Teachers' perceptions of adolescent girls' self-harm: a qualitative study

Introduction

Adolescent self-harm is a serious problem that is associated with an increased risk of psychological problems and suicidal behavior (Predescu & Sipos, 2023). Empirical findings show that young people often use it as a maladaptive strategy for managing intense emotions, interpersonal conflicts, or feelings of loneliness (Zanus et al., 2021).

In this context, the school environment is particularly important, since adolescents spend a significant part of their time there, and it is there that the first signs of self-harm can be detected. Teachers are therefore in a key position in recognizing risky behavior and providing professional help. However, several studies point out that educators often feel a lack of knowledge and unpreparedness, which can lead to insensitive or ineffective responses. On the contrary, adequate education and support enable them to respond more sensitively and effectively (Te Maro et al., 2019; Gargiulo, 2020).

Research to date has primarily focused on identifying risk and protective factors for self-harm, but rarely on examining teachers' perspectives. Therefore, it is still not sufficiently known how educators perceive this phenomenon, what experiences they have with it, and what procedures they consider to be effective. This study focuses precisely on the analysis of teachers' experiences and attitudes towards self-harm among adolescent girls.

Theoretical principles

Self-harm is defined as intentionally damaging one's own body tissue without suicidal intent (Butler & Malone, 2013). Cutting, burning, pricking the skin with sharp objects, biting or scratching the body (Dong et al., 2023; Xiao et al., 2022), less often hair pulling, excessive use of drugs or toxic substances (Hawton et al., 2012) appear most often in adolescents. A typical feature is a recurring course, while the frequency can vary from several episodes per day to several cases per month or only a few episodes per six months (Brager-Larsen et al., 2023).

Self-harm occurs quite often in adolescents (Lucena et al., 2022) – young people use it as a maladaptive strategy for managing emotional tension (Varo et al., 2025), stress regulation (Thum et al., 2023) or as a substitute for verbal expression of complex emotions (Mengyuan et al., 2023). International research confirms a high prevalence: 17–35% in global samples (Swannell et al., 2014; Zetterqvist, 2014; Møhl et al., 2014), 13–26% in Europe (Hawton et al., 2012; Plener et al., 2009) and 7.6–22% in the Czech Republic (Hrubá et al., 2015; Burešová et al., 2014). In Slovakia, only a limited amount of work is devoted to this issue - mainly in the school environment - while clinical data is lacking. Available findings point to the onset of self-harm already in early adolescence (11.9-14 years) (Linderová & Hradečná, 2023; Albores-Gallo et al., 2014; Glenn & Klonsky, 2013), at the same time, earlier onset increases the risk of more severe forms and suicidality (Ammerman et al., 2018). According to some studies, self-harm can occur in a significant part of adolescents, more often in girls, while the dominant form is cutting (Démuthová & Démuth, 2019; Linderová & Hradečná, 2023). The differences in the reported prevalence are mainly related to the methodology used and the definition of self-harm. In addition to cutting, other methods are also mentioned, such as tearing open wounds, scratching, biting nails or excessive alcohol use (Démuthová & Démuth, 2020). However, despite the relatively high prevalence, young people often do not seek professional help - the reason is stigma, shame or the unavailability of services (Gulliver et al., 2010; Radez et al., 2021). Overall, the available epidemiological data indicate that self-harm is a widespread and heterogeneous phenomenon, the occurrence of which varies not only between countries, but also according to research methodology and definition, which complicates its accurate capture.

In addition to risk factors, protective mechanisms that can mitigate the negative impact also play an important role. At the psychological level, the importance of mental well-being (Rusell et al., 2020), awareness of self-efficacy (Chen et al., 2022) and resilience (Nearchou, 2024) is shown. Some studies even suggest that selected narcissistic traits that support self-evaluation and stress management may also have a protective function (Alberdi-Páramo et al., 2022).

At the interpersonal level, the support of family and friends (Miller et al., 2021), as well as the quality of family dynamics (Fasolato et al., 2024), is of fundamental importance. At the same time, the literature draws attention to the paradoxical aspect when self-harm can in some cases function as a maladaptive way of regulating psychological pain and at the same time as a form of suicide prevention (Szewczuk-Bogusławska et al., 2021).

