New Study: 1 in 4 teenage girls engage in self-harming behavior, which frequently co-occurs with eating disorders

A new study published in the American Journal of Public Health found that nearly 1 in 4 teenage girls ages 14-18 in the United States engages in non-suicidal self-harming behavior. Self-harm or self-injury is the act of hurting oneself on purpose. The most common methods are cutting and burning.

Self-harm is a behavior pattern that indicates a lack of adaptive emotional coping skills and often co-occurs with eating disorders. Self-injury is particularly prevalent among people who have Bulimia Nervosa, with rates between 25 and 75 percent reported in various studies.

This article is heavily informed by the book A Bright Red Scream: Self-Mutilation and the Language of Pain, by Marilee Strong.

Why self-harm?

Self-harm may seem like a bizarre behavior, but it is actually a powerful self-soothing activity that has been developed by the person’s subconscious as a way to manage otherwise inexpressible anguish. In other words, the person who engages in self-harm is in a tremendous amount of psychic pain. Like eating disorders, self-harm is a powerful form of non-verbal communication, a very valid call for help when the person suffering lacks adaptive methods of seeking support.

Researchers have found that people who self-harm develop a conditioned response to pain that is not dissimilar to the numbing created by opiate drugs. This response is why many people who self-harm feel “addicted” to their behavior and often experience powerful cravings and withdrawal-like symptoms when they try to stop.

Who self-harms?

Self-injurers are often bright, talented, creative achievers. Self-harm is common among perfectionist and people-pleasers who present a happy face even when they are suffering greatly.

People who self-harm often put on a mask of self-sufficiency and appear fiercely independent. Underneath their mask, people with both eating disorders and self-harming behaviors suffer from an insatiable hunger for acceptance, love, belonging, approval, and nurturance. The self-harm becomes a way for a person to soothe themselves.

People who self-harm and have eating disorders can be described as maladaptive coping mechanisms that help relieve tension, release anger, regain a sense of self-control, and eliminate a sense of emotional deadness.

“I have come to regard these behaviors as morbid forms of self-help because they provide rapid but temporary relief from distressing symptoms,” says Marilee Strong, author of A Bright Red Scream: Self-Mutilation and the Language of Pain.

Self-harm and eating disorders

Researchers have observed common roots in both self-harm and eating disorders. They both have a strong correlation with childhood physical and emotional abuse, particularly sexual abuse. Often times, the abuse was not acknowledged or adequately treated, and the person who experienced may have suppressed the memory and “forgotten” it occurred.

Many (not all) people who self-harm and/or have eating disorders have untreated Post Traumatic Stress Syndrome (PTSD) and have internalized trauma. Instead of talking about and seeking comfort for their trauma, a person who has an eating disorder or self-harms seeks to process their trauma physically.

It has been proposed that both self-harm and eating disorders use the body to work out psychological conflicts and obtain relief from overwhelming feelings of tension, anger, loneliness, emptiness, and self-hatred. Many people use maladaptive coping mechanisms to manage PTSD symptoms such as dissociation, flashbacks, and hyperarousal.

Both self-harm and eating disorders can build a form of identity around the maladaptive behavior. A person can become strongly associated with their maladaptive coping mechanism and extremely resistant to stopping their behavior. “They come to believe that they are their symptoms, that there really is nothing but a void inside, and that if they were prevented from cutting they would fall apart, go crazy, disappear, cease to exist,” says Strong.

What parents need to know about self-harm and eating disorders

First, parents need to know that self-harm and eating disorders are complex coping behaviors. They are maladaptive, but that doesn’t mean they don’t provide a deep sense of relief to the person while they are engaging in the behavior. Self-harm and eating disorders are calming and soothing behaviors, and parents must recognize that the behavior is indicative of desperate emotional turmoil.

Parents cannot simply demand that a child stop self-harming or engaging in their eating disorders. They also cannot trust the child who self-harms or has an eating disorder to stop without treatment. It is frequently observed that a child who says they will stop or are “cured” when confronted by a parent simply determines to find a better way to hide their disorder.

