Self-harm is on the rise among teens, concerning both parents and health professionals who find it difficult to treat. A 2014 study conducted by researchers at Queens University found that one in every 10 teenagers has considered self-harming at some point. The National Center for PTSD estimates that 13 to 35 percent of students have injured themselves on purpose at some point.

But why are teenagers now turning more and more to intentional injury? Ruth Carter, now an adult, shed some light on what self-harming meant for her in her early adolescence, and how the habit was hard to break. She tells Healthline that she remembers first wanting to self-harm when she was 13 years old, working on a craft project with her fellow classmates.

“We were putting it together with hot glue and I purposely — quote ‘accidentally’ — used too much hot glue on one side of the pieces, knowing that when I pushed down, hot glue would leak out the sides and I would burn myself,” Carter said.

She recalls thinking that this was a bad idea, but feeling compelled to do it anyway, as the physical pain gave her a sense of relief from the physical and emotional abuse she was experiencing at the time.

“I felt really alone in the world,” she said. “The way I was running my life wasn’t working out, which is kind of an odd thing for a 13-year-old to be thinking.”

Carter continued to self-harm after that day until well into her mid-20s, never using razor blades or any other sharp objects, but preferring to scratch at herself until the skin broke. She describes feeling an overwhelming sense of emotional relief that she could only find within self-harm.

“That would be the way of managing my emotions,” she said. “Definitely the more stressed I was — from family situations or school or social situations — it was more likely to happen.”

Carter’s case is just one of many experienced by teens undergoing emotional, physical, and social pressures. While some will cut, scratch or pick at skin and hair, others will bang their heads against the wall or punch objects and themselves.

A recent study in the journal Pediatrics studied this rising trend in more depth, finding that self-harm was leading to an increase in visits to hospitals by adolescents — an overall jump from 1.1 percent to 1.6 percent of all adolescent visits. Researchers used data collected from a national trauma base, analyzing the records of more than 286,000 teens between the ages of 10 to 18 during the years 2009 to 2012. The study found that those who were sent to the emergency room had usually inflicted the harm upon themselves through cutting or piercing, which was more common in girls. Boys, on the other hand, were alarmingly found to use firearms. Other methods researchers found for teens to inflict self-injury were purposeful falls, suffocation and even poisoning.

Contrary to what many may believe, self-harm does not mean teens are attempting suicide. “The majority of self-harm behavior in adolescents is done without suicidal intent,” said Dr. Gretchen Cutler of the Children’s Hospitals and Clinics of Minnesota to Healthline. “In fact, adolescents are at a higher risk of non-suicidal self-injury compared to other age groups.”

Another 2012 study conducted in England actually found that only 25 percent of adolescents who self-harm reported feelings of suicide during their most recent injury. This, however, does not mean that self-harm is not linked to mental illness, or may not result in a suicide attempt in the future. Cutler warns that parents should still be alert if their child is exhibiting self-harm behavior.

“Any self-harm behavior is concerning, even without suicidal intent as adolescents who self-injure are at an increased risk for suicide attempts.”

In order to help treat those who engage in intentional injury, researchers and psychologists are trying to find the root of the need to self-harm. For many like Carter, the appeal of self-harm lies within its ability to relieve pent up emotional stress.

“Fewer of [adolescents] do it for attention, for other people to see,” says Dr. Benna Strober, licensed psychologist and certified school psychologist to Healthline. “More of them do it to self-soothe, and they don’t want other people to see it, especially their parents.”

In fact, most self-harmers will inflict injury in places like the upper arm, thigh, and upper chest, so that they are easier to hide. This is not an issue of attention at all, but an issue of pain that needs to be released in some way. Emotional difficulties, along with potential abuse or underlying mental disorders will often lead teens to self-harm in order to find relief from distress; the physical pain substitutes the emotional pain.

Teresa O’Brien, a 44-year-old resident of Dover New Hampshire describes her experience with self-harm as “a cry for help.” O’Brien engaged in cutting, or picking at her skin when she was a teen in order to find emotional release. “The physical pain certainly felt better. It kind of let out the emotional pain,” she said. “If you feel physical pain, you have something to actually hurt for.”

Because teens who self-harm take extra measures to make sure their injuries are not visible, and not all injuries result in hospital visits, doctors and parents are finding it hard to treat them. According to the study published in Pediatrics, only five percent of self-harmers were found to have a mental health disorder, though self-harm is often associated with disorders such as depression, PTSD, and bipolar disorder.

“The low number of patients with a recorded diagnosis is concerning,” said Cutler, “as this indicates missed opportunities to document mental health issues and link patients with follow-up mental health care.”

What’s more, those who do seek professional help for their harming find the habit hard to break. Strober claims that many of her patients will find difficulty in stopping because it is their only method to let out inner pain. For Carter, breaking the habit took three different therapists, and a new outlook.

“We had multiple rounds of therapy where focus was on managing my self-care, not damaging myself in anyway. It took a few years of just learning how to ride the wave of anxiety and not self-medicate.”

For many, self-harm may be the only way to feel. It is important that we do not reduce their feelings to cries for attention, but listen to what is causing these people to feel they must harm themselves, and seek to find other ways they can express their pain. Like all other mental health disorders, legitimizing their feelings is the first step to recovery.

Source: Kiger J, Heron J, Lewis G, et al. Adolescent self-harm and suicidal thoughts in the ALSPAC cohort: a self-report survey in England. BMC Psychiatry. 2012.

Cutler G, Flood A, Dreyfus J, et al. Emergency Department Visits for Self-Inflicted Injuries in Adolescents. Pediatrics. 2015.