New research shows that self-harming behavior may be on the rise among teens. Those who do it say it’s a way to deal with emotional pain.

The first time Ruth Carter remembers harming herself, she was 13 years old and helping make banners for her eighth grade graduation ceremony.

“We were putting it all together with hot glue,” said Carter, of Phoenix, Arizona, “and I purposely — quote ‘accidentally’ — used too much hot glue on one of the pieces, knowing that when I pushed down, hot glue would leak out the sides and I would burn myself.”

By the time the glue scalded her skin, Carter realized the hard way that this was a bad idea. But the physical pain gave her a way to cope with stress in her life, which included physical and emotional abuse as well as the sense that her life at the time wasn’t quite right.

“I felt really alone in the world,” she said. “The way I was running my life wasn’t working out — which is kind of an odd thing for a 13-year-old to be thinking.”

Eventually this single act of harming herself became a habit that stayed with her until she turned a corner in her mid-20s. She never cut herself with razor blades or other sharp objects, but she found emotional relief by scratching at her skin with her fingernails until the skin broke.

“That would be the way of managing my emotions,” she said. “Definitely the more stressed I was — from family situations or school or social situations — it was more likely to happen.”

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Carter’s story is not all that unusual — 13 to 35 percent of students have intentionally injured themselves at some point, according to the National Center for PTSD.

Typical actions include cutting, scratching, and picking or pulling skin or hair. Some people may also bang their head against the wall or punch objects or themselves.

A new study suggests that this type of behavior, which often begins during the teen or early adult years, may be on the rise.

Researchers found that between 2009 and 2012, self-injuries accounted for a growing number of visits by adolescents to emergency rooms — increasing from 1.1 percent to 1.6 percent of all visits.

Overall, the most common method of self-injury was cutting or piercing. This was also the most common method used by girls, while in boys it was firearms. Other ways that children and teens harmed themselves included intentional falls, suffocation, and poisoning.

The study, which was published online June 15 in the journal Pediatrics, used information collected from a national trauma database. This included more than 286,000 10- to 18-year-olds treated in emergency rooms between 2009 and 2012.

Although self-harming behavior in children may immediately trigger parental fears of suicide, that is rarely the case.

“The majority of self-harm behavior in adolescents is done without suicidal intent,” Gretchen Cutler, Ph.D., M.P.H., the study’s lead researcher from Children’s Hospitals and Clinics of Minnesota, said in an email. “In fact, adolescents are at higher risk of non-suicidal self-injury compared to other age groups.”

The trauma center data used in the Pediatrics study wasn’t detailed enough to tell whether adolescents who harmed themselves were trying to commit suicide. A recent study of adolescents in England, though, found that only 25 percent of those who reported self-harming wanted to die during their most recent episode.

Still, there’s good reason for parents and doctors to be alert for signs of self-inflicted injuries among teens and young people.

“Any self-harm behavior is concerning, even without suicidal intent,” said Cutler, “as adolescents who self-injure are at increased risk for future suicide attempts.”

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The motivation for adolescents to self-harm may not be what many people think.

“Fewer of them do it for attention, for other people to see,” said Benna Strober, Psy.D., a licensed psychologist and certified school psychologist. “More of them do it to self-soothe, and they don’t want other people to see it, especially their parents.”

To keep their behavior secret, some adolescents will harm themselves in areas where it’s less likely to be seen — upper arm, thighs, upper chest. And not all self-harming is severe enough to land teens in the emergency room. That makes it more difficult to really know how many adolescents are doing it.

The exact reasons that adolescents self-harm are complex, which makes it challenging to treat. Some may injure themselves to rebel against their parents, take risks, or to fit in with their peers.

But for many it provides a kind of release for emotions that they may not be able to deal with any other way.

“I think it might have been seen as something I did for attention, but it wasn’t. It was a cry for help,” said 44-year-old Teresa O’Brien, of Dover, New Hampshire, who suffered physical and emotional abuse as a teenager.

As a teen, O’Brien started harming herself, including cutting her arm and picking at her skin.

“The physical pain certainly felt better — it kind of let out the emotional pain,” she said. “If you feel physical pain, you have something to actually hurt for.”

Adolescents who self-harm may also suffer from other types of mental health problems, such as depression, post-traumatic stress disorder, and bipolar disorder.

Although the Pediatrics study only identified mental health disorders in about 5 percent of adolescents who harmed themselves, many problems may have been missed at the time of their visit.

“The low number of patients with a recorded diagnosis is concerning,” said Cutler, “as this indicates missed opportunities to document mental health issues and link patients with follow-up mental healthcare.”

Seeking out a mental health professional can help adolescents move from self-harm to self-care. But not everyone will be ready to stop right away, which is something that parents need to keep in mind.

“I always ask first, ‘Do you want to stop?’” said Strober. “Because sometimes they don’t want to because it makes them feel better. So why would they?”

For Carter, a shift in her outlook came with her third therapist, but even then it took a lot of hard work to change her habit of using self-harm as a type of emotional medication.

“We had multiple rounds of therapy where the focus was on managing my self-care, not damaging myself in any way,” she said. “It took a few years of just learning how to ride the wave of anxiety and not self-medicate.”

O’Brien, though, still turns to self-harming behavior to cope with stress, which completely overwhelmed her about three years ago. And without health insurance — another risk factor for self-inflicted injury identified by the Pediatrics study — she cannot afford the kind of counseling that might help.

“Jump ahead to where I am now, and I’m picking my legs — they’re completely scabbed up — and my face and my arms,” she said. “I think it comes from the same place as when I was a teenager — nobody listening, nobody gets it.”

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