Self-Harm

What is self-harm?

Self-harm is defined as the intentional, direct injuring of oneself, done without suicidal intentions. This can include cutting, burning, hitting or biting, interfering with wound healing, and other harmful activities. Self-harm is becoming more and more recognized as a way for people to try to deal with difficult feelings or situations.

Signs of Self-Harm

Although some people who self-harm may be suicidal, self-harm is often used as a way of managing difficult emotions without being a suicide attempt. However, self-harm can result in accidental death. If you are worried that your child is self-harming, here are some signs to watch out for:

• Unexplained cuts, burns, bruises, or blood on clothes
• Keeping themselves covered, avoiding swimming, or changing clothes around others
• Being withdrawn or isolated from friends and family
• Low mood, lack of interest in life, or depression
• Blaming themselves for problems or expressing feelings of failure, uselessness, hopelessness, or anger

Learning that someone you love is self-injuring can be shocking and upsetting. Finding out is often just the beginning. The road to recovery can be long and full of ups and downs. Of course, this process is often clearly stressful for your child, but it is important to acknowledge that it causes stress for you, too.

What makes a young person vulnerable to self-harm?

Each child and each family are different. Multiple factors can make a young person vulnerable to self-harm.

Depression, anxiety, low self-esteem, hopelessness, poor problem-solving skills, impulsivity, frustration, eating disorders, drug or alcohol abuse, and trauma can trigger a child to engage in self-harming behaviors.

A child can feel very anxious if there are a lot of stressful things going on in the family. There could be a lack of communication in the family, a fight between the parent(s) and the child, unreasonable expectations, neglect, too many rules or punishments, abuse, mental health problems, drug or alcohol abuse, a history of self-harm in the family, or money problems.

Social factors like problems with friends, bullying, abuse, easy access to ways to hurt yourself, friends who hurt themselves, social media, and the internet all play a role.

Why do adolescents self-harm?

Adolescents engage in self-harm behaviors:

• to manage extreme, uncomfortable emotions (guilt, sadness, overwhelm, anxiety, frustration, anger at themselves or others, low self-worth, and self-blame).
• to reduce tension
• to provide a feeling of physical pain to distract from emotional pain
• to express emotions such as hurt, anger, or frustration
• a form of escape
• an effort to regain control over feelings or problems
• an attempt to punish themselves or others
• to elicit care from others
• to identify with a peer group
• as a form of experimentation

Self-injury tends to bring a sense of relief or calm for those who find it useful. Some people who have been hurting themselves for a long time say that it gives them a rush of energy. Self-harm can be a sign of other problems, like depression, anxiety, eating disorders, or drug and alcohol use, which may need special treatment.

Self-harm can lead to other serious health issues.

Self-harm is a serious problem in and of itself. Self-harm is often repeated after it happens for the first time. Depending on the method, self-harm can lead to serious physical injury, including permanent scarring, the medical effects of a dangerous overdose, etc.

Self-harm can be a sign of other problems, like depression, anxiety, eating disorders, or drug and alcohol use, which may need special treatment.

Individuals who have self-harmed are at higher risk of suicide than other young people, although the risk is still low. For these reasons, it is important, where possible, to tackle self-harming behavior early.

How does emotion lead to self-injury?

As we all know, life can be hard at times. There are a variety of strategies that people use to manage intense or hard life experiences. Because thinking and feeling are strongly related, they can become intertwined in patterns that heighten the risk for self-injury. Teenagers are especially vulnerable because, as they grow up, their brains change in ways that make them more likely to see things negatively.

Two of the most common patterns linking emotion to self-injury are:

Rumination

This happens when a person repeatedly ruminates on or revisits a situation or event that made them feel bad. When they continue thinking about bad things, it tends to make them feel worse until it feels too difficult to handle. Children will then turn to self-harm out of desperation to calm and soothe those negative feelings.

Avoidance

People who have a lot of experiential avoidance will do things like self-harm to get rid of unpleasant feelings. This pattern of avoidance makes the need to find ways to self-soothe even stronger.

How do I know if my child is self-injuring?

Many adolescents who self-injure do so in secrecy, and this secrecy is often the clearest red flag that something is wrong. Although it is normal for adolescents to pull away from parents during times of high involvement with friends or stress, it is not normal for adolescents to be withdrawn, physically and emotionally, for long periods of time. It is also important to note that not all people who self-injure become distant and withdrawn; youth who put on a happy face even when they do not feel happy may also be at risk for self-injury or other negative coping behaviors. Some other signs include:

• Cut or burn marks on arms, legs, and abdomen
• Discovery of hidden razors, knives, other sharp objects, and rubber bands (which may be used to increase blood flow or numb the area)
• Spending long periods of time alone, particularly in the bathroom or bedroom
• Wearing clothing inappropriate for the weather, such as long sleeves or pants in hot weather

Self-injury is a secretive behavior, so it may be shocking to find out that your child is hurting himself or herself on purpose. However, denying the behavior is the same as denying your child’s emotional pain.

