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Teenagers and Self-Harm Addiction: How to Spot and Address Emerging Patterns

Learn how to recognize and address self-harm addiction in teenagers, including common signs, underlying causes, and effective treatment approaches. Explore how behavioral health professionals can support clients struggling with self-injury

Lindsay Rutter, MA, NCC, LPC

Last Updated: February 10, 2025

What You'll Learn

Recognize the signs and patterns of self-harming behaviors in teenagers.
Understand the potential compulsive nature of self-injury and its effects on the brain's reward system.
Learn effective treatment methods, including cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), to help clients develop healthier coping mechanisms.
Explore strategies for fostering open communication and assessing self-harm and suicide risk in therapeutic settings.

Contents

Importance of Recognizing Self-Harm Patterns and Addiction

Why is Self Harm Addictive?

How to Address Self-Harm

Self harm or self-harming addiction is not recognized as an official addiction, but it is an expression of distress signaling that an individual needs extra support. A teenager who self-injures may feel addicted to the behavior if it becomes a compulsive coping mechanism for intense emotions, and they need help breaking this habit. Recognizing self-harm and addressing it with effective treatment methods is vital for a client's safety and therapeutic progress.

Importance of Recognizing Self-Harm Patterns and Addiction

Teenagers may avoid talking about self-harm behaviors, so it's important to notice signs and patterns. Individuals may engage in the following types of self injury:

Cutting oneself
Pinching, biting or scratching oneself
Piercing the skin
Inserting sharp objects under the skin
Pulling hair out
Bruising various parts of the body
Burning the skin
Purposely picking at scabs
Hitting oneself
Binge eating or purging food after eating
Restricting food intake
Overexercising

Self harm can potentially lead to injury or health complications like infections. Recognizing and addressing self injury early is vital for protecting teenagers, preventing adverse effects and helping them develop safe coping strategies. Talking to a client about suspected self injury in a productive way lets them know they are safe to discuss all of their challenging thoughts and feelings with you.

Common Self-Harm Signs and Symptoms

The following signs and symptoms may indicate a teenager engages in self harm:

Scars appearing in patterns
Unexplained fresh wounds, such as scratches, cuts or bite marks
Frequent accidental injury reports
A habit of carrying sharp objects with them
Wearing long pants or long sleeves on hot days
Refusal to change clothes in social settings, such as a school's changing room
Frequent use of bracelets or wristbands
Blood stains on clothing
Reports of isolation or withdrawal from friends and family
An extreme increase or decrease in food intake
Exercising to the point of exhaustion or injury
A tendency toward emotional dismissal or suppression
Alexithymia, or an inability to recognize and express emotions
Self-blame and internalization of challenges
Low self-esteem or self-concept
A co-occurring condition, such as depression, anxiety or post-traumatic stress disorder (PTSD)

Why is Self-Harm Addictive?

While the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) does not recognize self-harm as an official addiction, it can affect individuals like a behavioral addiction. Individuals may develop a compulsive self-harm habit to relieve or cope with challenges, replacing intense emotions with physical sensations. Teenagers may continue engaging in self-harm despite negative effects because behaviors can trigger the brain's reward system.

The brain naturally produces mood-regulating neurotransmitters like serotonin and dopamine to help people feel motivated, happy, focused and satisfied when they engage in beneficial behaviors. However, the brain may also release these chemicals when an individual engages in self-harm, which is why some people may feel like they have a self-harm addiction.

How to Address Self-Harm

Several effective treatments exist to integrate eco-therapy into traditional practice. Some of the methods below work best in one-on-one sessions, while others may be better for group therapy sessions.

1. Prioritize Open Communication

Providing a space for younger clients to feel safe opening up is key. Prioritize an empathetic, nonjudgmental approach by actively listening to each client and validating their feelings. It's also important to make eye contact, speak in calm tones, remain neutral and respond objectively when clients disclose self-harm.

