Teen mental health and self-harm: Understanding feelings

Self-harm is a behaviour associated with mental health that is rarely talked about, but is actually quite common. Rates of self-harm in teenagers range from 14-39%. There are a lot of misconceptions and mystery around this behaviour. In this series we are opening up the topic of self-harm in teens. Last week we explored some of the reasons why teens might self-harm. This week we will build on this to understand the many feelings associated with this behaviour.

Understanding the feelings a young person who is self-harming might be experiencing is absolutely key to supporting them. When you can understand some of what someone is feeling, then you can respond appropriately. This is like an emotional life buoy for someone struggling with their mental health. If you’ve ever felt listened to and understood when you’re hurting, you’ll get this. That emotional connection lessens isolation and gives hope. Self-harm can be a way of managing big feelings like sadness and anger, but it also brings it’s own like guilt and shame. Some feelings are shown outwardly, but a lot are hidden inwardly.

How does it feel to be you?

The ‘big’ feelings

What are these ‘big’ feelings that self-harm is often used to manage or avoid? Often at the root is sadness or anger. Both sadness and anger are normal human emotions, but sometimes it can feel unsafe to let ourselves experience them. This might come from experience, our own ability to self-regulate or just a learnt way of being. For example if anger is seen as scary as a child then we may learn that it is not a safe emotion for ourselves. If we struggle to regulate our own emotions then we might not feel safe letting ourselves feel the full extent of them. For more on self-regulation see here. Some cultures, and within this some families, might be more or less comfortable showing emotions. Whatever the reason, someone who self-harms is likely to be feeling sadness and/or anger but may not feel completely connected to this.

Emotional rollercoaster

Teens who are using self-harm to manage these ‘big’ feelings will typically experience urges to self-harm when they are feeling more emotional.

In the same way, teens who use self-harm as punishment might feel urges to self-harm when their low self-esteem is triggered, perhaps during social interactions, if they perceive themselves to be underperforming or at any point that they are struggling with an internal negative voice. The feeling of worthlessness will link in with these ‘big’ feelings of anger or sadness.

The urge will increase as the feelings get bigger until it’s too hard to resist the urge. Once you self-harm there is an immediate dulling of this big feeling which can be experienced as relief. But it hasn’t gone away, more like subdued. Different feelings, often guilt and depression, become dominant. Over time, these core big feelings grow again, and with them the urge to self-harm increases. This cycle of emotions can feel like an emotional rollercoaster.


Self-harm is a behaviour that can become addictive, in a similar way to behaviours such as gambling and smoking cigarettes. This is because of that short-term sense of relief immediately after self-harming. During this time the body reacts to the behaviour and releases chemicals such as endorphins and dopamine. These chemicals can make us feel good but can also have a role in establishing and maintaining addictive behaviours. Looking at it another way, as humans we learn by doing. And if self-harm, even only for an instant, brings some relief, our brain will remember that feeling and remind us of it later.

Because of this, teens who self-harm are likely to be experiencing the urges to self-harm a lot more than they are actually doing it. Sometimes urges to self-harm can feel pretty loud and constant, and it can make choosing not to self-harm very difficult.


After the relief often follows guilt. Teens who self-harm may not want to be doing it. They may be actively trying to stop, or may have tried previously. As we know, it can be really hard to resist these urges. If you end up doing it anyway it can feel like failure. In truth, actually, stopping self-harm is a process that takes time and not resisting some urges early on is normal. Nevertheless, guilt can be tough. Young people may be feel they are letting others down and this can feed into low self-esteem.

Sometimes teens don’t want to stop self-harming. This is usually because self-harm is seen as an effective way to cope. And whilst it is not very healthy, and long-term keeps problems going, short-term it certainly is a way to cope. When other ways of coping are not accessible or effective stopping self-harm could leave a teen struggling with no way to manage their distress. This is why support is so important. Always seek professional help to make sure you have other coping strategies to use.


A large part of guilt is associated with the shame of self-harm. Self-harm is a topic that we still don’t discuss much openly, and it is often misunderstood as a ‘bad’ behaviour rather than a way to cope. The stigma of self-harm can lead young people to feel shame alongside guilt. Because of its physicality, this shame can be triggered when the young person sees or experiences pain from scars. Shame can lead a young person to hide this behaviour, doing it in secret and keeping it private.


Teens who are self-harming can feel very isolated. The urges to self-harm can mean it’s often on your mind, which can feel like a stark contrast to trying to concentrate at school or engage with friends. Emotions can be experienced internally which also makes the outside look very different to what someone might be experiencing on the inside. The stigma of self-harm can make it hard to talk about and isolation can be further compounded by keeping it secret.


Low self-esteem can be the reason self-harm is used as punishment. As we discussed last week, for these young people self-harm also feeds into how they see themselves, as deserving of harm. This sounds extreme but these teens aren’t always from extreme backgrounds. Lots of things can contribute to low self-esteem including trauma, bullying and perfectionism as well as diagnoses like depression or learning difficulties.

Flat emotions

As we know, self-harming is not a mental health diagnosis in itself, it’s a behaviour. But it is often associated with mental health diagnoses, particularly depression. Depression can mean low or flat emotions for a large part of someone’s daily life. Depression can also impact on motivation to change. For more on tackling depression see here. Whether or not someone has a diagnosis of depression, low mood is generally a large part of self-harm. And emotions can feel flat or numb when a behaviour such as self-harm becomes a means of avoiding their intensity.

It is so important to understand self-harm but this is a heavy topic. If you have got this far I suggest you go and do something uplifting like step outside, stretch or have a cool drink of water. I hope that by reading this you have more of an insight into how it feels to be someone who uses self-harm to cope. If you or your child self-harm and you are not being supported, then please do seek professional help. This is not something to go through alone. If you are in crisis then use provincial services or if you are looking for private support we can help at Imagine Therapy. Next week we’ll finish our deep dive into self-harm by exploring how to support teens who self-harm.

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