Reducing Self-Harm by Being Heard and Seen

Warning: This article discusses self-harm, self-injurious behaviour, and distress; if your teen or whānau needs immediate support in Aotearoa New Zealand, free call or text 1737 anytime, or contact Lifeline (available 7 am-12 am daily) by calling 0800 543 354 or texting 4357.

Discovering that your teenager is hurting themselves is terrifying.

When your teen is autistic, has ADHD, or experiences sensory processing differences, self-directed injury is rarely straightforward. It may not simply be about sadness or wanting to die. There can be a mix of sensory overload, communication difficulties, emotional pain and the way their nervous system processes and responds to distress.

Through my work with Fern Collective in Dunedin, I’ve learnt one thing that feels particularly important: keeping neurodivergent young people safe requires meeting them with open, non-judgemental harm reduction, rather than fear, panic or punishment.

Firstly, your whānau is not alone in navigating this

Finding out that your teen is hurting themselves can leave you with a lot of questions. You might wonder why it is happening, whether you should intervene, or whether you have somehow missed the signs. The reality is that many whānau are navigating this, and neurodivergent young people can be particularly vulnerable to self-harm and self-injurious behaviour.

• 1 in 4 young people report deliberately injuring themselves, primarily as a way to cope with unbearable emotions rather than to end their lives.
  
• Data has consistently shown that disabled and neurodivergent youth face significantly higher rates of self-harm, depression, and distress than their peers.
  
• About half of all Autistic individuals engage in self-injurious behaviour at some point in their lives, or it goes on throughout their lives in different forms.
  

This vulnerability is not a personal failure. It is driven by systemic stress: bullying, masking differences to fit in, sensory exhaustion, and environments that do not accommodate neurodivergent nervous systems.

Sorting out the differences: stimming, self-injurious behaviour, and self-harm

One of the first things that can help is understanding what we mean when we talk about self-injury. Not every behaviour that looks like self-harm has the same purpose, and the reason behind the behaviour can influence how we respond.

Stimming (self-regulation)

Repetitive movements or sounds (rocking, pacing, finger-tapping) used to balance sensory input or calm down. The key difference is the outcome: stimming leaves the teen feeling soothed and regulated, without physical injury.

Self-injurious behaviour (SIB)

Repetitive, direct trauma like head-banging on walls, biting hands, hair pulling, or severe scratching. It often happens impulsively during sensory overload, communication meltdowns, or unexpressed physical pain (like toothaches or gut issues). The goal is often sensory grounding or an involuntary reaction to agony.

Intentional self-harm (emotional release)

Deliberate acts (like cutting, burning or rubbing, stringing, starving yourself, over exercising) used to cope with overwhelming emotional pain, numbness, or shame. It happens during peak stress, causes physical injury, and is frequently followed by guilt or remorse. This ongoing can become a normal feeling, a normal pattern or routine as it sets in on fixation within comfortable range, rather than direct intent and then moves into the self injurious behaviour. However when identified or labelled this way it undervalues the worth the effort they went through to feel.

Why it can feel so hard to stop

If your teen struggles to stop, it is not a lack of willpower. The neurochemical rush, physical pain triggers a flood of endorphins and dopamine. For an under-stimulated, dysregulated ADHD or Autistic brain, this chemical surge feels like an instant, powerful nervous system reset.

When your first reaction is panic

Finding out your teen has hurt themselves can trigger a huge reaction. Fear, anger, shock and the urge to immediately make it stop are all understandable.

But the way we respond in that first moment can make a difference.

Punishing your teen, making the behaviour feel “naughty” or “silly”, confiscating items abruptly, or demanding they “just stop” can remove a coping strategy they have been relying on without giving them something else to turn to. It can also make them more likely to hide what is happening.

What Teens Say Actually Triggers the Urge

There isn't one single reason a young person self-harms. Through my work connecting with and supporting teens with learning and neurodivergent differences, I've noticed some common experiences that can sit behind the urge.

• Feeling unseen, ignored or unheard
• Being told off, criticised or rejected
• Feeling they have no say or control over their daily routines, decisions or choices
• Experiencing bullying, arguments, yelling or situations where they feel scared
• Being physically unwell, or experiencing past trauma or grief
• Feeling completely overwhelmed by their environment
• Feeling isolated, unable to cope socially or abandoned

Things you may start to notice

Sometimes the signs aren't obvious. You may notice changes in your teen's routines or behaviour before they tell you that something is wrong. These might include:

• Avoiding family routines such as dinner
• Spending much more time out of the house or in their room
• Becoming highly focused on their body or exercise
• Taking frequent or unusual trips to the bathroom
• Repeating certain statements or becoming particularly watchful
• Things going missing around the house, such as pencil sharpeners, small knives, dermaplaners, razors, rubbers or lighters
• Frequently replacing batteries in scales
• Locking themselves in the bathroom with music turned up, or taking extremely long showers

Practical, harm-reduction steps for whānau

Once you know what is happening, the question becomes: what can we actually do?

There isn't a single response that will work for every teen. Harm reduction is about keeping them as safe as possible while also working to understand what sits underneath the behaviour. It can mean starting with the immediate physical safety of an injury, while also looking at what your teen is experiencing and what support they need.

Keep the conversation open

React with calm curiosity rather than anger or visible panic. Let them know they can come to you about an urge or an injury without being punished or immediately losing their privacy.

Focus on wound care

Keep antiseptic wipes, teach them “one use” wiping, sterile dressings, never share or use unopened, and clean supplies accessible without shame making sure they know they can come to you for help, ask for preferences of products when shopping. Use the right bandage for the right thing to stop sweating, sticking, over heating.

Show them that their body is important and worth caring for.

Teach the signs of infection

Help your teen learn what to look out for, including increasing heat, spreading redness, swelling, pus or fever, and make sure they know when to ask for medical help.

Find a safer way to meet the need

If your teen is seeking a strong sensory experience, look for safer ways to provide that input. The right option will depend on the person and what they are seeking from the behaviour. This might include sensory tools, movement, resistance activities or something else that helps them regulate without causing injury.

Some alternative ways might be squeezing or rubbing ice on their skin, cold-water facial plunges, putting a rubber band around their wrist and gently flicking it.

Other ways might be using acupressure rings, spiky sensory balls, or heavy resistance bands. Chewelry for biting urges; boxing pads or heavy weighted blankets for blunt-impact urges.

Reduce sensory load and demands

Before trying to change the behaviour, look at what is happening around your teen. Are they overwhelmed, exhausted, overstimulated or feeling like they have no control?

Dim bright lights, offer noise-cancelling headphones, create opportunities to unmask, reduce unnecessary demands and give them genuine choices where you can. Most importantly, talk to them and listen to what they are telling you.

Healing begins when we shift the question

Instead of reacting with fear or asking, “How do we force this behaviour to stop?”, we can start asking, “What does my teen's nervous system need right now? What are they struggling to feel, or seeking to feel?”

Self-harm is not something we want for our young people, but responding with shame, punishment or secrecy can leave them more isolated. Harm reduction gives us another way forward: staying alongside them, keeping them as safe as possible, and working to understand what is underneath the behaviour.

Sometimes knowing what is happening means we can support our teens far better than if they are left to navigate it alone.

If you’re unsure about what you’re seeing, want some guidance, or simply need to talk things through, you don’t have to navigate this on your own. Your GP is a great first port of call and can help you understand what’s happening and connect you and your whānau with further support if needed.