Social Anxiety: How to Manage Well

Social situations tend to make many of us anxious. Some of us find meeting people a challenge. Walking into a place where there are people we don’t know makes us uncomfortable. It is common to try to work around these uncomfortable situations in order to survive in the world.

Anxiety can prevent us from taking part in social activities. It can cause us to have problems at work or keep us from going to gatherings. When we are missing out, it is high time to take a close look at our anxiety and the social phobia it is causing in order to better understand it and to better enable us to get help.

When Social Anxiety Becomes a Disorder

The more you know about a problem, the easier it is to find a solution. The same is true with social anxiety and the disorder behind it. Learning more about the diagnosis of it and what it entails will help you assess your symptoms so you can determine whether seeking mental health assistance is advisable. In the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (or, DSM-5), Social Anxiety Disorder is described as:

“Marked anxiety or fear having to do with a social situation, or situations, where the individual is exposed to the possibility of being scrutinized by others. It might be brought on by something like a conversation with another person or persons, meeting new people, being observed when drinking, eating or something similar, and/or performing or speaking in front of others such as giving a speech.”

In children, the anxiety must be brought on in a setting that is pure rather than just when they are interacting with adults.

The individual has anxiety and fear of acting in a certain way or of showing the symptoms of anxiety in a fashion that will be viewed negatively such as being embarrassed or humiliated which will ultimately lead to being rejected by or offending others.

The situations are typically socially oriented and almost always instigated by anxiety or fear. It is common for children to express their anxiety and fear through crying, freezing, clinging, throwing tantrums or not speaking when they are in social situations.

Social situations which provoke negative emotions are either endured with great anxiety and fear or avoided altogether. The degree of anxiety or fear is exaggerated in comparison to the threat that’s posed from the situation or the socio-cultural context. Generally, the individual experiences the anxiety and/or fear for a period of six months or longer.

The negative feelings of anxiety or fear or the action of avoidance bring on significant clinical distress or the inability to function properly in the individual’s occupation, social life or another important area. It’s important to note that the avoidance is not brought about by drugs, illicit or prescription.

If there is a medical condition that exists (like Parkinson’s disease, disfigurement from injury or burns, obesity or such) the problem is only classified as social anxiety if it is not caused by the medical problems or if it is in extreme excess.

Self-diagnosing is not wise when you are concerned if you have a mental disorder just as it is not advisable to self-diagnose when wondering about medical problems. It is imperative to be certain that you are given the correct diagnosis and, if warranted, the right treatment as well. It is recommended that you incorporate time with a therapist to ensure you get the proper diagnosis.

Rekindling Our Bodily Connection

Anxiety is never comfortable. That is why our natural reaction is to get as far as we can away from it. We do whatever we can in order to avoid feeling it. The problem is that this type of reaction is counterproductive to the diagnosing of the problem and to successful treatment. With this in mind, the next time you feel anxiety creeping in, try to turn to it instead of away from it. Acknowledge your feeling. Don’t hide from it.

It is also helpful to approach it with curiosity. Ask yourself where you are feeling it. Perhaps it is in your stomach, or the area around your chest or in your neck. Sometimes, tingling fingers or hands accompany fear and anxiety.

Try to get a grip on it through taking deep, controlled breaths. Breathe in through your nose and then out slowly through your mouth, counting to three. Once you have completed the deep breathing exercise, attempt to figure out what the trigger is.

There are times the trigger will be obvious. You may suddenly recall that you are about to go to a party where there will be a number of people you don’t know. Or, it may seemingly come out of nowhere. It is a good idea to ask yourself where it came from anytime your anxiety or anger rises suddenly. Even if you don’t have the answer, you will be taking a step toward your recovery.

Trigger Complexities

Our mind, body, and emotions are all interconnected which means there can be a myriad of possibilities when it comes to causes for our anxieties, social ones included. It is a defense mechanism that we develop early on to deal with traumatic experiences. We naturally defend ourselves against further harm and protect ourselves from the pain as well.

Imagine you are in a dark room full of furniture. You can’t see the furniture so you continue to bump into it time after time. A therapist helps you to identify and understand the triggers you have, much like illuminating the furniture, one piece at a time.

When you can clearly see the furniture, the less likely you are to run into it as much and when you happen to, you know just what you ran into. Throughout the course of time, you may even decide to move the furniture elsewhere rather than it being in the middle of the room where you easily bump into it.

Understanding Social Anxiety

It is conducive to have a range to work with when we are trying to get a handle on our anxieties in social situations. When you note that it is rising, assign it a suitable number. “I feel my anxiety is at a 7 on a scale where 10 is the highest,” you may tell yourself. If you find your anxiety is in the 7-and-over range much of the time, it would be a wise idea to set up a meeting with a qualified therapist.

If you leave high anxiety unchecked, you can condition your body to be chronically anxious. That is why there are some disorders of anxiety that only get better with medication.

When you have identified the degree of your level of anxiety, the next thing you will want to do is to make an attempt to lower it by using the tools you have at your disposal. When our anxiety is soaring, it is very difficult to think with a clear head and deep breathing can be helpful at times like this. It sends a signal to your sympathetic nervous area (the system that deals with fight or flight) that it is alright to be calm as there is no danger.

While you are doing deep and slow breathing, you can try to think and focus on just one thing. It might be a smooth stone, a waterfall or a word. Since our minds can only handle thinking about one thing at a time, it becomes impossible to dwell on the fear at hand when we are thinking about a stone or waterfall. Initially, it may be difficult to do because we feel as if we are thinking of a million things at once, but in reality, our minds are just racing with many thoughts coming at us, one by one.

Controlling our focus is the key to stopping the circus. It takes some practice but it can be done. When you think of positive things about yourself, you will find that your anxiousness subsides. A good bit of the worry we have is based on things that are not true. You may feel God is going to punish you for something or that you are going to get a disease. Think of fears you had in the past that never came to pass. That is very helpful in recognizing the unwarranted fears.

Putting your thoughts and feelings into perspective is helpful too. Since there are millions of things that have the ability to kill you, you can see how it is a complete wasting of your time to try to figure out which of those things you will die from. Living in the here and now means not being obsessed with the past or the future. Now is all we have anyway so, why not chose to live in it?