If a teenager attends mandated therapy against their desire, you can strengthen the therapeutic relationship by asking them how they would like to spend their time in therapy and honoring their preferences. Acknowledging a teenager's feelings and giving them some autonomy during sessions can increase trust and help them openly discuss self-harm experiences. It's also vital to explain the following details to maintain honest communication with your client and help them feel empowered throughout the process:

Specific interventions and techniques for addressing self-harm
Mandated reporting and your duty to protect your client if they show signs of needing additional support or intervention
The types of information you must share with parents or caregivers if the client is under 18

2. Assess Self Harm and Suicide Risk

Not all individuals who engage in self-harm experience thoughts of suicide. Referring a client to the hospital unnecessarily can decrease their trust and hinder the therapeutic relationship, so it's important to avoid making assumptions. However, it's also essential to assess suicide risk during intake and at periodic intervals. You can use the following instruments to screen for self-injury, assess the functions of self-injury and monitor a client's risk of suicide:

Kim Gratz's Deliberate Self-Harm Inventory questionnaire
Matthew Nock's Self-Injurious Thoughts and Behaviors Interview
Catherine Glenn and David Klonsky's Inventory of Statements About Self-Injury

3. Focus on Underlying Causes and Alternative Coping Mechanisms

Clients may have a strong reliance on self-harm when they first begin therapy. Stopping behaviors abruptly can potentially cause self-harm withdrawal symptoms, such as restlessness, irritability, anxiety and strong urges to engage in self-injury. If a client does not feel ready to fully change self-harm habits at first, you can begin with the following goals:

Addressing the root causes of their self-harm
Diminishing risks
Realizing and focusing on their strengths
Helping them enhance alternative coping mechanisms

After working through challenging emotions and strengthening beneficial coping mechanisms, you can help the client work toward stopping self-harm behaviors.

4. Implement Effective Treatment Methods

Mental health professionals often use the following treatment methods to help clients work through self-harm challenges:

Cognitive behavioral therapy (CBT): CBT can help individuals identify emotions, thoughts and situations that trigger self-injury behaviors and challenge their patterns.
Dialectical behavior therapy (DBT): You can implement DBT in treatment plans to help clients develop safer coping mechanisms, regulate their emotions and reduce self-harm
Mentalization-based therapy (MBT): MBT methods help clients understand the connection between mental state and behavior.
Family interventions: Family interventions may be necessary if a client's self-harm is related to strained family relationships. Improving attachment and family cohesion can make a significant difference in a client's emotional regulation and self-esteem. You can also provide psychoeducation to the family and encourage family support for the individual.

5. Evaluate Your Personal Feelings About Self-Harm

Self-harm can be challenging to treat, and mental health professionals often experience burnout or challenging emotions when addressing it. Reflect on your feelings and reactions frequently, and work through specific challenges in supervision so you can remain empathetic, open and present with your clients.

Why Trust ICANotes for Self-Harm Therapy Documentation?

Working with individuals experiencing self-harm requires special care, attention and detailed documentation. ICANotes offers a behavioral health-specific electronic health record (EHR) solution to help you simplify documentation and spend more time focusing on patients.

Our intuitive charting solution features a user-friendly interface and customizable templates to streamline processes and make your job easier. Frequently updated security features help you protect patient information, meet stringent industry standards and comply with the Health Insurance Portability and Accountability Act (HIPAA).

With ICANotes, you can streamline reporting, billing and note-writing to manage your practice efficiently.

Simplify and Improve Your Documentation with ICANotes

Eco-therapy approaches — such as nature walks, gardening, and animal-assisted therapy — can help alleviate climate anxiety and enhance overall mental well-being. As a mental health professional, you can incorporate ICANotes into your practice as a trusted partner to help you manage your documentation.

Our EHR features easy-to-use mental health templates and notes to help streamline the documentation process. This makes it easier to stay organized and helps you remember key information for each client. With ICANotes, you can efficiently offer holistic care and enhance the quality of life for individuals living with climate anxiety.

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02-26-2025