Significant protective factors also appear in the school environment. Quality relationships, a positive climate and a sense of security reduce the risk of risky behavior, while support from teachers and peers has a preventive effect (Václavíková et al., 2020). A strong attachment to school and engagement in learning are associated with a lower incidence of antisocial behavior or substance use (Mihić et al., 2022). A positive school self-concept, i.e. the perception of one's own success and abilities, also has a protective function (Čerešník, 2015). These factors indicate that the school can represent an important preventive environment where at-risk students can be identified and interventions provided with less stigma than in a clinical setting (Gargiulo, 2020).

At the same time, however, self-harm is a significant challenge for schools (Foss, 2006). Teachers are often the first adults to notice students' self-harming behavior and provide professional help. However, many report feelings of helplessness and unpreparedness related to a lack of quality, evidence-based training (Burn et al., 2023). Studies show that most educators have never received adequate training in self-harm. For example, in England and Wales, over half of teachers admitted that they had not been offered such training (Colville et al., 2024). Lack of preparation can thus lead to insensitive or inadequate reactions, which underlines the need for systematic education and methodical support for teachers.

Adolescent self-harm is a phenomenon with a high prevalence, numerous risk and protective factors and significant consequences for the individual, family and school. Despite intensive research into its epidemiology and psychological context, how it is perceived by educators who come into direct contact with it in the school environment remains insufficiently researched. The lack of knowledge and methodical training can limit their ability to respond appropriately and provide professional help. The presented study therefore focuses on the investigation of the experiences and attitudes of teachers towards self-harm in adolescent girls with the aim of approaching their perspective and contributing to the development of targeted support in the school environment.

Research Objective

The aim of the study is to examine how secondary school teachers perceive adolescent girls' self-harm, what factors they associate with it, and how they evaluate their readiness and possibilities of support in dealing with it.

Research Questions

Based on the goal of our work, the following research questions were set: VO1: How do teachers perceive and experience situations associated with self-harm by female students at school? VO2: What factors do teachers associate with the emergence of self-harm? VO3: How do teachers perceive their readiness to deal with self-harm and what sources of support do they use?

Research file and used methods

Five secondary school teachers from four regions of Slovakia participated in the research (four women, one man). The respondents represented gymnasiums, vocational and medical schools, and their teaching experience ranged from 2 to 27 years.

Table 1 Characteristics of the participants

The criterion for inclusion in the research was personal experience in solving a case of self-harm in a student and at least one year of teaching experience. The selection was opportunistic, influenced by the schools' willingness to participate in the research. A smaller number of participants corresponds to interpretive phenomenological analysis, which focuses on an in-depth understanding of individual experiences and the meanings that participants attribute to their experiences.

The study focuses on adolescent girls, since, according to several studies, self-harm occurs more often in girls than in boys (Démuthová & Démuth, 2019), and all teachers involved in our research described experiences with female students.

The data were obtained through semi-structured interviews, which were carried out in school premises in a confidential atmosphere and without the presence of other persons. The interviews lasted approximately 30 to 45 minutes. Even before being included in the research, the participants were informed that the topic of the interview would be related to sensitive experiences associated with self-harm among pupils, and they had the opportunity to consider their participation.

The research was carried out in accordance with the ethical standards of the APA (2020) and the Code of Ethics of the Slovak Chamber of Psychologists. Ethical questions were consulted with the supervisor of the thesis, who supervised the observance of the principles of research with human subjects. Since the research was carried out as part of a diploma thesis, it followed the internal ethical framework of the faculty, without the need for formal approval by the ethics committee. The participants signed an informed consent regarding voluntary participation, anonymity, confidentiality and consent to recording. Along with the informed consent, they were also given a list of available contacts for professional help (e.g. school psychologist, Trust Line, IPčko) in case the interview evokes unpleasant emotions.

The data were processed exclusively by the author of the study. The recordings were stored in password-protected encrypted storage, personal data was stored separately from the transcripts, and the recordings were securely deleted after the end of the research. Transcripts have been anonymized by removing identifiable information, and respondents are identified in the text with codes R1-R5.

Interpretive phenomenological analysis was used to process the interviews. This method was chosen because it allows understanding the subjective meanings and personal experiences of the teachers, which are crucial when investigating such a sensitive topic. The analytical procedure involved repeated reading of the transcripts, writing descriptive, linguistic and conceptual notes, identifying and grouping themes within individual interviews and then comparing them across the entire set. The result was the identification of superordinate themes that capture the meaningful core of teachers' experiences. The interpretation was anchored in the data through direct quotations from the participants. Analytical notes documenting the development of the interpretation were continuously recorded during the analysis, which created the so-called audit trail allowing to follow the individual steps of the analysis. This procedure contributed to the transparency of the analytical process and anchoring the interpretation in the data.

