):466. doi: 10.3390/children11040466)
Dr. Mark Mayfield defines NSSI as “a deliberate and intentional, self-induced, non-lethal act of bodily harm, which is done to reduce, avoid, and/or communicate mental, emotional, physical, and/or spiritual distress.” In short, NSSI is a way that a teen is trying to manage BIG emotions and cope with how hard life feels to them.
When a teen self-harms, the body releases a flood of dopamine and endorphins sending a powerful rush of relief, but this cycle requires more to produce the same relief. This creates a dangerous cycle of increasing severity of self-injury causing a teen to experience increasing shame, confusion and concern.
You may be surprised to learn that NSSI is not limited to cutting. It includes but is not limited to: scratching, pricking skin, picking, burning, biting or hitting one’s self, banging one’s head or another body part against the wall, and pulling hair on head or body. NSSI can also include more indirect forms such as substance abuse, eating disorders, risk taking-- physically and sexually--and medication mismanagement.
How can you help a teen who is struggling?
1. Assess suicidality. Approximately 93% of self-injuries are considered to be non-suicidal. However, it’s always necessary to assess suicidality. If you are a parent, don’t be afraid to ask your teen directly, “when was the last time you thought about killing yourself?” and “which ways have you thought about killing yourself?” While this may feel scary and uncomfortable to talk about, these are important conversations to have with those we love. If you don't feel comfortable asking directly, you can call or text 988 to help guide you through the process. You can also seek immediate support from a doctor, therapist or the local ER. ***If you discover someone you love is thinking about killing themselves, seek immediate help through your local ER department or 911.
2. Freak out privately and then be a calm presence. If you discover that someone you love is not suicidal but IS practicing either direct or indirect self-harm behaviors, try not to freak out in front of them. A teen’s brain is not a fully functioning adult brain; they need to borrow your calmness and trust that you can walk through this with them, even if you’re scared. Talk with a therapist, trusted friend, spouse or pastor when you need to process your own feelings. Then, practice deep breathing, calm yourself, and be a support by listening to your teen. Do not ask “why are you doing this?” as this question may increase shame and guilt. Most times, they can’t communicate the why, they just know the behavior they are practicing brings some relief to tough emotions. Be prepared for your teens’ strong reactions and try not to take it personally.
3. Create a safe space. Go through your home and environment and search for anything that could be used for self-harm, then lock it up. This is not fail-proof, but it does help put distance between your teen and their NSSI.
4. Seek counseling for your teen. This point cannot be understated-- NSSI is not something someone will “just get over” or “grow out of.” Your teen needs professional support to help them work through the underlying causes of NSSI and to develop new and effective coping skills. Whenever possible, choose a therapist who is trained specifically in working with NSSI.
5. Take care of yourself emotionally, mentally, and spiritually. NSSI doesn’t just affect your teen, but also all who love and support them. Taking care of yourself may mean counseling for yourself. Additionally, seek spiritual support from those who can walk with you, encourage you and pray for you. Don’t do this alone.
6. Speak life. Best-selling author and Pastor Mark Batterson says, “words create worlds.” Both you and your teen need to hear the truth being spoken out loud multiple times a day. Audibly speaking truth is a practice that helps us contain and triumph over lies we may tend to believe.
7. Connect with your teen. Deeper conversations about emotions and feelings can feel out of place or uncomfortable. Here’s a great resource to help initiate conversations. https://www.youngminds.org.uk/parent/how-to-talk-to-your-child-about-mental-health/ Remember, it takes time and practice. Be ready to talk when they are, which may mean right as you’re trying to go to bed, side-by-side in the car, on a walk, etc. Take the time to interrupt whatever you are doing to listen and be present.
Helpful Resources
Two of my favorite apps that I often prescribe to clients are:
Calm Harm app which helps your teen to ride out the urge wave by giving them hundreds of different options with which to replace self-harm.
How We Feel app allows your teen to track feelings by providing a list of feelings. They can track where they feel it in their body, what they were doing, who they were with and add a journal entry.
Additionally, Dr. Mark Mayfield created a very helpful booklet about NSSI and your teen. If a teen you know is self-harming, this is a must read. https://www.focusonthefamily.com/wp-content/uploads/2020/04/Self-Injury.pdf
Final Note
Remember, this is not a hopeless situation, but it does require immediate professional support. While the path ahead is challenging, you can overcome this with the right care and help.
Children (Basel). 2024 Apr 14;11(4):466. doi: 10.3390/children11040466
Child Adolesc Psychiatry Ment Health. 2025 Nov 19;19:128. doi 10.1186/s13034-025-00982-6
