UNDERSTANDING ADOLESCENTS’ SELF-HARM

October 10 is the World Mental Health Day. Although it is devoted to health in the workplace, we are publishing an article on the subject of self-harm in adolescents, related to the aims and mission of the OveHum. To do this we have again our collaborator, Mª Victoria Sánchez López, specialist in Clinical Psychology of the Laberinto Group

When a teen is engaging in self-injuring behavior (burning, scratching, cutting, sticking, etc.) often generates various reactions in the environment, ranging from fear, worry and distress to rage and even indifference.

To understand this, we must consider some of the factors that are explained below.

There are several ways to understand self-harm from a psychological point of view, we will focus here on self-injury as uncontrolled impulses. To explain this, we are going to refer to evolutionary psychology: what are the conditions that favor the development of mental health in children.

In the baby-caregiver relationship, the latter’s task is to be available and attentive to the instinctive signals (crying), to transmit a need (eating, sheltering, sleeping, physical contact …), translate them, understand what is the mental state behind that behavior (the mentalization capacity, associated with prefrontal brain structures) and attend them systematically, in an affective, quiet, pleasant and secure environment. When this is repeated over and over, the child is internalizing a feeling of security, that he is important, looked at, cared for, and loved; learning to tolerate unpleasant states, because he is confident that it will be solved with the caregiver’s help, who is aware. Then every time, with more autonomy. So his self-concept develops. He also learns, that others are reliable people, who come when it is needed, as soon as they can. This relationship with the primary caregiver enables a secure, stable and long-term relationship, generating great internal security. This is secure attachment, which makes it possible to explore the physical and mental world, both his own and other’s. In neurobiological terms: the pre-frontal cortex of the caregiver calms the altered limbic system of the child.

“If I am calm, I can think about mental states (how I find myself and the others)”. 

Now, there are cases with failures in this process, which generate damage in the later years. This can occur when:

• the signs are not taken care of (caregivers with alcohol or depression problems), or are incorrectly taken care of,
• the adult transmits an altered emotional state to the child (anguish),
• there are traumas blocking the secure attachment, cognitive processes (thought, social learning, attention, memory) and mentalization

The child learns to inhibit needs and contain emotions, he learns to disconnect; therefore, he doesn’t learn to regulate and calm down. Neural pathways that allow connection and emotional regulation do not develop properly.

When learning channels are closed, thinking and behavior become rigid:

“I cannot see other perspectives, I cannot listen, everything becomes a threat, I am defensive not to suffer”.

The consequence of all this is that, when the child grows and activates his system of attachment/need to bond – for example, in a situation of emotional activation -, there is a cascade of neurobiological reactions (amygdala, hormonal) that he is not able to handle.

People with secure attachment can counteract this cascade, through the ability to mentalization, associated with other (prefrontal) cerebral pathways. They thus calm the limbic system, and restore balance. When a child has not learned to calm his limbic system, in situations of emotional activation there will be greater emotional dysregulations, and other pathways are activated, such as the pituitary-adrenal, causing palpitations, panic attacks, etc.

The reward / attachment system will also be activated, with small dopamine discharges that will lead the teen to seek the bond at all costs. When this is repeated, it is often the environment that ends up tired and does not respond in the way that the person needs. We enter here on escalation: when the person feels alone, the limbic system is activated even more, requiring more dopaminergic discharge. At this moment, the only way the person finds to calm down is through uncontrolled impulses, for example, through self-harm. The psychic anguish relates to the traumatic, being impossible to return to the here and now, to the present moment. The injury calms him by the dopaminergic discharge and brings him to the present, through pain, blood, etc.

Adolescence is a period of vital crisis, where one rethinks who he is, and reformulates the image that has been built through his parents, to another one seen through the peers; and this creates insecurity. On the other hand, there is a refusal to find refuge in the parents, who have been the figure of attachment so far.

If we add hormonal changes, impulsivity (seeking immediate reward), insecure attachment, deficit in emotional regulation (not well-formed prefrontal pathways) and / or traumatic situations to this insecurity, it is very likely that self-harm behaviors appear as a form to calm down and regulate.

What to do if I know a child / adolescent who is self-injuring?

Seek help from an expert in clinical psychology for family, children and youth. It will help the family repair attachment problems and manage emotions in a non-harmful way, connect with their needs, and understand trauma. It will help to understand the mental states that lead to uncontrolled impulses, to provide strategies of self-regulation and management of frustration.

All this will help build a secure attachment, which will help develop a general sense of security and tranquility to the personal, family and social context. This will facilitate an optimum psychic development, which translates into well-being and health.

What not to do?

• To judge
• To scold
• To ignore
• Focus only on behavior.

It is necessary to make the effort to try to understand what is the mental state behind the behavior, helping to express himself, returning to the here and now, inspiring support, affection, calm and security.

Author: Mª Victoria Sánchez López, Psychologist. Specialist in Clinical Psychology.