During the implementation of the research, the researcher was aware of her position as a psychologist, which can influence the course of interviews and the interpretation of data. Therefore, she strove for a neutral conduct of the interviews, active listening and openness to the perspectives of the participants. Reflexivity was an important part of the process so that the results were anchored as much as possible in the experience of the respondents and not in their assumptions.

Analyses and results The analysis of the interviews took place in accordance with the principles of interpretive phenomenological analysis (IPA) with an emphasis on the detailed processing of individual cases. Each interview was first analyzed separately (idiographically) focusing on the meaning the participants attributed to their experience. Subsequently, patterns of similarities and differences between the cases were identified. The results therefore represent an interpretation of how teachers interpret their experience. Three superordinate thematic areas emerged from the analysis, which capture different ways of constructing the teacher's role, understanding the causes of self-harm, and perceiving one's own competences. Themes are illustrated with authentic quotations and supplemented with interpretation taking into account the differences between individual cases.

Table 2 Overview of identified topics

The teaching role between moral responsibility and the limits of competence

The participants described the experience of pupils' self-harm not only as a specific event, but as a situation that tests their understanding of their own professional identity. In their statements, the tension between personal responsibility, emotional involvement and awareness of the limits of one's competence repeatedly appears.

This tension is most evident in the statement of R5, who describes his experience as follows: "I realize that I am the one who is responsible for the students in the class and has to act. When it happened, it was a shock. I took it home, I thought about her, I prayed for her to get through it. You couldn't just cut it off."

This section suggests that self-harm is not just a disciplinary or administrative problem for her. The wording "must act" expresses an internal moral imperative that goes beyond work duty. The expressions "I took it home" and "it couldn't be cut" point to the blurring of the line between the professional and personal spheres. Religious language ("I prayed for her") can be interpreted as a way of coping with helplessness and at the same time as a manifestation of a value framework in which caring for the student's "soul" is an integral part of the teacher's role. In this case, the teacher's role is constructed as deeply engaged and personally experienced.

In contrast, R2 describes the situation more pragmatically: "I handled the situation myself", since there was no school psychologist at the school at the time. Her statement indicates an acceptance of direct responsibility, but at the same time uncertainty appears in the next part of the conversation ("am I responding correctly"). Although responsibility is internalized here, it is accompanied by doubt about one's own competence.

A different framework is offered by R4, who states that she did not perceive the situation as significantly burdensome because she knew about the presence of the school psychologist. In this case, the responsibility is divided and the emotional load is regulated through system support. Delegating to an expert here does not mean lack of interest, but setting the boundaries of one's own role.

The tension also manifests itself in the area of ​​mindfulness. Teachers emphasize the need to monitor changes in behavior, but at the same time admit that many signals can only be recognized in retrospect. R5, for example, states that she realized some signs only in retrospect. This experience points to the ambivalence between trying to be sensitive and knowing that not everything can be caught in time. Thus, self-harm appears as a phenomenon that disrupts the sense of control over class reality.

Overall, it can be concluded that the encounter with self-harm destabilizes the clear boundaries of the teacher's role. Participants move between caring, controlling, delegating and regulating their own emotions. For some, the situation means a deep personal commitment, for others it is more manageable thanks to a clearly set boundary of competence. It is this tension between commitment and limit that shapes their interpretation of the experience more significantly than the act of self-harm itself.

Self-harm interpreted as a response to pressure and emotional loneliness

In participants' interpretations, self-harm does not appear as an isolated or incomprehensible act, but as a behavior to which they try to make sense through wider narratives of pressure, family background and young people's emotional experiences. In doing so, they create frameworks of meaning that shape not only their understanding, but also their subsequent reaction.

One of the dominant frames is self-harm as a response to pressure. R3 describes it as "a reaction to psychological pressure that girls can't handle". The wording "can't cope" shifts the focus to the adolescent's individual capacity and implicitly constructs the problem as a deficit of coping strategies. Similarly, R1 talks about "long-term stress" and "strict parental control", creating a picture of an environment that overwhelms a young person. In the case of R5, the pressure is tied to a specific story, because the pupil was "going through a difficult period". Pressure here is not an abstract category, but an individualized experience.