It will be easier to think clearly when your anxiety has subsided and is under control. That is the time to think about the root of your social anxiety. Know the difference between normal anxiety and anxiety that is not typical. If you are at odds with someone and are nervous about running into them, that is normal. But, if you fear to encounter anyone, that is not.

What is it that scares you about the given situation? Do you worry that you will not know what to do or say and will look foolish? Are you afraid you will say something but it won’t be appropriate? Do you fear you will fall or break something and look clumsy?

In each one of the cases mentioned, fear is the underlying factor. You are afraid of looking foolish or like a jerk. You are afraid that you will be rejected or hated. While the fear is not legitimate because it is exaggerated, it certainly feels true. Until you take it by the horns. Realize that one of the greatest fears humans have is abandonment. Do you fear you will be left alone?

The stakes seem incredibly high when social anxiety tells that you will do or say something so bad that you’ll be hated, despised or abandoned. But when you start to understand more about the situation, you can make a plan and have a way out. You can control and manage your situation and fight the lies that you have let yourself believe.

Managing Social Anxiety

There are many experiences when it comes to anxiety and everyone is different. It is not possible to address each possible situation so I will be using a few vignettes with various examples of possibilities for the approaches. These are generalized in order to hopefully paint a picture that many can imagine themselves in.

First Vignette – A twenty-eight-year-old male is employed at a large company where there are no inside walls and the individual desks are grouped. Each person in the area views and contributes to everyone’s work. One day, the man walks into the area and his heart begins to race. He feels like he is getting dizzy and reaches to steady himself. He gets out of the building as quickly as he can and the thought of ever going back paralyzes him with overwhelming anxiety.

Approach Possibilities – When there is a symptom of dizziness or any form of chest pains, it is certainly recommended that a physician is consulted in order to rule out any medical causes. If medical causes are ruled out, then you can look further into the root.

One thing to check into is if anyone he is not comfortable with moving in closer to his proximity. Has the work he has been doing been brought into the spotlight and he has been ignoring it to where it has become an insurmountable anxiety? Perhaps the close quarters in his work setting is finally closing in on him. Is there anything about the area of his workspace that has undergone change or has any of the relationships changed?

If all environmental factors have been ruled out, it could very well boil down to a psychodynamic contributor, like having an overly critical father or mother who continually made him feel belittled. While this issue is one that can take some time to really work through, there are short-term solutions that can temporarily help to boost his self-confidence.

This is where the tools mentioned above could really help to calm anxiousness in the moment. Focusing on one single thing could be very helpful. If the given anxiety has continued for over six months, it might not respond to somatic techniques in which case, a visit with a qualified psychiatrist might be in order to talk about the possibility of an anti-anxiety prescription. Persistence and patience when pursuing a diagnosis is the best route to getting the best care possible.

Second Vignette – A thirty-something-year-old female always has anxiety creep up when she is in public, but one night when she is at a party where she doesn’t know hardly anyone, she gets so anxious that she has to flee the party.

Approach Possibilities – Like the man in the first vignette, the manifestation of chest pains or dizziness is a good indication a doctor should be seen as a first step.

If leaving the party helped to calm her, it might be of help to rule out the environmental factors that could have possibly been present. Asking if there was anything in the room that seemed to be threatening in some familiar way is a good place to start. Smells can initiate triggers too. Was there a smell that could have triggered an old trauma response emotionally?

Perhaps someone vocalized something that triggered the response. Maybe there was a person who appeared to be familiar but who she couldn’t seem to place and that mentally distressed her. And, there might be a person who had a similarity to someone within her past who was threatening.

Environmental factors should be ruled out and psychodynamic roots can be addressed and looked into too. Taking steps of desensitization may well be the most helpful answer so that she doesn’t have to avoid going to parties for months or even years.

The first thing she might attempt is to go to another party in order to see if the problem is a recurring one. Then, she could try meeting a stranger and a friend together. Then she could be around one friend and five or so strangers at once.

As she does this, she should monitor her anxiety level and also watch for triggers. She can then begin to get in touch with the level of her anxiety and can work to develop solutions for workarounds and also to address the specific issues she has.

While there are common factors, everyone’s individual anxiety is different. It is something that is unique to them and only them. It takes courage and it takes determination to face fears and to wonder about them so we can reduce anxiety by developing and using techniques.

If anxiety is disrupting your life, it is time to get help so you can explore your thoughts and feelings. Getting help will help you take steps toward a life of growth and better health. You can be free.

“Anxious,” courtesy of Sascha Berner,, CC0 License; “Thinking,” courtesy of Jacob Botter, Flickr CreativeCommons (CC BY 2.0); “Stretch,” courtesy of Jacob Postuma,, CC0 License; “Alejandra thinking II,” courtesy of Luis Alejandro Bernal Romeo, Flickr CreativeCommons (CC BY-SA 2.0)

How Do I Know if I Need Help for Depression?

Emotions, including sadness, are a natural part of what it means to be human. As much as Facebook friends might never admit it publicly, life isn’t all “likes” and “shares.” When sadness becomes all-encompassing and debilitating over an extended period, it may be time to consider the need to get help for depression.

We’ve all heard of depression, but how much do we really understand about it? It’s often misunderstood in terms of its clinical diagnosis and greatly overused in pop culture.

According to a recent 2016 national survey on drug use and health, an estimated 16.2 million adults 18 or older across the United States experienced at least one or more major episode of depression (SAMHSA, 2016).

This number represents nearly 5% of all adults (Bureau, 2016) with the highest percentage of occurrence among adult females (8.5%). From 2005 to 2015 depression had the highest increase among teenagers with the most rapid increases seen in young people (A. H. Weinberger, 2017).

When Should I Get Help for Depression?

Because depression can vary in how it presents itself, it’s difficult to know whether it’s truly a mental health concern or simply a case of the blues.

Below are some of the more common symptoms of depression that you should be aware of:

A pervasive feeling of sadness and hopelessness

Changes in emotional functioning are one of the most noticeable early signs of depression. You may notice yourself feeling more irritable, or just plain sad more days than not. Things suddenly feel hopeless, crying becomes a daily routine, sometimes for no clear reason.