Self-harm and eating disorders are neither manipulative or attention seeking, but their existence indicates that parents need to pay more attention to the child and help them build adaptive coping mechanisms. This is not because the parents are “bad,” it is because the child needs help, and parents are in a position to provide the help needed.

Parents can become distracted by the external signs of self-harm and focus only on the physical act, but they must know that the pain their child is inflicting on their body pales in comparison to the acute psychological pain they are experiencing inside. Parents must train themselves to pay attention to the unexpressed pain vs. focusing on the harm exhibited on the body. The act of self-harm can be viewed as a “form of language written on the body,” says Strong.

What parents can do to help their child who self-harms

Parents are in a powerful position when it comes to helping a child who self-harms and/or has an eating disorder. But to help our children, we must learn more about what is going on and prepare ourselves for a challenging recovery. Both self-harm and eating disorders are powerful behavioral addictions and should never be taken lightly or without sincere dedication to education and treatment.

Before following the steps below, you must assess whether your child is in immediate physical danger. Contact the National Suicide Prevention Lifeline (24 hours): 1-800-273-8255 to determine whether hospitalization is necessary. Only consider these steps once your child is physically our of danger. 

1. Plan your approach: it is a common mistake to fly into a panic and approach your child immediately when you suspect self-harming behavior. This can backfire and create a greater obstacle to recovery. Take some time to learn about self-harm and internalize the fact that self-harm is not “manipulative,” “disgusting,” “abhorrent,” or whatever it is that you naturally first assume. Only approach your child once you fully understand and have internalized that their self-harming behavior is serving a valuable purpose in their life. Your goal must be to help them find other ways to meet their needs. If your only goal is to stop the self-harming behavior, you risk sending it further underground where it can become more destructive.

2. Seek help: find a therapist who has experience helping parents who have children who have maladaptive coping behaviors like self-harm and eating disorders. As long as the child is physically safe, parents should take time to see a therapist to gain perspective and learn about the behaviors. Work with the therapist to determine the best course of action. Many (not all) people who self-harm come from enmeshed families where identity, family roles, and boundaries are confusing to the child. Many (not all) also tend to suffer from a lack of secure attachment and abandonment issues. You need the help of a qualified therapist to begin addressing these familial issues – if they exist – in order to help your child.

3.  Begin treatment: your therapist should help you identify the best course of treatment for your child, which may include various forms of therapy, including Dialectical Behavioral Therapy (DBT), which has shown promise in treating people who self-harm. You will also likely need to invest in family therapy. Self-harm is a private act your child is taking against themselves, but it is often indicative of larger challenges in your family structure. Your child may find greater success in recovery if you spread the burden among all family members rather than place the entire burden of recovery on your child who is self-harming.

4. Become emotionally literate: your child who is self-harming is suffering from a lack of language skills to express their pain and suffering. For whatever reason, your child did not learn to process emotions in an adaptive manner, which involves expressing negative feelings like anger, jealousy, grief, and fear. Parents who learn emotional literacy – the ability to acccept, define, and express emotions – can help their children develop adaptive coping mechanisms to replace their self-harm and eating disorders.

5. Provide a balanced environment: maladaptive coping mechanisms are responses we develop in response to arousal. In addition to helping children express themselves emotionally, parents can help minimize the potential for arousal spikes by providing a safe and appropriate environment. This includes providing plenty of food, rest, play, comfort, and stimulation.

6. Take it slowly: never forget that self-harm and eating disorders provide a valuable form of self-care. If you try to remove the behavior before your child is ready, it will either dive deeper into the shadows or morph into another behavior like drug abuse, drinking, sexual promiscuity, shoplifting, and more. Don’t ever think about your child’s self-harm as an indication that they are a criminal or a liar. Don’t try to control the behavior, but rather seek to replace it with kindness and compassion.

The most important thing a parent can do when their child is in recovery from self-harm is to trust that their child and the whole family can improve together. It takes a lot of effort, and will not be a perfect or linear process, but full recovery is completely possible.


Bright red scream bookA Bright Red Scream is a groundbreaking, essential resource for victims of self-mutilation, their families, teachers, doctors, and therapists.

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