"We have gone from teenagers facing the world to teenagers afraid of the world."

"When we talk about non-suicidal self-injury , we can distinguish two main groups. On the one hand, there are those that serve a more intrapersonal function, that is, when the person uses self-harm as an attempt to regulate their emotional distress. Some adolescents, especially in the last ten or fifteen years, incorporate self-harm as a very maladaptive way of coping with emotions common at this stage of life, such as sadness, anger, hopelessness, or distress."

On the other hand, there are other teenagers who use self-harm as a way to communicate their distress , with a more interpersonal objective. Perhaps unintentionally, they are conveying their disagreement with someone or something, and they haven't found another way to express it.

And sometimes, within this more interpersonal function, many teenagers have found in self-harm a sign of identity ; they feel a sense of belonging to a group of teenagers who also cut themselves and with whom they share their distress. These are teenagers who identify with emotional distress. These are complex cases because they don't self-harm in response to a specific negative emotion and they don't have a mental health problem. In fact, most teenagers who self-harm do not have a mental health disorder.

"It's a very interesting topic because it has a strong social dimension and speaks to how adolescence has been constructed today. What we know for certain is that self-harm has a significant social contagion . We see this often in classrooms. And we also know that emotional distress has become a defining characteristic of adolescence. Thirty years ago, for example, the adolescent of today was someone who confronted the world, rebellious, transgressive, engaging in questionable and undoubtedly maladaptive behaviors, but not through self-harm; rather, it stemmed from a confrontation with the world. Now we have adolescents who are afraid of the world ."

Emotional distress has become a defining characteristic of adolescence today. We've gone from rebellious teenagers to teenagers anxious about life.

It is also clear that there has been a social shift that has made these behaviors more widely accepted and less stigmatizing , because adolescents often feel more understood by other adolescents with similar characteristics who have used these behaviors as a coping mechanism. What does continue to create stigma is having a mental health disorder.

"It's true that we always tend to think that previous generations have been better than the current one. Teenagers are more easily dysregulated because, aside from hormonal changes, they face complex challenges at this stage. This has always existed, and it's true that we shouldn't dramatize it. But there's a combination of factors that can explain why we're seeing an increase in teenagers who self-harm. In addition to the identification we mentioned earlier with distress, with the anguish of living, we also have teenagers who are much less resilient than 25 or 30 years ago, as various longitudinal studies have shown. Therefore, they will feel the same emotional distress, but they will manage it less effectively because they lack the skills to do so."

All of this creates a feeling in adults, in parents, that they are facing a situation for which they have no tools. In other words, I feel strong enough to say no to a teenager, even if they get angry, but when I set limits and they respond with self-harm, I feel helpless.

That's why I believe it's incorrect to analyze self-harm solely from a mental health perspective; it needs to be approached from a much broader sociological viewpoint. We're not dealing with "sick" teenagers; we're facing a shift in the social construction of adolescence, a shift in which we've all played a part.

"The challenge in discussing self-harm is maintaining a balance between not panicking, exaggerating, and assuming it's always linked to a mental health disorder (which is the risk we face because we've become accustomed to it being that way), and thinking that self-harm is just a 'childish prank' typical of adolescence, because, whatever the case, it's unhealthy behavior. In fact, we have data and know that adolescents who self-harm frequently, repeatedly, are at greater risk of suicidal behavior , for example."

The key is to thoroughly screen anyone who self-harms to determine if there is an underlying mental health disorder, and whether the intervention should focus on broader social goals, not just psychological and emotional ones. It has been shown, for example, that teenagers who feel they have a peer group, who are part of the group at school, and who can rely on them for outings on weekends, are less likely to engage in self-harm. But if a mental health disorder is present, it must be treated.

Teenagers who are part of a group at school and who can count on them to go out on weekends have a lower risk of self-harming behavior.

In other words, we must not deny the reality of serious and recurrent self-harm in adolescents, who sometimes have a disorder or the beginning of a mental health disorder, but we must be aware that there are also adolescents who self-harm occasionally as a maladaptive way of coping with the world and who, often, when they have other regulation strategies, stop doing it."

To begin, they need to recognize their emotional states. Nothing comes from nowhere, and usually when someone cuts themselves, it's because there's been a change in their emotional state. It's important to work with the teenager on the cause of this state : what upset you to the point of feeling sadness, anger, hopelessness, or misunderstanding? Sometimes they simply tell us, "That day I didn't get out of bed, I didn't go to school, and I started thinking..." And we help them see that there are small signs, like in this case, staying in bed, that indicate they might end up self-harming. Therefore, let's change this situation. Even if you don't feel like it, start the day, go to school, not to perform well, but to follow a daily routine. However, when self-harm increases and you only think about cutting yourself, let's create a safe environment, without anything in the room that could be used to hurt yourself.

Often, they themselves tell us which specific strategies work for them by explaining what they do when they're not self-harming: "I dance, I listen to music, I go to the gym, I meet up with a friend and talk to her..." Ultimately, it's about giving them simple alternative behaviors based on their hobbies and interests, helping them see that they have the capacity to control their behavior. And also teaching them how to ask for help.

I always explain the same thing to them: You don't choose what you think and feel, but you do choose what you do. We have to empower them; we can't treat them as vulnerable people, because that won't allow them to be resilient.

“Teenagers like to feel validated in their emotions. Therefore, the first thing parents, as adults, must do is not minimize their emotions . If they tell us they cut themselves because they argued with a friend, we shouldn't say things like, ‘If I had to cut myself every time I argued with my boss…’ Validating their feelings means saying, ‘I understand you might feel bad, because when I've argued with someone I care about, I've felt bad too…’”

It's also important that life doesn't come to a standstill . For example, it's not a good idea to decide to stop going to school unless advised by a qualified professional. If we want to help them become resilient, they need to engage with daily life's challenges, and we can't simply shut down when we're going through tough times.

The media must start showing role models of teenagers with conventional lives who cope with things in an adaptive way.

And we must begin to demystify the idea that the goal in life is emotional well-being , is happiness. We must accept that there will be moments of discomfort in life, and when this happens, the goal is to know what we can do to face them, to have strategies that allow us to cope with them as best as possible.

Finally, the media must start showing role models of teenagers with conventional lives who cope adaptively. We need to see teenagers again in the streets, laughing, having fun, enjoying themselves, having their disagreements, but not considering self-harm as a way to solve their problems.