You may begin to blame yourself for your condition and the lack of control you feel with your emotions. This is often accompanied by growing feelings of anger internalized to yourself.

Things you might find yourself saying things like:

  • “I can’t do this anymore.”
  • “Why do I feel this way, no matter how hard I try nothing changes?”
  • “I should just give up.”

Lashing out and reduced patience

If you’re noticing that you’re very short-tempered or yelling at your spouse or kids a lot, or otherwise lashing out. Instead of working through your feelings, and identifying their root cause you may project them onto others, blaming those around you for the feelings you have about yourself.

Things you might find yourself saying:

  • “You don’t understand me, you never have.”
  • “All you do is think about yourself, you don’t care how I feel.”
  • “Why am I always angry, I hate myself. I’m a horrible parent.”

A lack of appetite or disinterest in food

A sudden change in weight, either gaining or losing, can be a warning sign of depression. You may lack appetite, or no longer remember the last time you ate or have interest in foods that were once enjoyed. This is often tied to feelings of low self-worth regarding body image.

Things you might find yourself saying:

  • “No matter how hard I try, I’ll always look this way. I can’t change a thing.”
  • “I cry by myself and then I eat, it’s what makes me feel better for a short while.”
  • “I’m not hungry right now.”

Fatigue, lethargy, reduced physical activity

Another common symptom associated with clinal depression is being extremely restless at night and constantly tired during the day when awake, with little to no motivation to get out of bed to start daily activities. Going to work, or getting the kids on the bus in the morning becomes overwhelming. Even trips to the grocery store may begin to seem like they are simply too much to handle.

Things you might find yourself saying:

  • “Can we go out another time, I’m just not up for it today.”
  • “I’m falling behind on my work, I just can’t keep up. Who cares anymore, it doesn’t matter.”
  • “Why am I so tired all the time. I can’t get any good sleep, I just need to rest a little longer.”

Having feelings of worthless or excessive guilt

You may experience increased feelings of guilt about things that have occurred in the past. Regret and a growing sense of how little you matter to the fabric of everyday life with your friends and family may begin to fester. This often is accompanied by an increased or sudden onset of thoughts of death or dying.

Things you might find yourself saying:

  • “It might be better for everyone if I wasn’t around anymore.”
  • “It’s as if I didn’t exist now, no one even notices that I’m not around.”
  • “No one cares about me, and why should they, I’m a mess.”

A loss of interest interesting or pleasurable activities

It is common for people who are experiencing depression to experience a decreased or complete loss of interest in life. Things that once provided a sense of accomplishment or fulfillment no longer provide any satisfaction. Spending time with friends or family becomes more of a chore as isolation and solitude increase.

This often results in even greater feelings of worthlessness as one considers a possible reality where they are no longer tethered to the lives and activities of others they once identified as foundational to their sense of self.

Things you might find yourself saying:

  • “It doesn’t matter. Nobody cares about me anyway.”
  • “I’m all alone.”
  • “They will be better off if I’m not there. They don’t want to spend time with me anyway.”

Hope Through Christian Counseling

If you are reading this and you are concerned that you are experiencing one or more of these changes in functioning, health, or lifestyle, it is important that you seek treatment to determine the underlying cause.

Many different issues can be at the root of the emotions that cause symptoms of depression. A number of counselors at Huntington Beach Christian Counseling work directly with individuals and families who struggle with depression.

Give us a call and we can meet with you today to help you find the path to a functional and enjoyable life once again.

ReferencesA. H. Weinberger, M. G. (2017, October). Trends in depression prevalence in the USA from 2005 to 2015: widening disparities in vulnerable groups. Psychological Medicine.

Bureau, U. C. (2016, July). Quick Facts United States. Retrieved from US Census:

SAMHSA. (2016). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Retrieved from SAMHSA:


“Depressed”, Courtesy of Anh Nnguyen,, CC0 License; “Eruption”, Courtesy of Yosh Ginsu,, CC0 License; “Depressed”, Courtesy of Alex Boyd,, CC0 License; “Depressed”, Courtesy of Ian Espinosa,, CC0 License

What Makes Teen Depression Different from Depression in Adults?

Picture this – everything is changing. Your body is maturing. You are being given more and greater responsibilities. Fun and friendships are a big focus, but you seem to have neither.

You know tons of people your age, but can you trust them? Do they even really like you? Just who are you anyway? Suddenly, you are second guessing everything and everyone, even yourself.

Even the normal things you did are not the same. The insatiable appetite you once had has dwindled to barely being hungry at all.

You find it next to impossible to fall asleep yet it’s a grueling task to drag yourself out of bed the next morning. You find yourself in a low or bad mood much of the time. Nothing feels right anymore. Does this sound familiar?

If the symptoms above describe how you are feeling, chances are you are either a teenager, you are suffering from depression, or both. Given the body’s chemical changes and the challenges faced in general, just being a normal teen can resemble depression in many ways.

The teenage years are full of highs and lows. The rollercoaster ride of the turbulent teens can be rocky enough without adding depression to the equation. The combination of being a teenager and being depressed at the same time can be overwhelming.

Teen Depression

The fact is that depression in teens is different from depression in adults because teenagers are different from adults. Some of the differences are as follows:

The Social Scene

A sense of low self-worth is a common indication of depression. Feelings of unworthiness are often all-consuming. Negative self-talk tends to be a huge part of the cycle. The stress and anxiety that these struggles cause is heightened even further by a lack of drive or motivation.

One way in which we all tend to decide how we measure up is by comparing ourselves to others. Have we accomplished all that she has? Will we ever be as good as him? When comparing physical traits like weight, body proportions, and looks, it can easily get out of hand.

Comparing ourselves is a natural thing to do but a very destructive one too. Think about it – when comparing, you will either come up on the high or low end of the stick. Neither is conducive to a healthy self-image.

Depression has a voice that speaks to our heart and minds. The message is never a positive one. It tells us things like that we are not good enough, not attractive enough or not smart enough. We are easily deceived into believing lies, especially when we are comparing ourselves to others which only fuels the fire. As we look outward to set our standards, we are passing judgments inwardly.

