Self-Harm in Teenagers: What Lies Behind the Pain
Self-harm in adolescents is rarely a wish to die. Most often it is an attempt to manage emotional pain that feels unbearable — suffering for which the young person still has no words. Understanding this pain is the first step toward restoring the connection between the child and their loved ones.
A mother notices several thin lines on the arm of her 15-year-old daughter. Her first thought is: “She wants to die!” Her next: “Where did I go wrong?” The child stays silent. Fear stands between them.
This reaction is natural. For any parent, it is extremely difficult to see their child hurting themselves. It is important to know that self-harm is rarely the result of a single specific cause or a single parenting mistake. It arises from a complex interaction between personality traits, experiences, relationships, mental health, and the way the young person copes with intense emotions.
Rather than looking for someone to blame, it is more important to try to understand what pain lies behind this behavior.
Self-harm (non-suicidal self-injury – NSSI) is the deliberate infliction of harm on one’s own body without the intention to die by suicide (American Psychiatric Association, 2022). The most common forms are cutting, scratching, burning, or hitting one’s own body. It is important to emphasize that self-harm and a suicide attempt are not the same thing, although they can occur together. For this reason, every instance of self-harm requires careful professional assessment.
Self-harm is a serious mental health problem in adolescence. Early recognition and timely professional support significantly increase the chances of effective help (World Health Organization, 2020). Although it is included in the DSM-5-TR as a condition for further study, self-harm is a well-researched clinical phenomenon with clearly described functions, risk factors, and effective approaches to intervention.
At first glance, this behavior seems hard to understand. But when we look at the psychological mechanisms behind it, the picture becomes clearer.
One of the most common functions of self-harm is regulating intense emotions that a person struggles to bear (Nock, 2009).
Many adolescents describe experiences such as:
- intense anxiety;
- anger;
- shame;
- a feeling of emptiness;
- emotional overload;
- a sense that no one understands them.
Physical pain can temporarily reduce the intensity of psychological pain. This does not mean that self-harm is a solution, or that it should be accepted as a normal coping method. It means that, in that moment, it is the only way the young person manages to cope with unbearable emotions.
The paradox is that the young person is not seeking the pain itself. They are seeking the relief it temporarily brings. But the brief relief is usually followed by guilt, shame, and self-criticism (Klonsky, 2007). This can create a vicious cycle, in which suffering leads to self-harm, and self-harm generates new suffering.
One of the most widespread myths is that young people harm themselves to attract attention. In reality, this behavior very often remains hidden and is linked to feelings of shame and fear of others’ reactions. Self-harm is more often a signal: “I don’t know how to cope with what I’m feeling.”
It can be connected to difficulties in emotion regulation, experiences of bullying, rejection, family conflict, traumatic experiences, anxiety, depressive states, low self-esteem, and feelings of loneliness (Cipriano et al., 2017).
It is important to remember: self-harm is not a diagnosis. It is a sign of suffering that needs to be understood.
Sometimes emotions are so intense that a person has no words for them. That is precisely when the body may begin to speak in place of the psyche.
From a psychotherapeutic perspective, the symptom is understood as an attempt to express something that cannot yet be shared (Peseschkian, 2003). Self-harm is not merely an action, but a form of communication – a way of saying something for which there are still no words. In some psychodynamic understandings, it can be linked to aggression directed at the self, in which inner tension and destructive impulses are turned toward one’s own body instead of toward the outside world (Menninger, 1938).
For this reason, the goal of psychotherapy is not only to stop the behavior, but to understand the pain behind it. As the young person begins to find words for their experiences, other ways of coping gradually emerge.
When they learn about self-harm, many parents feel fear, guilt, and helplessness. This is a natural reaction. But the most important thing they can do is preserve the connection with their child.
