In this guest blog, Robert Young, a senior investigator at the MRC/CSO Social and Public Health Sciences Unit, discusses his latest research into the self-harming behaviors of ‘alternative’ teens published in BMC Psychiatry this week.

I’ve just travelled the 30 metres from my temporary research office to the Music therapy room in the basement of the Ulm Child & Adolescent Psychological Services building. In front of me are two German ‘Alternative’ teens, both referred to the clinic to help control their self-injuring behaviours.

The first is blasting out (in English) the Linkin Park song ‘In The End’, while the second energetically accompanies on the drums. Paul Plener, my psychiatrist co-author, is on bass guitar, while the resident music therapist leads on keyboard.

I, on the other hand, demonstrate my singular lack of musical talent by precariously balancing on some species of Bongo drum, while randomly pawing its surface – hopelessly out of time. This is what happens when an academic researcher makes the bumpy transition from theoretical to applied psychological intervention!

My visit to the clinic is part of an ongoing collaboration with Paul looking at the links between youth sub-culture and self-harm.  Despite all we know about the enormous social influence that a teenager’s peer group has on their behaviour, adolescent psychiatrists for the most part steer clear of the murky world of youth sub-culture.

Undeterred, about eight years ago I became interested in media reports of what was portrayed as a ‘minor epidemic’ of self-injury among Goth, Emo and other tribes of ‘alternative’ teens. Surprisingly our work found a strong link, with about half of all alternative teens engaged in self-injury or attempted suicide (a tenfold increase compared to other teens). Yet the reasons behind the high rate remained elusive, as did the clues to possible effective interventions.

Our recent work, published in BMC Psychiatry, looked at the rates of attempted suicide and non-suicidal self-injury in 452 German teenagers. We found that despite the fact participants were from a different nation and there was an eight year gap since the last research, the rates of self-injury were almost identical (45.5%). This roughly translates into a sevenfold increase in attempted suicide among German Alternative teens, and even adjusting for other major risk factors such as bullying did not attenuate the association.

How can we use this research to guide treatment? This research emphasises the strong, but not necessarily causal, link between adolescent identity and psychopathology, but more intriguingly it suggests that psychological therapy tailored to adolescent identities might be particularly effective.

Paul’s ongoing work explores the usefulness of music therapy for self-harming adolescents. Music therapy is as effective in treating adolescent psychopathology as any other form of therapy, but given that alternative teenagers are intrinsically attracted to music and are at high risk of self-injury this seems a perfect therapeutic match.

Pilot works confirms this and the method is almost universally accepted by ‘alternative’ teens who may normally be resistant to traditional forms of treatment. Given that the number of evidenced-based, effective treatments for self-injury is low, leveraging adolescents natural inclination is an innovative way forward.