The teenage years are a time of tremendous transitions. During adolescence, your body is changing from that of a child to one of an adult. Boys’ voices are cracking and changing. Girls are developing chests. While initially, it is a time of pride and excitement, the whole scenario can all change in a heartbeat when the class laughs at the shrieking voice or the girl gets whistled at by a crowd of boys.

Girls are generally the first to undergo visible physical changes. The earlier they do so, the more difficult the adjustments may be. They take note that they are “different” which can make the changes even rougher. Soon enough, boys find themselves in the midst of puberty, too, and begin comparing themselves and their changes to that of their peers. Late bloomers may have the hardest time of all whether male or female.

Teenage girls may feel as if they are in a whirlwind, being pushed into womanhood too fast, too soon. They may long to stay a little girl for as long as they can. Boys can feel left out and lonely if they don’t shoot up in height, begin to talk in a deep voice and no facial hair is surfacing. It’s easy to feel like the boat left without you. Or, that you are the only one in the boat.

Going through the various stages of puberty is enough to deal with but the fact that teens tend to experience them in different time frames can be extremely frustrating and difficult to adjust to. These factors are very challenging for even well-adjusted teens so when depression is thrown into the mix, you can only imagine the complications.

Modern technology, especially social media, hasn’t made the situation any easier either. Although bullying has been around probably since the beginning of time, within the past 20 years, it has taken on a new face. It is ever-present. It used to be that if you were being bullied, you could at least escape within the confines of your own home. That’s not the case any longer, though.

Smartphones, tablets, and platforms like Facebook, Twitter and Snapchat have changed the dynamics of teenage lives forever. Through posts, tweets, texts and messaging, bullies can stalk their prey even in the privacy of the victim’s home.

The hurtful words can come through at any time of the day, anywhere you are. They can rip you apart and bring you so far down that it’s almost impossible to get back up. In times past, you could at least run and hide from bullying but today, that is next to impossible to do. Even when the devices are not around, the implications echo on.

The very nature of social media can be a breeding ground for depression to set in and it can make existing depression much worse. Imagine if your so-called friends were posting unflattering pictures of you or publically taking pot shots at you. Even grown adults would have trouble digesting such cruel things.

Not only can social media platforms open up a sea of opportunities to stage bully battlegrounds, they can also promote the temptation to compare. There’s the popular girl who just got asked to prom, the football jock posing in a photo with his new trophy and your friend showing off the new puppy she’d rather spend time with than you. It’s up close, personal and always in your face.

Being a teenager isn’t easy. It has never been, but it is more difficult now than it ever was before. Even normal teen changes can make it seem like the world is caving in but when you toss in a dose of depression, it can be devastating.

The Teenage Identity Crisis

The teen years are a journey. You are exploring many things that will become your foundation for adulthood. You may be searching for your identity, finding out what your interests truly are and figuring out who you can trust and rely upon. It is a wonderful time of self-discovery. Unless you have depression.

Wondering is a natural and positive part of growing up. It opens your eyes to exploring new options and to seeing things from a different perspective. It is not to be confused with doubting yourself, everything and everyone around you.

Depression steals the wonder from your teenage years. Instead of experiencing curiosity in a healthy way, you are anxious and perhaps even paranoid. You aren’t sure about the world around you so how could you be sure of yourself?

Depression can stunt the natural phase of development in teenagers. It can also cause deep-rooted insecurities that can carry over into the adult years. Athletes face a similar problem when they are trying to become better and stronger. They need to stretch their limits and move out of their zone of comfort in order to get to the next level.

But, if they are injured, they risk suffering even more damage if they push themselves too hard. The same is true for teenagers who are depressed. They are in a weakened state so the natural process of finding themselves can result in a damaged self-image.

Hope Abounds

Now that it has been established how difficult teen depression can be, it’s time for the good news. The situation is full of hope. Not only can finding help free teenagers from depression, it can give them the tools they need to set them up to succeed later in life. Medical recommendations can be addressed as well such as the possibility that an antidepressant is needed.

While the thought of an adolescent taking an antidepressant in such formative years might seem alarming, it is safe when practiced under the guidance of a skilled psychiatrist or a well-trained nurse practitioner. Still, great benefits can result from therapy by itself.

It is quite common for teens to feel as if they don’t have anyone who is there just to listen to them without passing judgment. It would be ideal if adolescents and teens were comfortable talking to their parents but usually, they aren’t. They feel intimidated. That is why talking to a professional can be so beneficial.

Within the state of Washington, even thirteen-year-olds have the right to complete privacy in their counseling sessions. While it may seem a bit strange to parents, it certainly is comforting to the teenagers.

Knowing that their secrets are safe encourages them to open up so they can receive the treatment they need and deserve without fear that there will be repercussions. The exception is when the client’s safety is at risk.

By addressing the issues of teen depression, teenagers can develop a strong self-esteem that will carry over to adulthood. The process of moving through the pain and dealing with the problems head-on means that hope abounds for a positive future.

In therapy, teens learn to set goals for themselves, both short and long-term ones. They also are given the tools that can help them with their current state of depression. These tools also help if they are hit with depression again in the future. Learning coping skills at an early age is priceless.

Teens who experience positive counseling are more likely to seek help if they run into problems when they are adults. They learn that therapy is a safe place where they can get the treatment they need to improve the quality of their life. Teenagers who have positive outlooks about the counseling they receive may very well encourage their friends to go for help. The power of positive peer pressure is amazing.

Taking the First Step

Help can’t begin until the first step is taken. If you’re a teen who is feeling depressed, or if you have a friend or a family member who is, start by seeking help. Talking to a counselor is a safe way to be heard without judgment and to get to know yourself better. You will also learn coping skills so that you can deal with the depression.

If you’ve been waiting for someone to give you a push in the right direction, this is it! Perhaps you are nervous about taking the first step. Fear and anxiety are symptoms of depression. Don’t let depression steal another moment of your life.

Admitting you need help isn’t easy, especially when you are a teenager. In fact, nothing is easy when you’re a teenager. That is all the more reason to take that first step. You don’t have to live in depression another day. There is help. Reach out to a counselor in your area so that you can get started on your brand new beginning today.


