It's rare to find a teenager not connected to some smart device.

QUESTION: I am married with three children – a girl and two boys – and have what I considered a fairly average family life, up until last weekend.

My daughter, our eldest, who just turned 16, told us she had self-harmed on at least two occasions over the past six months. Last night she revealed she did it again.

She is a beautiful, bright girl with a boyfriend and a few close friends. However, she has always had self-esteem issues and is wracked with self-doubt about everything. She finds social situations very difficult and performs much better on a one-to-one basis.

School is a very stressful place for her as she finds coping with people she doesn't like very difficult.

When I suggested we get her to a therapist she told us, point blank, that she will not discuss herself with “complete strangers”.

She said she did not want to kill herself but wanted to hurt herself because she thought she deserved it, and that there was a release of sorts and a sort of adrenalin rush associated with it. It is breaking our hearts that our sweet baby girl is doing this to herself despite our best efforts to give her a life of love and support. I feel so helpless.

She won't accept any help. I worry desperately that she will kill herself.

ANSWER: Self-harm is a common problem for teenagers, with one study finding that about one in 10 teenagers self-harms, with girls three times more likely to self-harm than boys.

Drug overdoses, with medicines like paracetamol, are the most common method of self-harming. However, the self-harm you describe appears to be cutting.

Self-harming is terribly worrying for parents. It can also be worrying and distressing for the teenager too. Typically, cutting occurs for much the same reasons your daughter describes: it offers relief from bad feelings.

Teens who cut themselves are rarely trying to kill themselves. Even though your daughter has cut herself, it doesn’t mean she is about to commit suicide. The act of cutting or scratching herself is, most likely, a coping mechanism for dealing with strong emotions, intense pressure or the stresses of social interaction. This happens because either she hasn’t developed effective ways to cope or her coping skills may be overpowered by intense emotions.

It seems, therefore, that on three occasions she has been overwhelmed by particularly troubling feelings and has found that cutting herself gives some relief.

Unfortunately for her, any relief will be temporary. Your daughter will already know that whatever troubles triggered her to cut have still remained; they were just briefly masked.

Self-harming can become a compulsive behaviour because the brain starts to connect the false sense of relief with the act of cutting, and it craves this relief the next time the tension builds. So, what does remain a worry is that she may fall into a habit of using cutting and self-harm as a means of dealing with emotional stress or pain.

Also, it is possible she may become hopeless about her ability to cope and this may increase her risk of considering suicide.

What is really positive for her, and for you, is that she has chosen to tell you about her self-harming. For many teenagers, the cutting can remain secret for years.

Opening up about her self-harming behaviour massively reduces the risk of it becoming either a compulsive habit or escalating to suicide.

I do recommend you get professional help for her, even if she is resistant. Although most youngsters who self-harm by cutting do not intend to hurt themselves permanently, it can happen. It’s possible to misjudge the depth of a cut (meaning it requires stitches) or it can become infected. Moreover, she really needs help to learn some effective coping strategies to deal with troubling feelings or stressful social situations.

In the first instance, she needs to identify exactly what troubles she found that the cutting helped to relieve. You have identified that her self-esteem is low. Her own comment about feeling she deserves to be hurt or damaged also points to low-esteem.

But, why does she think she deserves to be hurt? What issues had arisen in the days or weeks before she cut herself each time? You can help her identify some of these things, but you may find she needs more specialised help from a good therapist who specialises in working with teenagers and is familiar with the dynamics of self-harm.

Don’t give her a choice about seeing a therapist. Once she is in the door it is up to the therapist to help her realise that, like taking the risk of talking to you, talking is the best way to avoid self-harming.

Take advantage of the fact she has opened up to you to encourage her to open up further. You may find that it helps to talk to her potential therapist yourself, in advance. This may give you a sense of what you can do to help and also give you some ideas to further encourage her to the door of the therapist’s office. – Irish Independent