Adolescents Who Self Harm And Their Bodily Sensations

The University of Queensland’s PhD candidate Emily Hielscher has recently released findings from a study looking closely at adolescents and self-harm (See Reference below). The results of a systematic review (An analysis of a collection of historical research studies) found that adolescents who self-harmed lacked self-awareness about their bodies.

Hielscher reported that teens who self-harmed also “didn’t feel they had ownership of their body and felt somewhat like an alien within their own skin.” It was suggested that self-harming adolescents “may not be recognising or evaluating their own bodily sensations correctly”, and that the “link between emotions and the body could be key to understanding why young people self-harm”. Hielscher reported that poor emotional control is likely to be part of the picture but that it is not suggestive as the causal links as not all that experience periods of highly aroused negative emotions go on self-harm.

In thinking about these findings I cannot but help finding myself delving into attachment and developmental theories as well as evolutionary neurobiology to hypothesize further.

Our early development begins as a non-verbal process due to the hierarchical nature of brain development (developing from the bottom to the top). This means sensory information becomes our first way of understanding the world, how we understand ourselves and our relationships with others. However, due to the normal developmental limits in language and abstract thinking (complex ideas) we need a safe bigger person who has these higher order brain skills, i.e. a primary carer, to integrate the meaning with the sensory experience.

Through a pattern of repetitive responses by a caregiver towards the infant/child, the attachment relationship thus facilitates the meaningful linkages between sensory experiences (eg. Grumbly tummy); emotions (stress) and activated behaviours (feeding/provision of nutrients). When these interactions are nested within safety, strong links are made between neural pathways connecting our experience with meaning (understanding). Stronger links ultimately lead to interpreting the world more accurately and being able to better manage these experiences (oh my tummy is rumbling – I must be feeling hungry – let’s go and find some food).

Unfortunately we know the opposite is true through cases of extreme developmental deprivation or relational disruption during this developmental period. Any fractures to any of the elements of these brain developmental processes has been shown to result in integration difficulties; misinterpretation of internal arousal; hyper or hypo sensitivity to experiences and deficits in language.

What we are potentially seeing is a disconnection between the bottom brain messages (sensory information) and the top brain messages (meaning/understanding/thinking). What we need to focus on is re-linking these processes together again. It is no wonder then that Emily Hielscher’s take home message was that adolescent self-harmers “may benefit from developing a better awareness and understanding of their body.”

In fact there are already many psychotherapeutic practitioners who are already using more body-based techniques (what is being called a “bottom up approach”) with clients to re-order their brains and facilitate a relationship between sensory experience and meaningful and accurate interpretation of these experiences. The work is influenced by Gestalt (understanding parts in relation to the whole) and attachment-based frameworks (understanding the importance of relational templates across a lifespan). Some of these practitioners include (but are not limited to) Peter Levine (Somatic Experiencing Therapy); Pat Ogden (Sensorimotor Psychotherapy); Ruella Frank (Developmental Somatic Psychotherapy); David Emerson (Trauma Sensitive Yoga).

Want to start integrating more body awareness into your practice with young clients?

1) Try googling “body mapping” and you’ll be offered a bunch of activity ideas.

2) This book by Gabi Garcia is a great tool (You can go and hear it being read on You Tube)

3) Maybe try some yoga together with your client (again google has more ideas and resources for purchase).

4) Hey Warrior by Karen Young is a great story linking brain components/processes with body experiences. Plus you can purchase a squishy soft amygdala toy as a companion for the book.


Emily Hielscher, Thomas J. Whitford, James G. Scott, Regine Zopf, When the body is the target—Representations of one’s own body and bodily sensations in self-harm: A systematic review, Neuroscience & Biobehavioral Reviews, Volume 101, 2019, Pages 85-112,


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