“Laundromat,” courtesy of Drew Roberts,, CC0 License; “Feeling Down,” courtesy of,, CC0 License; “Crying,” courtesy of markzfilter,, CC0 License; “Downcast,” courtesy of whoismargot,, CC0 License

Warning Signs of Self Harm in Teens

Have you ever encountered self-injury in a friend or loved one? Even if you haven’t, chances are you know someone who intentionally harmed themselves. In 2006, researchers estimated that 14-17% of adolescents and young adults have engaged in self-harm behaviors (Whitlock, Eckenrode, & Silverman).

In a 2007 study, over 46% of adolescent participants reported that they had engaged in non-suicidal self-injury (Lloyd-Richardson, Perrine, Dierker, & Kelley).

The results of other studies confirm that adolescent self-harm is an issue that is all too prevalent and needs to be taken seriously. The psychology community refers to self-harm as Non-Suicidal Self-Injury (NSSI). The definition of NSSI is:

The intentional infliction of injury by an individual upon his or her person in a socially unacceptable manner but without the intent of suicide.

What is your gut reaction to the phrase “self-injury”? If you’ve never experienced an instinct to harm yourself, you might feel unable to relate or understand why someone would hurt themselves. You might wonder what the warning signs or and how you can help someone who is self-injuring regularly.

In this article, we will explore these issues and work towards an increased awareness of self-injury and how to address it.

What Does Self Harm in Teens Look Like?

Self harm in teens can take multiple forms. Individuals may rely on one primary method or a variety of methods. Counselors often note an escalation in these behaviors, beginning with milder forms of scratching or cutting and increasing to a more severe level.

Researchers have discovered that self-injury often displays addictive features (Nixon, Clouter, & Aggarwal, 2002), which explains why it can be so hard to stop.

Methods of self-injury are distressing to hear about, but it’s important to understand the forms this behavior can take. Researchers have identified the most common forms, including biting, cutting, hitting oneself, and burning (Lloyd-Richardson, Perrine, Dierker, & Kelley, 2007).

Punching objects, interfering with the healing of wounds, pinching oneself, pulling out hair for the purpose of hurting oneself, and breaking bones are more examples of forms of self-injury.

Still, further examples include punching objects, disturbing wounds in the process of healing, pulling hair, and breaking bones. Tools of choice can be razors, pencil sharpeners, scissors, paper clips, etc. Any sharp object can be utilized.

As for the physical location of injuries, we often see cuts on the arms and legs, particularly the upper thighs.

What Causes Self-Injury?

If you haven’t struggled with self-harm, you might find it too hard to grasp why someone would hurt themselves. It’s vital to form an understanding of the reasons behind self-injury. This allows us to offer true empathy and support.

Of course, self-injury isn’t caused by just one factor. Here are a number of possible issues that may lead to a desire to hurt oneself:

  • Self-injury can be a form of manipulation, but it should not be assumed that this is the primary reason.
  • It can be a way to “wake up” from a sense of numbness.
  • It can be a way to punish oneself for real or perceived failure in some other area of life.
  • It can signify a lack of ability to process intense emotions (a common struggle in adolescence); it may seem easier to deal with physical wounds.
  • Along the same lines, self-injury is a way to focus on something other than one’s emotions.
  • It’s often assumed that self-injury is a form of attention-seeking. This can be true, but again, this shouldn’t be the default assumption. And even if it is true, it’s crucial to consider why there’s a felt need for attention along with a lack of ability to communicate this need in a constructive way.
  • Self-injury can serve as a release of tension (Nixon, Cloutier, & Aggarwal, 2002).
  • It can be a way to feel in control when other aspects of life feel out of control.
  • It can signal a lack of ability to express one’s emotions verbally, and a choice to instead communicate them through self-harm.
  • Similarly, self-injury can indicate that an individual feels unable to soothe their emotional pain in any other way, whether it takes the form of depression, anger, or some other condition.
  • When someone is injured, the brain may release chemicals that produce a soothing effect.

Self-injury may seem like a relief at the moment, but it provides false and destructive relief. After an incident, the individual often feels a sense of shame and guilt, which can trigger an even greater desire to self-harm. The behavior then becomes a cycle.

Professional treatment can be a crucial component in breaking the cycle and developing coping mechanisms to avoid the urge to self-harm.

Risk Factors for Self-Injury

What are the risk factors that might lead someone to engage in self-destructive behaviors like cutting? Many possible factors relate to the emotions and how well they are regulated, including:

  • A habit of internalizing emotions, especially anger
  • Low self-esteem
  • Mental illness, including depression, anxiety, PTSD, etc.
  • Having a friend who self-injures
  • A general difficulty with emotional regulation
  • Being abused either now or in the past

Warning Signs of Self Harm in Teens

Self harm in teens is usually accompanied by a strong sense of shame, leading to attempts to hide the outward signs of the behavior. Even so, there are still signs that can indicate the possibility that self-harm is occurring. These signs can be used to assess the situation, but they can also be present in the absence of self-injury.

  • Visible scratches, marks, or other wounds that are explained away or brushed off as quickly as possible.
  • Wearing a lot of bracelets or armbands all the time to hide wounds.
  • Wearing long sleeves during hot weather.
  • Increasing isolation (often linked to depression).
  • Suddenly refusing to wear a bathing suit (this might also be due to modesty or body image issues).
  • In general, wearing unusually concealing clothes.

Suicide attempts

According to research, self-injury is a significant risk factor for suicide attempts. Researchers Klonsky, May, and Glenn (2013) found an association between the two. Moreover, they discovered that self-injury was the second leading risk factor for suicide attempts, suicidal thoughts being the first.

This study also found associations between suicide attempts and impulsivity, anxiety, depression, and borderline personality disorder. Numerous other studies have identified a link between self-injury and suicide attempts.

This doesn’t mean that self-injury always leads to attempted suicide; oftentimes there’s no link at all. However, since there is an increased risk, the possibility of suicidal thoughts should be discussed as soon as possible. If suicidal tendencies are present, seek professional help immediately.

How to Help

Let’s revisit the question of your instinctive reaction to the issue of self harm in teens. You might find it frightening or feel helpless when you realize someone you love is hurting themselves. These are normal reactions.

Your own feelings need to be processed as a first step, so you can respond from a place of calm support rather than emotional reactivity.

The primary need of someone who self-harms is to have a place of compassion and safety where they can find support and empathy and learn to express their feelings.