The second framework focuses on the family as the primary source of vulnerability. Participants spontaneously direct an explanation to divorces, conflicts or the loss of a close person. R2 describes a situation in which "the mother complained about her own life instead of solving her daughter's problems". This formulation constructs the image of the child as a person whose needs remain in the shadow of adult problems. In another case, R5 mentions a “cold reaction from the father”, suggesting emotional unavailability as a potential source of loneliness. The family context thus becomes the main explanatory framework, which shifts the center of gravity of causes outside the school itself.

However, the strongest shift in meaning comes from a psychological framework in which self-harm is interpreted as the regulation of unbearable inner tension. This shift is especially noticeable in the student's mediated statement, which R1 states: "The only thing that could somehow calm me down was seeing my own blood. I tried everything possible, meditating, resting, but I couldn't stop it."

This statement changes the perspective from a moral evaluation to a functional understanding of behavior. Self-harm is not presented here as an attempt to harm oneself in a suicidal sense, but as the last available tool to regulate intense emotions. The words "the only" and "I couldn't stop it anymore" indicate the experience of hopelessness and the absence of alternatives. Teachers who convey this statement implicitly accept an interpretation in which the student is overwhelmed rather than defiant.

An interesting aspect is that the school as an institution appears rather indirectly in these interpretations. Although the pressure to perform is mentioned, it is more often placed in the wider context of family expectations or social setting. This implicitly shifts the responsibility for the emergence of behavior beyond the immediate pedagogical level.

Overall, it can be concluded that teachers construct self-harm mainly as a result of overload and emotional loneliness. This interpretive framework supports empathic understanding and allows the pupil to be perceived as a person in crisis. At the same time, however, it can narrow the view of behavior mainly to its regulatory function and reflect less on other possible meanings or broader systemic factors.

The tension between trying to help and the limits of pedagogical competence

The tension between trying to help and being aware of one's own limits repeatedly appears in the interpretations of the participants. The experience of self-harm not only opens up the question of "what to do", but also "am I good enough for this". The theme of competence thus appears to be closely connected with professional identity.

Recognizing warning signs is seen as a moral obligation, but at the same time as an uncertain ability. R1 states that she “tries to be attentive,” indicating active effort and value commitment. In contrast, R3 admits: "... I didn't notice him, but the school pointed it out to me." This statement reveals the experience of the failure of expected mindfulness. Retrospective awareness in R5 ("I only realized in retrospect...") points to a situation in which the meaning of signals appears only after the event. Thus, self-harm is constructed as a phenomenon balancing between the visible and the hidden, thus undermining the teacher's confidence in his own ability to catch the problem in time.

The feeling of unpreparedness is formulated explicitly and without packaging. R3 says: "We don't know how to proceed ourselves." R4 adds: "One tries to help, but one feels that one does not have enough education to do so." These statements do not express a lack of interest, but rather a tension between a high level of responsibility and a lack of tools. In the language of the participants, the motif "he tries, but..." appears, which can be interpreted as a conflict between commitment and competence uncertainty.

A strong significant moment comes from R2's statement after the school psychologist started: "When the school psychologist came, I was very relieved. I knew that these cases would be handled professionally."

The wording "I am very relieved" signals the release of the accumulated burden. Here, the expert is not only a source of knowledge, but also an emotional support and stabilizing element of the system. The shift from "I have to handle it" to "someone competent will handle it" can be understood as a mechanism of helplessness regulation. Delegation does not appear as abdication, but as protection of professional identity.

Similarly, R4 emphasizes that "the teacher cannot do everything by himself", thus legitimizing the boundary of the pedagogical role. R5 speaks of cooperation with external experts as a necessity in cases where the situation exceeds the school's capabilities. In these statements, a model of shared responsibility emerges, as the teacher remains the first point of contact, but the final solution is shifted to the professional framework.

Interestingly, the need for an expert appears especially in situations where the teacher feels emotionally overwhelmed or insecure. Expertise is thus not only a technical intervention, but also a symbol of safety and order in a situation that disrupts the sense of control.

Overall, it turns out that the issue of preparedness is not reducible to the level of knowledge. It is about managing the limits of one's competence and negotiating between the role of a teacher and the expectations that the situation brings. Teachers move between trying to be a support and knowing that they cannot carry everything by themselves. It is this negotiation of boundaries that becomes central to their interpretation of experience.

Thus, the experience of self-harm not only raises the question of intervention, but also the reflection of one's own professional identity. Teachers move between empathy and control, between engagement and protecting their own boundaries.

