An Integrated Approach to Young Adult Mental Health Rehab

Self-harm relapse prevention

Preventing Self-Harm Relapse: 5 Approaches to Maintain Recovery and Break the Silence

Reading Time: 6 minutes

Why do young people self-harm and how they can find self-harm recovery? Since self-harm typically starts in early to mid-adolescence, many young adults who struggle with this behavior may have been in treatment before, were able to stop, and then had a self-harm relapse during a period of emotional distress. Preventing self-harm relapse starts with understanding the mental health issues underlying this behavior.

How Many Young Adults Self-Harm?

Unfortunately, self-harm is not uncommon. Up to 25 percent of young people engage in self-harm, also known as self-injury. And while self-harm is considered a non-suicidal behavior, young people who self-harm are more likely to attempt suicide in the future. Self-harm is also linked to a higher risk of mental health conditions, struggles with education and employment, and lower well-being overall. 

This explains why the proportion of adult ER visits for self-harm increased by 18 percent soon after the pandemic began, and continued to increase in 2021 among adolescents. 

Why Do People Self-Harm?

An important part of learning how to help someone who self-harms is understanding why they engage in this behavior. Here are the most common reasons why people self-harm:

  • To release emotional pressure (In one study, 85 percent of participants said this was their biggest reason for self-harming.)
  • In order to control how they’re feeling
  • To get away from intolerable emotions
  • As a way of punishing themselves or expressing anger at themselves
  • Being triggered by exposure to self-harm relapse in others or in the media.

In short, young people use self-harm as a way to cope with intense emotional distress—typically caused by a sense of isolation, relationship challenges, social comparison (often triggered by social media), and difficulties at school or work. While they may experience short-term relief after engaging in self-harm, this coping mechanism is not only unhealthy but also life threatening. 

In some cases, self-harm, which is often referred to as NSSI (non-suicidal self-injury), is a symptom of a specific mental health disorder. NSSI can be a symptom of depressionanxietyPTSDbipolar disorderborderline personality disorder, or schizophrenia. 

Statistics on Self-Harm and Mental Health in Young Adults

One of the biggest dangers of self-harm relapse is the risk of suicidal behavior. People who engage in self-harm are more than four times as likely to subsequently make a suicide attempt. Moreover, young adults who regularly self-harm are also at higher risk for mental health issues in future. Specifically, they are six times more likely to be hospitalized for mental illness. In addition, they are at higher risk for anger issues, low self-esteem, and substance abuse. 

Know the Facts

20% of young adults who self-harm are later hospitalized for a psychiatric condition.

Furthermore, even if a teen stops self-harming by the time they enter young adulthood, the mental health repercussions continue. In one study, researchers tracked teens who had engaged in repetitive self-harm and measured their mental health 10 years later. They found that the young adults had significantly higher levels of stress, anxiety, and problems with emotion regulation. In addition, many of the participants had experienced a self-harm relapse.

Different Forms of Self-Harm

When young adults have a self-harm relapse, they often use the same form of self-harm that they did as teens. Or they may engage in a different type of self-injury. Common forms of self-harm include:   

  • Cutting oneself, typically on the arms and legs—the most prevalent type of self-harm 
  • Scratching, biting, or burning the skin
  • Pulling out hair
  • Picking at scabs and wounds
  • Banging one’s head or body against walls or hard objects
  • Ingesting poisonous substances 
  • Disordered eating
  • Inserting objects into the body
  • Overdosing on drugs or drinking to excess
  • Excessive exercising to the point of collapse or injury.

In addition, risky behaviors like driving recklessly, getting into fights, staying in abusive relationships, and having unsafe sex can be forms of self-harm. Young adults may intentionally put themselves in harm’s way as a method of self-punishment or a way to cope with distressing emotions. 

Signs of Self-Harm Relapse

Because self-harming behaviors are typically done in secret, the primary way to identify different forms of self-harm in a friend or loved one is by observing signs. These can be hard to recognize, as young people often learn how to hide self-harm scars or give plausible excuses for self-harm scars. 

Here are some of the signs of self-harm:

  • Fresh cut, bruises, scratches, other wounds, or recent scabs
  • Wearing clothes that cover up the skin, even in hot weather, or avoiding situations in which they need to reveal skin, such as swimming or changing in front of people
  • Acting impulsive and seeming unstable
  • Expressing feelings of hopelessness or worthlessness
  • Difficulties with relationships, increased isolation and social withdrawal
  • Blood stains on bedding, clothing, towels, or tissues
  • Having a supply of sharp objects, including razors, safety pins, nail scissors, knives, needles, shards of glass, or bottle caps
  • Spending long periods of time alone, often in the bathroom or bedroom.