Self-injury carries medical risks, such as the risk of infection, so if you are not the parent or guardian it’s important to contact them about this behavior. Adolescents may fear this disclosure and might respond better if they are included in the process of telling their parents. Remind them that you are on their side, but that you have an ethical obligation to consider their safety.

Avoid responses that may be instinctive but are probably not helpful:

  • Anything that communicates shame or blame, since these feelings are most likely already present and may contribute to the problem.
  • Demanding that the behavior stop immediately. This might just lead to the teen hiding it better. (Instead, remind them that you are worried about them and available to talk anytime they need it. If the behavior is more serious and risky, immediate professional intervention may be needed.)
  • Not taking it seriously.
  • Punishing them.
  • Discussing it with anyone besides caregivers or professionals.

Treatment for Self-Injury

As we have seen, self-injury can become a pattern that is very hard to stop. The individual may use it as a coping mechanism and a consistent way to ease their emotional pain. When they attempt to stop the behavior, they often experience intense urges to revert to it.

But there is hope! Professional therapy can be a path for healing and recovery from these devastating behaviors. It can take several forms, including individual, family, or group therapy. Medication may be another possible method of treatment.

In therapy, a person who self-injures will develop the ability to cope with and communicate their emotions and needs in a healthy, constructive way. They will learn skills for expressing emotions and connecting with other people in their relationships.

Part of the therapeutic process is also identifying the underlying reasons that led to self-injury, such as anxiety, depression, anger, etc. These underlying conditions will be treated as well.

Therapeutic treatment for self-injury is important and may even save a life. If you or someone you love is harming themselves, don’t hesitate to reach out for help. We want to help you find the path to healing.

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Codependency Treatment for Partners: You Have Options

The term “codependency” describes a condition that was first identified in the context of alcoholism and chemical dependency. The family dynamics of alcoholics were actually playing a role in preventing them from becoming or staying sober.

Researchers began to study the spouses or intimate partners and members of the alcoholics’ families and identified a distinct disorder that exists alongside of addiction and makes it worse.

This disorder was labeled codependency. Discovering and defining codependency has led to the creation of treatment programs that work alongside addiction treatment. Professionals assess and treat family dynamics as well as the person struggling with addiction. Mental Health America defines codependency this way:

“Codependency is a learned behavior that can be passed down from one generation to another. It is an emotional and behavioral condition that affects an individual’s ability to have a healthy, mutually satisfying relationship. It is also known as ‘relationship addiction’ because people with codependency often form or maintain relationships that are one-sided, emotionally destructive and/or abusive.

The disorder was first identified about ten years ago as the result of years of studying interpersonal relationships in families of alcoholics. Codependent behavior is learned by watching and imitating other family members who display this type of behavior.”

A codependent person has an unusually high desire for emotional intimacy. To fulfill this desire, they play the part of caregiver or rescuer. They often find themselves in relationships with unreliable or abusive partners.

When a person is repeatedly attracted to unstable partners, this is a red flag for codependency. People who struggle with alcoholism or other forms of addiction are in dire need of help and rescuing. From an unhealthy perspective, they need a partner who will enable their addiction.

The addiction model describes the process of gratification followed by a withdrawal that addicts experience. The concept of codependency explains how codependents are also trapped in this cycle. They want to be passionately engaged with their partners, and if their partner creates distance, the codependent can go through withdrawal symptoms such as anxiety and desperation.

What causes the alcoholic to create distance? It’s when their cycle reaches the binge phase of self-indulgence in their chosen substance. Once they’ve achieved their fix or high, they inevitably face the consequences. At this point, the codependent can seek his or her own “fix,” achieving a sense of intimacy and being needed by “helping” the alcoholic and saving them from the consequences.

Outside of the cycle description, this dynamic has also been compared to a dance between the addict and the codependent. The codependent accepts a one-way relationship, but it doesn’t only hurt them. It also hurts the addict and contributes to the addiction taking a stronger hold in their life.

Not all experts agree that codependency should be called an addiction. Amir Levine, M.D., and Rachel Heller, M.A., in their book Attached, describe it this way:

“While the teachings of the codependency movement remain immensely helpful in dealing with family members who suffer from substance abuse (as was the initial intention), they can be misleading and even damaging when applied indiscriminately to all relationships.”

According to Levine and Heller, a seemingly excessive attachment need can be rooted in evolutionary biology. Their book describes codependency as a social construct based on a cultural norm of independence and self-reliance.

Research no longer supports the idea that healthy parent-child bonding requires complete self-reliance on the part of the child. Levine and Heller claim that codependency concepts, applied indiscriminately to non-addictive relationships, make even healthy dependency patterns seem questionable.

Attached posits a theory called “New Science of Adult Attachment,” suggesting that dependency is based on our DNA, not on addiction.

Christians may relate the theory of healthy dependency to the book of Genesis, which says, “A man will leave his father and mother and be united to his wife, and the two will become one flesh.” Levine and Heller claim that we actually do receive happiness from our partners, not just from within ourselves:

“Numerous studies show that once we become attached to someone, the two of us form one physiological unit. Our partner regulates our blood pressure, our heart rate, our breathing, and the levels of hormones in our blood. We are no longer separate entities.

The emphasis on differentiation that is held by most of today’s popular psychology approaches to adult relationships does not hold water from a biological perspective. Dependency is a fact: it is not a choice or a preference.”

In Attached, the concept of “mutual reactivity” is described as an example of normal dependency. Partners become upset on each other’s behalf and respond to each other’s emotions and experiences like they are their own. But this description of mutual reactivity is viewed as a lack of boundaries or emotional enmeshment by codependency experts and the mental health community.

Attached does acknowledge the possibility of over-attachment, which the authors call an “activated attachment system.”

“Remember, an activated attachment system is not passionate love. Next time you date someone and find yourself feeling anxious, insecure, and obsessive – only to feel elated every once in a while – tell yourself this is most likely an activated attachment system and not love! True love, in the evolutionary sense, means peace of mind. ‘Still waters run deep’ is a good way of characterizing it.”

Attached proposes a more balanced approach than the common mental health emphasis on differentiation and emotional independence. Instead, the authors say we should acknowledge that we have an inherent need for attachment and dependence on our partners, and when this need is met, we will feel secure.

