Source: Jetrel/Shutterstock

About 1 in 4 girls and about 1 in 10 teen boys in the U.S. report deliberately harming themselves without intentions, a new report has found—one of the first to examine self-harm outside of a clinical setting, its authors say.

The report, published last month in the American Journal of Public Health, used survey data from more than 60,000 adolescents, ages 14 to 18, across 11 states; the data was collected by the Centers for Disease Control and Prevention (CDC) in 2015 as part of its Youth Risk Behavior Surveillance System. Teens were asked if they had deliberately hurt themselves, with no intention of suicide, at any point in the previous year. Overall, 17.6 percent of the sample indicated that they had—approximately 24 percent of girls and 11 percent of boys.

Rates of non-suicidal (NSSI) varied widely by state; in Idaho, for instance, more than 30 percent of teenage girls and 12.5 percent of boys reported recent NSSI; in Delaware, 17.7 percent of girls and 6.4 percent of teen boys did. Only 11 states opted to ask the self-harm question and had enough responses to be included in the study, somewhat limiting the dataset, says Nick McRee, associate professor of sociology at the University of Portland and one of the study’s authors. Still, girls reported higher rates of NSSI than boys in every included state.

“The numbers for females are particularly disturbing to me,” he says. “This is a really, really high prevalence of self-harm.”

Certain factors, such as being bullied or identifying as LGBT, were linked to a greater likelihood of self-harm. These risk factors were associated with self-harm for both genders, McRee said, but girls in the sample reported them more frequently.

Most self-harm studies in the U.S. have been conducted in clinical settings, McRee says, and involve a conversation between a pediatrician and a teen. Since those studies were necessarily limited in their size and scope, it was difficult to determine if their results could be extrapolated to the larger teen population. “What we’re adding is that this behavior is not restricted to the clinical population,” he says.

This study found a slightly more pronounced gap than past datasets have shown, says Janis Whitlock, director of the Cornell Research Program for Self-Injury Recovery. The self-harming teenage population is typically found to be about 65 percent female and 35 percent male, she adds.

“NSSI is usually undertaken, paradoxically, to make you feel better,” she says. “It tends to move someone from a state of high agitation or high disassociation to a state of calm.” It can also be used as a way to prompt or expressions of sympathy, particularly for adolescents who feel particularly alone in their emotional challenges. “The psychological desire to feel better (that is at the root of NSSI) is really healthy—but the behavior itself is unproductive in the long run.”

Whitlock, who was not involved in the study, cautioned that the broad nature of the self-harm question may have skewed the data slightly, particularly for male respondents. “Some of the things that young men do that we would consider self-injurious”—like punching an object with the conscious intent of hurting themselves—“wouldn’t come to mind” when asked one yes-or-no question about self-harm, she says.

McRee acknowledged that limitation, but added that since the study’s results sync up pretty closely to data from clinical settings—where questioners can be more explicit. “That gives me some that kids aren’t necessarily interpreting the question differently than they are in a clinical setting,” he says.

Self-harm of this kind is a relatively new subject of study, according to Whitlock. Though clinicians have been aware of it, particularly among adolescents, for decades, it was often examined only in its relationship to suicidal thoughts or behavior. Studies on NSSI have only begun to pick up speed in the last 15 years or so, she says, with the first representative study of U.S. college students conducted by Whitlock and colleagues in 2006.

High rates of self-injury, like those found in the current study, can appear alarming—particularly to parents—but it’s hard to know exactly how much they’ve changed over time because the data is limited, Whitlock says.

McRee and his colleagues undertook the study because they “were concerned that the behavior might be widespread”—a concern that seems to be justified. “Those numbers really suggest that youths engaged in that behavior are not an isolated subset of the population.” Acknowledging this is critical to adequately addressing the problem, he says, because for teens and parents struggling with self-harm, “it’s easy to conclude that they’re alone.”

In order to properly address the high rates of NSSI, McRee and Whitlock argue, the issue should be viewed as a public health problem. “It’s going to require a multi-faceted approach,” McRee says, one that will ideally include public awareness efforts, improved outreach to at-risk youths, and further study of the broader social factors that lead to teen self-harm.