Very well put and interesting to read. I have had some experience with self-harming teenagers and unfortunately, all of them had to be institutionalized in order to receive proper help and treatment. The good news is, it worked (at least for those that I personally know). When talking to one particular girl, her explanations why she does it are almost identical to what you have described especially that part with getting relief even when only looking at a sharp object.

I have found that medication + counseling is the key because I observed how only medication or only counseling did not help, at least not in the long run. It was surprising to me when I noticed how patients who received bigger and bigger doses of drugs did not get better until they found a quality therapist to talk to just as those who spent years in therapy did not get better until they started taking medication. I guess those two compliment each other and work best when together. Anyways, thanks for quite an interesting and educational read.