This document discusses self-harm and suicide in teenagers. It notes that deliberate self-harm is a strong risk factor for future suicide attempts. Self-harm is often used as a coping mechanism to relieve intense feelings like emotional or physical pain. While self-harm provides temporary relief, it is an unhealthy and dangerous coping strategy. The document provides advice on how to respond sensitively if a teenager discloses self-harm and how to help get them the treatment and support they need.

1. Cutting
a presentation by
Alan Brandis, Ph.D.

2. Suicidal Thoughts Are Common in Teens
From Better Off Dead, 1985, starring John Cusack

3. Teen Angst is Common
(and can be profitable)
Band: Suicidal Tendencies, 1983

4. Deliberate Self-Harm (DSH) is the
strongest risk factor for future suicide.
• English study, 2000: 11,583 patients who presented to
hospital after DSH between 1978 and 1997
• The risk of suicide in the first year of follow-up was 0.7%,
which was 66 times the annual risk of suicide in the
general population.
• The risk after 5 years was 1.7%, at 10 years 2.4%, and
at 15 years 3.0%.

5. Co-Morbidity of DSH
• Self-harm is listed in the DSM-IV-TR as a symptom of
borderline personality disorder.
• However, patients with other diagnoses may also self-
harm, including those with depression, anxiety disorders,
substance abuse, eating disorders, post-traumatic stress
disorder, schizophrenia, and several personality
disorders
• Evaluation, diagnosis and treatment is essential to
prevent progression and escalation

6. Motivations for Self-Harm
May be used to fulfill a number of different functions.
Used as a coping mechanism which provides
temporary relief of intense feelings:
• Emotional pain
• Dissociation from body
• Anxiety
• Depression
• Stress
• Emotional numbness
• Sense of failure or self-loathing
• Wish to feel connection to other cutters

7. Origins of Self-Harm Behaviors
• Often associated with a history of trauma and abuse,
including emotional and sexual abuse
• Most common in adolescence and young adulthood,
usually first appearing between the ages of 12 and 24.
• Self-harm in childhood is relatively rare but the rate has
been increasing since the 1980s.
• Information initially shared by peers, or learned about
through music or media
• Many teens have little or no perspective, everything is
“life or death” to them
• Often, teens cannot engage in objective problem-solving

8. Precursors to Self-Injury

9. Cycle of Self-Harm

10. Cutting is not the only method
of Self-Harm used

11. Physiological Markers For Cutting, Other Self-
Harming Behaviors By Teenage Girls Found
University of Washington psychologists found:
• Adolescent girls who engage in behaviors such as
cutting themselves have lower levels of serotonin, a
hormone and brain chemical, in their blood
• They also have reduced levels in the
parasympathetic nervous system of what is called
respiratory sinus arrhythmia - a measure of the ebb
and flow of heart rate along with breathing -
characteristic of people who are anxious and
depressed, and among boys who are delinquent

12. DSH Does Not Hurt (Much)
• Interestingly, self-injurers report little or no pain during
Self-Harm Events.
• They show a higher level of pain analgesia on lab-based
tests of pain tolerance.
• This finding has been reported consistently across
studies of DSH and represents one of the most intriguing
directions for future research on this topic

13. Famous Self-Injurers
Princess Diana Angelina Jolie
Johnny Depp
Courtney Love
Marilyn Manson
Amy Winehouse

14. Humor

15. How to tell if a student
may be self-mutilating
• Long sleeves in warm weather, wrist bands
• Resistance to attend or dress in P.E.
• Emotionally numb
• Signs of repressed anger, irritability
• Withdrawal from activities
• Unusual interest in things that cut – knives, razor
blades, etc.
• May be reported to you by their friend

16. How NOT to Respond to Self-Harm
• Don’t react in horror or upset. ("Oh, my God! How can
you do that to yourself?" or "Doesn't that hurt?")
• Don't be directive or judgmental. ("You must stop that."
Or, “How could you do that to yourself?") Reassure them
that there is nothing to be ashamed of.
• Don’t say, or imply, that some sort of punishment or
negative consequence will be imposed.
• Don’t agree to keep it a secret. They need to get help,
and you must make sure that they get it.
• Don’t become a detective or inquisitor. Let them tell
about their situation as they feel comfortable doing so.

17. Best Ways to Respond
• Encourage connectedness without invading their space. ("I can see that
you are hurting and I’d like to help." Or, "I may not be the right person to talk
to, but I can help you find someone who is.")
• Acknowledge their feelings. Offer to listen. ("You must be feeling really
upset about something. I'd like to help.")
• Identify the behavior as a coping mechanism, not just a bizarre habit,
and preferable to the alternative of suicide. ("I guess hurting yourself seems
like the best way you have right now to deal with your feelings.")
• Empathize, but don’t pretend to "know" how they feel. (“When I have a
problem, I feel better when I talk to someone about it.")
• Emphasize hope. ("It is probably hard to imagine giving up this way of
dealing with your feelings, but lots of people learn healthier ways to cope. I
am sure we can find someone to help.")

18. Dealing With the Student’s Family
• May be in denial
• May overreact
• Help parents understand context
• Assist with referral(s)

19. Atlanta Area Psychological Associates
(770) 953-6401
atlantapsych.com
We provide Free Assessments for Fulton County
Students and Fulton County School District Employees