Fear often drives parents to react impulsively – constantly watching their child, removing every sharp object, or insisting the child promise “never to do it again.” Sometimes accusations, threats, or attempts to minimize the pain appear, with words like “there’s no reason to feel that way. ” These reactions usually come from love and worry, but they can increase shame and make it harder for the child to open up.
It is more helpful for a parent to say: “I can see this is very hard for you. I don’t fully understand what you’re going through, but I want to understand you.”
- Listen before offering solutions
The young person often needs, first of all, to be heard.
- Don’t minimize the pain
Phrases like “there’s no reason to act like that” can make them feel even more alone.
- Don’t blame yourself or the child
Self-harm is not the result of a single mistake. It is a signal of difficulty that requires understanding and support.
- Seek professional help
Self-harm always deserves attention. Psychological and psychotherapeutic support can help the adolescent develop healthier ways of coping. If there is any concern about suicidal thoughts, severe depression, or a risk to the child’s life, do not delay seeking an emergency psychiatric evaluation.
Self-harm provokes fear, confusion, and helplessness. It frightens parents, worries teachers, and often remains misunderstood by peers. But behind every mark on the skin stands a young person trying to cope with an experience that feels unbearable to them.
Real change does not happen only when the self-harm stops. It happens when the young person begins to understand their own emotions and discovers that there are other ways to cope with suffering.
Therapy creates a space in which the adolescent can gradually talk about fears, anger, shame, loneliness, or feelings of rejection, without being judged.
Parents also have an important role – not to be perfect, but to stay close to their child and to seek help when the situation exceeds their own capacity.
The mother from the beginning of this article will probably never forget the day she saw the cuts on her daughter’s arm. But that is not the end of the story. For many families, this very moment becomes the beginning of conversations, of seeking help, and of gradually rebuilding trust.
The most healing question is not: “Why did you do it?” but: “What were you going through that made you need to do it?“
There is no accusation in this question. There is curiosity, empathy, and a readiness to hear a pain that has long gone without words. This is how recovery begins – from the feeling that the pain no longer has to be carried alone.
Rosa Fileva-Hadjova is a psychologist and psychotherapist with more than 15 years of professional experience working with adolescents and adults. She holds a bachelor’s degree in psychology, a master’s degree in clinical social work (specializing in mental health), and is a certified positive psychotherapist with the Bulgarian Association of Positive Psychotherapists (BAPP) and the World Association for Positive and Transcultural Psychotherapy (WAPP).
She is the founder of Emotional Consult – a Center for Psychological Counseling and Psychotherapy, created with the mission of providing professional psychological support to adolescents, adults, and families during periods of difficulty, change, and personal development.
In her practice, she combines various psychotherapeutic approaches, placing each person’s individual story, experiences, and needs at the center. She works with anxiety, depressive states, panic attacks, emotional crises, interpersonal conflicts, difficulties in adolescence, and support for parents.
Her professional interest is directed toward understanding human behavior in its context – because behind every symptom, conflict, or difficulty lies a story that deserves to be heard.
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Association Publishing.
Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal self-injury: A systematic review. Frontiers in Psychology, 8, Article 1946. https://doi.org/10.3389/fpsyg.2017.01946
Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226–239. https://doi.org/10.1016/j.cpr.2006.08.002
Menninger, K. (1938). Man Against Himself. Harcourt, Brace & World.
Nock, M. K. (2009). Why do people hurt themselves? New insights into the nature and functions of self-injury. Current Directions in Psychological Science, 18(2), 78–83. https://doi.org/10.1111/j.1467-8721.2009.01613.x
Peseschkian, N. (2003). Psychosomatics and Positive Psychotherapy – Volume 2.Varna: Slavena. [in Bulgarian]
World Health Organization. (2020). Guidelines on mental health promotive and preventive interventions for adolescents: Helping adolescents thrive. Geneva: World Health Organization.
This material is for educational purposes and does not replace professional psychological or psychiatric assessment. If self-harm is present, it is advisable to seek support from a mental health specialist.