For family and friends of young adults who have self-harmed in the past, these signs may be familiar. Therefore, a self-harm relapse may be easier to identify and address. 

Can Alternative Strategies Prevent Self-Harm Relapse?

Some self-help sites and mental health experts suggest so-called harm minimization as one approach for how to help someone who self-harms. This strategy is also known as mimicking. The idea is to substitute dangerous self-harm, such as cutting, with a non-life-threatening action like holding ice on your skin, snapping a rubber band on your wrist, or drawing on your hands with a red magic marker. 

Snapping a rubber band on your arm leaves a mark and it’s painful. It’s self-injury.

Michelle Seliner, MSW, LCSW, CEO of S.A.F.E. Alternatives

A young person who self-harms may find minimization tactics helpful in a moment of crisis. However, both researchers and people who have recovered from self-harm believe these alternatives don’t really address the problem. That’s because they activate the same self-destructive mindset and behaviors, even though the action itself is less dangerous. In fact, in a poll about substitute behaviors conducted by the self-harm recovery program S.A.F.E. Alternatives®, more than half of respondents said these mimicking strategies actually increased their impulse to self-injure. 

how to help someone who self harms
how to help someone who self harms

5 Ways to Prevent Self-Harm Relapse 

One of the most effective ways to support self-harm recovery is to become aware of your triggers. If you know what kinds of situations or feelings catalyze the urge to injure yourself, you can be proactive in preparing yourself emotionally for these stressful moments. 

But it’s not always possible to head off the distress that triggers self-harm. If you or a friend or loved one finds themselves on the verge of a self-harm relapse, these five approaches can help. 

Distract yourself.

  • Call or text a friend to chat about something light and easy.
  • Take a shower (don’t keep razors accessible in the shower).
  • Get moving—dance, walk, do a workout or yoga class, take a bike ride.
  • Watch a standup comic or TV show that makes you laugh.
  • Drink a glass of water.
  • Start an organizing project or clean your room.
  • Count to a thousand.

Try a calming technique.

  • Snuggle with a pet.
  • Take a bath with a good book.
  • Put on music you love.
  • Do a meditation or other mindfulness exercise.
  • Listen to a visualization using guided imagery for relaxation. 
  • Hold a smooth rock or other object that makes you feel grounded.
  • Do a self-massage with a scented oil on your arms and legs. 

Practice self-expression.

  • Journal about your emotions.
  • Draw, paint, or make a collage.
  • Make music—sing or write lyrics.
  • Write a poem or short story. 
  • Play an instrument. 

Change your environment.

  • Go outside, even if it’s just to walk around the yard or the block.
  • Move to a different room, preferably where people are.
  • If you have a kitchen in your living space, do a simple task like washing dishes.
  • Leave home and go shopping or to a park.

Connect with others and break the silence.

  • Talk honestly about what you’re going through with someone you trust.
  • Share your story on social media or a blog to help destigmatize self-harm relapse. 
  • Find a self-harm recovery group, in person or online. 
  • Ask close friends and family members to write you notes of love and support that you can read when you feel triggered. 
  • Set up a chat or group text with friends or family to share positive and hopeful words, images, and stories.

Treatment for the Underlying Causes of Self-Harm Relapse

In order to achieve sustainable self-harm recovery and avoid the dangers of self-harm relapse, young adults need treatment for the underlying emotional distress. Whether distress is triggered by depression, anxiety, trauma, or another mental health condition, healing the underlying issues is essential. At Newport Institute, we support young adults to address the root causes of self-harming behavior and build self-worth and self-compassion. 

Young people at Newport Institute also learn healthy coping mechanisms, using modalities proven to be effective for self-harm. Cognitive Behavioral TherapyDialectical Behavioral Therapy, and mindfulness-based therapies are particularly successful in helping young adults learn to tolerate distress, reframe negative thinking, and improve well-being.

Contact us today to find out more about our integrated and evidence-based approach to young adult treatment. 

Sources

Lancet: eClinical Med. 2021 Nov; 41: 101175. 

Annals Emergency Med. 2021 Oct; 78(4). 

Eur Child Adolesc Psychiatry. 2021 Mar; 30(3): 475–492. 

Front Psychol. 2020 Jan 10; 10: 2016. 

Archives Suicide Res. 2019 Jul; 24(3).

Psychol Med. 2016 Sept; 46(16): 1–9 and 2016 Jan; 46(2): 225–236. 

Psychiatry Res. 2009 Apr 30; 166(2­–3): 260–268.

Co-Occurring Disorders / February 18, 2022

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