Cutting, burning or scratching themselves is the only way some teenagers cope with life. How can you help them? Joanna Kenrick, a teacher and author, offers advice
What do you do when you can't cope? Do you look forward to a glass of wine? A long bubble bath? A good chat? Whatever it is, you will have a favourite method of dealing with your life when it gets you down. Self-harmers have a method too, only they would prefer you not to know. Because you might think they are odd, disgusting, or crazy.
Self-harmers don't hurt themselves to fulfil some sick desire. Most do it because it's the only thing that helps them get through the bad times. It externalises the internal pain.
When I started researching my novel, Red Tears, I found this concept incredibly difficult to understand. I could understand that people who were depressed or suffering from anxiety would turn to negative coping methods.
I could even relate to the idea of self-punishment. But what would cause someone to cross the line between feeling bad and physically cutting their own arm?
One in 15 teenagers has self-harmed, according to last year's national inquiry into self-harm. Oxford University academics estimate the figure is more likely to be one in 10 for girls aged 15 to 16.
So why do they do it? Self-harmers themselves told me of their many reasons: some had been abused, some came from unstable families; many were bullied. Some were academic perfectionists afraid of failing - still more told me they felt guilty because they couldn't identify a "good enough"
reason for their self-harm.
Many of the young people I spoke to said they didn't know how to talk to their parents. Some didn't want to ask for help because it would be admitting failure, others didn't even realise that they needed help.
Most self-harmers find that the act of cutting, or burning, or scratching brings momentary relief from the external pressures of life - pressures from parents, friends and teachers. But how does it work? One theory is that hurting yourself releases certain brain chemicals that give you a "buzz", much like smoking or drinking. The rush of opiates clears a path through the internal confusion and makes the self-harmer feel calm, powerful and in control.
This would also explain why so many self-harmers consider themselves addicted to it - many people told me that the longer they self-harmed, the more serious the injury needed to be in order to get the same effect.
Conversely, a small number need to feel pain because they are suffering from dissociation - where they feel emotionally numb. Cutting or burning helps jolt their body into feeling something, anything, to prove they are still alive.
Many self-harmers take comfort from tending to the injury afterwards. For young people who feel that they are not in control of their own lives, cleaning and bandaging their arms or legs can give them reassurance that they are able to look after themselves.
Almost all of the self-harmers I spoke to said that their self-harm was nothing to do with suicide. Suicide ends life; self-harm prolongs it. "If I didn't self-harm, I'd probably kill myself," said one girl, paradoxically.
She wasn't being deliberately contrary; self-harm had become her only coping skill. Of course, many self-harmers do have suicidal thoughts, and long-term self-harmers are at greater risk of eventual suicide, but it is important to grasp that suicide and self-harm are different. On the whole, self-harmers don't want to kill themselves - they want to live.
So why are so many teenagers turning to such a destructive coping method? Of course, there isn't just one answer. But some ideas pop up time and again: academic pressure, bullying, the internet.
The current education system places more pressure on teenagers than ever.
And unlike a few years ago, it is constant. In many secondary schools, pupils are graded on achievement and effort as often as every six weeks.
Between the ages of 14 and 18, they face four sets of major public exams: key stage 3, GCSEs, AS and A2 levels. Many courses are modular, meaning pupils sometimes have exams every term which count towards their final grade. There is no room now for "late developers": if the pupil is not progressing in line with national standards there is no leeway for catching up.
The pressure placed on teachers to get results is naturally passed on to pupils. Sarah Costello is 17 and has been self-harming for four years.
"Teachers are the worst for putting pressure on us," she says. "While they want the best for their pupils, putting the school at a high rank in the league table is their priority."
Sarah is a perfectionist. Her self-harm stems from frustration with her own achievements and her inability to deal with her emotions productively. She has also been bullied. Bullying happens in all schools - the difference for self-harmers is that they have not usually managed to find support elsewhere. Frustration, anger and guilt leads to a lowering of self-esteem and in some cases clinical depression.
The internet, meanwhile, has enabled thousands of self-harmers to share worries and experiences. Undoubtedly this has improved their lives as they discover they are not alone and that there are people who have been through it and come out smiling. However, there is a real concern that vulnerable young people are exposed to ideas they would not have had on their own.
Teenagers who spend time in chatrooms because they feel they cannot talk to people "IRL" (in real life) come across other troubled teens. They naturally talk about their problems and the way they deal with them.
Self-harming can be promoted as a valid way of dealing with stress. And after all - it's your own body, isn't it? But if it works, self-harming can become the only coping skill a teenager has. Without exception, all of the self-harmers I spoke to said they wished they had never started. This is not the same as wanting to stop. It's one thing to recognise that the behaviour is destructive but quite another to stop doing it. The feelings that caused the action are still there.
In contrast to the "genuine" self-harmers, there is a growing minority of teenagers who self-harm because "it's what my friends do". These are the girls who walk around displaying their scarred arms, actively asking for pity and sympathy - girls who are labelled "attention-seeking" and manipulative.
Yasmin Eshref is 19 and started cutting herself at the age of 13, although she recognises that she had been self-harming in other ways since the age of six. "In a weird way, self-harming is seen as quite a cool thing to do,"
she says. "For a lot of teenagers, self-harm is about being glamorous, and gothic, and making a big statement about how unhappy they are."
N (name has been changed), aged 24 and a self-harmer for 10 years, agrees. "My sister and her friends at school seemed to think that your problems weren't worth anyone worrying about unless you self-harmed to show how serious it was."
The rise of self-harm among teenagers should be setting off alarm bells for teachers, parents and anyone who comes into contact with young people. The fact that so many young people are not learning the skills they need to deal with the stresses of life should be a matter of concern. We are all guilty of sometimes dismissing a teenager's problems because, after all, that's what being a teenager is about, isn't it?
Sarah Witkowski-Baker is 18 and lives in London. She says: "We've all heard an adolescent say `nobody understands me' but this is rarely, if ever, taken seriously. Teenagers are expected to feel like that. The fact that it's a genuine, upsetting feeling or problem is disregarded. And being invalidated can really hurt."
More adults than ever are in therapy or being diagnosed with mental health, personality or learning disorders. If people don't learn how to deal with stress as a teenager, how can they be expected to deal with stress as an adult? Perhaps it's time we looked at prevention at 15 rather than cure at 35
Joanna Kenrick lives in Oxford and teaches English and drama at Wychwood School for Girls. Red Tears is her first Young Adult novel. She has previously published a picture book and two short stories for teenage reluctant readers. Red Tears is published by Faber and Faber at pound;6.99