If you learn your child is self-injuring, you are likely to experience a range of emotions, from shock or anger to sadness or guilt. All of these are valid feelings. You may feel angry or frustrated that your child has possibly lied to you about his or her injuries because you see the behavior as pointless or because it is out of your control.

As a parent, it’s often frustrating and scary to see your child engage in self-harm. You may feel compelled to tell them just to “stop it!” But remember that you can never control another person’s behavior, even your child’s, and trying to do this does not make things better. You may feel as if you did not offer enough love and attention to your child. However, though your actions can influence your child’s behavior, you do not cause their self-injury.

Even though empathy can help you understand your child’s situation, sympathy and sadness can be condescending because they imply that your child needs to be pitied. These feelings may also make it more difficult for you to understand the behavior.

Helping Your Child

Address the issue as soon as possible. Don’t presume that your child will simply “outgrow” the behavior and that it will go away on its own. Keep in mind this can and does happen for some young people—some do mention “outgrowing” their self-injury. This typically occurs because they learn more adaptive ways of coping.

It’s important to remain calm when talking to your child. Let them know you are there for them. Listen more than you speak, and don’t try to solve the problem. It’s also important not to bring up the topic of self-harm right away, which can make your child feel defensive and not want to open up to you.

A good way to start the conversation is to bring it up in casual conversation. Ask if anything is worrying them and how they are feeling. Tell them you are not judging or dismissing them and that you love them and will always be there to support them. Show that you are prepared to listen to what they have to say and try not to minimize the importance of their reasons for self-harm.

If they don’t want to talk, ask them to write you a note, send you an email, or a text message about how they feel. Sometimes it’s easier for kids to share how they feel without the pressure of seeing your immediate response. They may not want to talk to you specifically. Try not to be offended or hurt. Ask if they would rather speak to someone else, like a counselor or another family member. The most important thing is to get them comfortable enough to open up and talk to someone.

What are some helpful questions I can ask my child to better understand his or her self-injury?

Know that direct questions can feel scary and invasive at first, especially when they come from someone they know and care about, like you. It is best to start by helping your child see that there is a problem and that they need help.

Here are some examples of what you might say:

“How do you feel before you self-injure?” “How do you feel after you self-injure?” (Help them retrace the steps leading up to an incident of self-injury—the events, thoughts, and feelings that led to the behavior.)

“How does self-injury help you feel better?”

“What is it like for you to talk with me about hurting yourself?”

“Is there anything that is really stressing you out right now that I can help you with?”

“Is there anything missing in our relationship that, if it were present, would make a difference?”

“If you don’t wish to talk to me about this now, I understand.” I just want you to know that I am here for you when you decide you are ready to talk.

“Is it okay if I check in with you about this, or would you prefer to come to me?”

Enhancing your ability to talk and listen to your child is not only important for recovery, but it is also a valuable skill set to further develop for all of your interactions with your child. But, as we all know, having an honest and open conversation with someone, particularly when the topic is sensitive, can be very difficult. Choose a time and place appropriate for the conversation. Your child is more likely to be open to sharing and listening if you are in a quiet place where there won’t be any interruptions or other things to take their attention away.

Things to Avoid Saying or Doing

The following behaviors can actually increase your child’s self-injury behaviors:

• Yelling
• Lecturing
• Put downs
• Harsh and lengthy punishments
• Invasions of privacy (i.e., going through your child’s bedroom without their presence)
• Ultimatums
• Threats
• Power struggles. (You cannot control another person’s behavior, and demanding that your child stop self-injuring is generally unproductive.)

The following statements are examples of unhelpful things to say:

• “I know how you feel.” This can make your child feel as if their problems are trivialized.
• “How can you be so crazy to do this to yourself?”
• “You are doing this to make me feel guilty.”

Alternatives to Self-Harm

Because self-harm is helping the young person cope with difficult feelings, it is important to think of other ways they might manage their feelings. These can include distraction, learning how to deal with stress, and thinking of other ways to get rid of strong feelings. Sometimes, joining a social activity or sports group can also be helpful. It can also provide a form of social support.

Some people find that putting off harming themselves can decrease or get rid of the urge. Reducing the accessibility of objects that might be used for self-harm (e.g., pencil sharpeners, knives, medication, etc.) may help to delay the impulse to self-harm.

When to Seek Further Help

If you are worried about your child, especially if the self-harm or distress gets worse or if you see problems like anxiety or low mood, you should get more help as soon as possible. This is best done through your pediatrician or mental health professional. They can administer a mental health assessment and use the results to create a supportive treatment plan.