“Attachment principles teach us that most people are only as needy as their unmet needs. When their emotional needs are met, and the earlier the better, they usually turn their attention outward. This is sometimes referred to in attachment literature as the ‘dependency paradox’: the more effectively dependent people are on one another, the more independent and daring they become.”

This newer approach suggests that we simply recognize that looking to others to fulfill our needs is natural human behavior. Meanwhile, the concept of codependency sounds the warning that our attachment needs could be based on harmful patterns learned in childhood and that they may become addictive.

In both theories, the solution is similar: seek out the right partner, one that is emotionally available and willing to meet your needs.

Levine and Heller describe a needy person differently than an addiction expert might. In addiction circles, the needy party will be called a codependent or an addict. But those who speak in terms of attachment, such as Levine and Heller, would instead use words like anxious or avoidant.

Either way, the dance between the needy person and their partner looks the same. The person who says, “Love me, please!” and the person who says, “Go away” are often attracted to one another and end up in relationships.

Terry Gaspard, MSW, LICSW, has written an article called “Overcoming Codependency: Reclaiming Yourself in Relationships.” She says:

“Many people stay in self-defeating relationships too long because they are fearful of being alone or feel responsible for their partner’s happiness. They may say they want out – but they end up staying. Others may leave but repeat the same or a similar self-destructive pattern in a new relationship.

The adrenaline rush that they experience when they feel passionate toward someone can be addictive. For many people, the reason behind excessive emotional reliance on a partner is codependency – a tendency to put others’ needs before their own.”

The authors of Attached say that this neediness is rooted in biology, but that doesn’t mean recognizing its legitimacy will solve all our problems:

“The question is what happens when the person we rely on most–and in fact depend on emotionally and physically–doesn’t fulfill his or her attachment role?

After all, our brain assigns our partner the task of being our secure base, the person we use as an emotional anchor and a safe haven, the one we turn to in time of need. We are programmed to seek their emotional availability. But what if they aren’t consistently available?”

Gaspard lists several obstacles to finding true love, including self-defeating thoughts, self-sabotage, fear of rejection, self-judgments, and a lack of support. Levine and Heller offer explanations of different attachment styles to help people navigate competing needs in their relationships.

They devote several chapters to explaining the nuances of the different styles and how you can identify which one describes you and which describes your partner. They also give examples of how different types of attachment look in real life, along with solutions for improving your relationship and resolving conflict.

So what are the attachment styles Levine and Heller have identified? There are three: anxious, secure, and avoidant. (You may recognize that these are similar to the addiction model of codependent, interdependent, and detached.)

If you have an anxious attachment style…

You will place a high value on being close and intimate with your partner. You will fear to lose your partner. You will be attuned to the subtleties in your partner’s nonverbal communication, and you may take everything personally. This style can be overly sensitive, prone to getting upset and saying things they’ll regret.

If you have a secure attachment style…

You’ll be a loving partner who feels comfortable and secure in your relationship, balancing your sense of freedom with a healthy level of intimacy. You will also be good at communicating what you need and reading your partner’s emotional cues.

If you have an avoidant attachment style…

You will place a high value on your autonomy and independence. This doesn’t mean you won’t desire intimacy, but too much might make you feel uncomfortable. Your partner might often complain that you seem detached or don’t open up enough.

Levine and Heller suggest that the concept of codependency is more useful in relationships characterized by substance abuse, while their theory of attachment styles is better for non-addictive relationships.

Considering both theories can offer us a helpful balance and suggest relationship patterns to avoid, such as those described by Gaspard. Can you identify any of these patterns in your relationship?

  • Poor boundaries. Do you have trouble saying “no” to requests? Do you let others take advantage of you?
  • Ignoring red flags. Are you unwilling to confront major problems such as dishonesty, jealousy, or destructive habits?
  • People-pleasing. Do you overachieve just to make other people happy or win their approval? Are you afraid to bring up problems because you don’t want your partner to reject you?
  • Staying in a destructive relationship. Have you been abused or neglected in your relationship and felt like you couldn’t leave?
  • Giving too much. Are you in a one-sided relationship? Do you neglect self-care? Do you think that taking time for yourself is inherently selfish?
  • Defining your self-worth by what others think of you. Are you so focused on other people’s opinions that you don’t value your own opinion of yourself?

The theories in Attached are helpful ways to describe problematic relationship patterns in otherwise healthy couples. This avoids the stigma surrounding codependency and concepts that are intended to address issues related to substance abuse.

If you are not yet in a relationship, you can benefit from reading Attached and understanding how to find a partner who is willing to meet your emotional needs. If you are already married, Attached can help you identify the attachment styles in your relationship and how to overcome problems to have a more fulfilling connection.

Where family dynamics are extremely toxic or affected by substance abuse, the concept of codependency offers a road to freedom from destructive relationship patterns that affect both children and adults.

If you feel that there are attachment or codependency issues in your relationship, it may be helpful to make use of tools to assess any addiction problems in your family, such as:

  • The alcoholism/drug addiction self-test at the National Center for Alcoholism and Drug Dependence
  • The sexual addiction screening or other tests at the International Institute for Trauma and Addiction Professionals

Once the presence of addiction has been ruled out, Attached can be a helpful resource for understanding and growth of relationships.


“Face-off”, Courtesy of Silvia and Frank,; CC0 License; “Hold My Hand,” courtesy of Ezra Jeffery,, CC0 Public Domain License; “Lean on me,” courtesy of Rosie Ann,, CC0 License; “Green spaces,” courtesy of jean_mingmo, Flickr Creative Commons, CC0 License

Do Not Battle Alone: Seek Help for Depression

The LORD himself goes before you and will be with you; he will never leave you nor forsake you. Do not be afraid; do not be discouraged. Deuteronomy 31:8

Among the psychological struggles plaguing people in the US, depression is one of the more common ones. The states that “MDD [Major Depressive Disorder] affects more than 16.1 million American adults, or about 6.7% of the U.S. population age 18 and older in a given year.”