Discussion including study limitations

The aim of the study was to examine how secondary school teachers perceive adolescent girls' self-harm and how they rate their readiness to respond to these situations. The findings show that an encounter with self-harm is a complex experience for teachers that affects their professional role, emotional experience, and perception of their own competencies. Data interpretation identified three interconnected areas: constructing the teacher's role in addressing self-harm, interpretive frameworks explaining the emergence of this behavior, and perceptions of the limits of pedagogical practice in providing help.

The interviews confirmed that teachers consider self-harm to be a serious problem closely related to the emotional difficulties of pupils. At the same time, they emphasized the obstacles to its early recognition, as adolescents often hide this behavior. Such an experience is consistent with the literature, which repeatedly highlights the hidden nature of self-harm and the risk of delayed intervention (Hall & Melia, 2021; Townsend et al., 2022).

At the same time, the respondents described the high emotional burden associated with contact with this phenomenon. The feelings of shock, bewilderment, and uncertainty they reported are consistent with the findings of Gao et al. (2025), according to which self-harm causes anxiety and frustration among educators. These responses indicate that confronting self-harm is not only a professional but also a personal challenge that goes beyond traditional pedagogical competencies.

Teachers identified mental pain, stress and pressure from school and parents, problematic family relationships and the influence of peers as the main factors associated with self-harm. These attributes are consistent with the literature that emphasizes the multifactorial nature of self-injury and the importance of emotional dysregulation, interpersonal conflict, and social pressure (Miscioscia et al., 2022; Townsend et al., 2022; Yao et al., 2023). Special attention was paid to the family environment, where divorce, loss of a loved one or conflictual relationships appeared to be risk factors. This view is consistent with research that confirms that a disturbed family climate and a lack of support increase the vulnerability of adolescents (Liu et al., 2025; Shi et al., 2024). Likewise, the topic of parental expectations and academic pressure, which the literature considers to be a significant predictor of self-harm (Guo, 2024; Steare et al., 2023; Du et al., 2016), appeared repeatedly.

These findings support the understanding of self-harm as a heterogeneous phenomenon that is shaped by a combination of intrapersonal, family and wider social factors. The aforementioned conclusion is consistent with both epidemiological and clinical studies that point to the complexity of the mechanisms leading to self-harm (Tang et al., 2025; Fu et al., 2025).

Another significant finding was that teachers do not feel sufficiently prepared to deal with self-harm. They lack systematic training and clearly defined procedures, which reduces their confidence and leads to fears of an inappropriate reaction. Similar findings are reported by foreign studies, according to which most educators do not receive specific training in this area and consequently feel unprepared for direct intervention (Gao et al., 2025; Townsend et al., 2022).

The key source of support are school psychologists and external organizations that provide teachers with methodological and interventional background. Teachers rated their availability as an important support that reduces the burden associated with solving crisis situations. This finding is in line with the literature, which emphasizes that collaboration with specialized services contributes to more effective intervention and reduces the feeling of isolation among educators (Fazel et al., 2023; Borg & Pålshaugen, 2019).

Based on these results, it can be concluded that teacher support should be based on systematic education in the field of mental health and self-harm, creating clear school protocols for crisis situations and strengthening the availability of professionals directly in schools (Matthews et al., 2021; Gao et al., 2025). Without these measures, the solution to self-harm remains fragmentary and dependent on the individual initiative or experience of individual teachers (Te Maro et al., 2019).

We consider the main limitation of the study to be the small number of participants and the subjective nature of the data, which reflect individual experiences and which cannot be generalized to the entire school environment. Nevertheless, the results bring valuable knowledge about the reality of Slovak educators and point to areas that require systematic support and further research.

At the same time, the results point to the need for clearer procedures in dealing with self-harm in the school environment. Based on the findings of this study, several basic steps can be recommended when self-harm is suspected: sensitive detection of warning signals and an individual interview with the student, involvement of a school psychologist or other expert, informing legal representatives and, if necessary, mediation of further professional help. A clearly defined procedure can help teachers reduce uncertainty and promote more effective collaboration between the school and professionals.

Conclusion with a recommendation for practice

The study showed that teachers perceive adolescent girls' self-harm as a serious problem closely linked to emotional and family difficulties. Although they strive to provide support and mediate professional help, they often feel unprepared and limited in their options. Systematic education of teachers, introduction of clear school protocols and strengthening of cooperation with experts therefore appear to be key for practice. It is equally important to focus on the prevention and support of the teachers themselves, so that they have sufficient competences and resources to handle this difficult issue.

Author: Mgr. Sabrina Luščíková

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