And even for adolescents, depression is an issue. “In 2015, an estimated 3 million adolescents age 12 to 17 in the United States had at least one major depressive episode in the previous year, according to the National Institute of Mental Health.” (

These statistics are not surprising, however, given that life is so unpredictable. Negative experiences like the death of a loved one, separation, illnesses and accidents, failure at work or school and other forms of emotional or physical harm can readily cause severe depression.

Fortunately, it can be overcome.

The Various Ways to Get Help for Depression

Because depression is a common issue, much research has been done to discover ways to battle depression. Here are some things to do to receive help for depression.

1. Talk to somebody

One important step is to open up to someone about the problems causing the depression. The more a person stays isolated, the more hopeless the situation becomes. Speaking to a trusted family member, friend, or colleague can do wonders to lift the emotional burdens. Just the feeling of being cared for through their concern can make a sufferer feel that they are not alone.

Professional counseling is another way as some loved ones are unsure of what to say, especially if the issue is very complicated or life-threatening. Professional counselors can better probe the issue to get to the true root of the problem. If needed, counselors may also prescribe medicines to combat the problem.

2. Get diagnosed

There are different forms of depression such as major depressive disorder, seasonal affective disorder (SAD), postpartum depression, premenstrual dysphoric disorder, persistent depressive disorder, and even depression due to medical conditions. Each one has its own characteristics.

Since depression recovery requires the willing cooperation of the sufferer, it helps that the sufferer feels that they are in good hands. This is more quickly done if the type of depression is known so that the counselor knows how to objectively explain what the sufferer is going through.

3. Join a support group

For many people undergoing struggles – emotional or physical, it helps to know that you are not alone. In a support group, experiences are shared, and emotions are unburdened.

4. Contact a crisis worker

In case depression leads to suicidal thoughts, it is imperative that the sufferer speaks to somebody about this. Sadly, many are not able to as they feel ashamed to reach out to a loved one or there may be no loved ones around to speak to. Fortunately, there are hotlines specifically for this need.

  • One may call the suicide prevention lifeline at 1-800-273-8255 or visit their website
  • One may also text 741741 and be connected immediately to a crisis worker for no charge.

5. Learn more about depression

A sufferer of depression can proactively choose to deal with their situation by learning more about what they are going through. There are many available resources (e.g. blogs, articles, videos and books) that deal with this, many of which written by people who dealt with depression themselves.

Here are some helpful options:

While there are several good books out there discussing depression, two very good Christian books on surmounting depression are:

  • When the Darkness Will Not Lift by John Piper
  • Spurgeon’s Sorrows: Realistic Hope for Those Who Suffer from Depression by Zack Eswine

Take Care of Yourself

As with any mental issue, help from others is important in order to address what is causing the suffering. But there are also things that a sufferer must do for themselves to take care of their physical, mental and spiritual health. Failure to do so will make the depression will feel even more insurmountable.

1. Exercise and diet

Just like in other sicknesses, mental issues or injuries, if the physical body is not well, then overcoming the problem becomes more difficult. A weak body can affect the mind and soul. While a depressed person may not “feel” like taking care of themselves, it is important that this is still done. For example, a quick jog around the neighborhood or a trip to the gym can give the sufferer a healthy change of scenery to uplift their mood.

Additionally, a proper diet is necessary to prevent sickness and ensure that one’s mood does not become even more morose, adding to the depression.

2. Yoga

In recent years, yoga has become quite popular in Western culture as a way to keep the body and mind strong.

The physical discipline required to do it, as well as the emphasis on deep breathing and mindfulness of one’s body and thoughts, do wonders for obtaining self-control and peace of mind. Research has even shown that yoga can positively combat anxiety.

3. Keep a journal

Similar to the methods of Cognitive Behavioral Therapy (CBT), journal writing allows a person to focus on their mental process and how that may be affecting them. When thoughts are written down, a sufferer may look at them objectively to unlock the negative thoughts behind their mental issues. Journal writing may also work as an “eraser” or “editing marker”, allowing a person to remove negative ideas or perhaps view them in a different light.

But even if journaling does not allow them to see the roots of their negativity, at least it may serve as an outlet for emotional release.

3. Listen to healing music

Music can be a means to heal if the melody and message are right. The following are some Christian artists whose songs can help heal.

  • Sleeping at Last

Try the songs “Saturn”, “Emphasis”, and “You are Enough.”

  • Bellarive

The song “Tendons” is about the act of grace committed on the cross.

  • Josh Garrels

The songs “Beyond the Blue,” “Farther Along,” and “Born Again” are very helpful.

  • Needtobreathe

Many of their light-hearted tunes contain much depth for the soul.

4. Read the Bible and Pray

I waited patiently for the LORD; he inclined to me and heard my cry. He drew me up from the pit of destruction, out of the miry bog, and set my feet upon a rock, making my steps secure. He put a new song in my mouth, a song of praise to our God. Many will see and fear, and put their trust in the LORD. – Psalm 40:1-3

All over Scripture, it is clearly seen that there is an on-going spiritual battle for our souls. Prayer and Bible reading are direct ways to fight the darkness’ powers that threaten to turn us away from God.

When depressed, a sufferer may feel that their spirit is at an all-time low, making it easier to succumb to negative thoughts about self-harm (e.g. suicide, alcohol or drug abuse) or breaking relationships (e.g. divorce, running away, isolation). This is why it is very important for the sufferer to reconnect with God.

Another helpful spiritual activity is to have someone pray for you or pray with you. As earlier stated, opening up to others is already a helpful step when battling depression.

It helps to know that somebody cares about your situation. But corporate prayer is also a powerful method in dire circumstances as there are two or more of you seeking God’s wisdom and help through Christ.

As stated in Matthew 18:19-20, “Again I say to you, that if two of you agree on earth about anything that they may ask, it shall be done for them by my Father who is in heaven. For where there are two or three gathered together in My name, I am there in their midst.”

Our Savior knows what is like to be human and what it means to struggle. If there is anyone that can help, it is He.

Depression is a serious issue indeed. It saps a person’s emotional, physical and spiritual energy, causing them to look at life from darkly tinted lenses.

If you or someone you know is suffering from it, it is best to get help soon. The abovementioned methods should be reviewed and applied. However, if professional counseling seems to be the best path, then you should get into contact with a professional Christian counselor who can listen to your concerns while applying Scripture to heal both mind and soul.

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