You can’t imagine your child would hurt herself. And yet you’re seeing disturbing signs. She’s become withdrawn, spending more time than usual in her room. She’s wearing long-sleeve shirts, even in summer. And you’re seeing bloody tissues in the wastebasket.
If you suspect self-harm, there are things you can do—and things you shouldn’t do.
Self-Harm and Children
Self-harm is not a mental illness. It’s a symptom of emotional distress, a behavior to compensate for a lack of coping skills. It occurs most often during teenage and young adult years, times of great transition that can trigger overwhelming emotions. Mental health disorders may co-occur with self-injury; these include borderline personality disorder, depression, anxiety, eating disorders and PTSD.
It’s estimated that 17% of adolescents and 13% of young adults practice self-harm. Rates of self-harm are thought to be higher among girls than boys. But because boys often present behaviors and outward signs perceived as “normal,” such as punching walls and bruising, rates for boys may be underreported. And behaviors like drug use and unsafe sex may not be reported as self-harming, even though they are extremely harmful.
“NSSI is a strong predictor of later suicide attempts. [College] students who self-injured at the beginning [of one study] and did not report suicidal thoughts, plans or actions at the time, but who went on to engage in 20 or more self-injuring behaviors, were 3.4 times more likely to have attempted suicide by the study’s end.”
American Psychological Association
Race and socioeconomic status are not determinants of self-injury, but sexual orientation is a risk factor. More gay or bisexual males and 47% of bisexual females self-injure. Children most at risk are those who have experienced trauma, neglect or abuse. Other risk factors include stressors like social isolation, bullying and conflict with parents or teachers.
Areas of the body most frequently involved are the wrists, arms, legs and torso. Self-harming behaviors include:
- Cutting, branding or burning the skin
- Head-banging or hair-pulling
- Scratching, biting or picking at skin
- Inserting objects under the skin, piercing the skin, carving words or images on the skin
- Self-hitting or hitting solid objects
Why Does It Happen?
Self-harm is a child’s attempt to cope with emotional and psychological pain. Obviously, there are more constructive ways to cope, but self-harming individuals have a hard time managing, expressing or understanding their emotions. Feelings that become unmanageable can include anger, guilt, worthlessness, rejection, self-hatred or confusion over sexuality. Having friends who self-harm, or visiting websites that present it as a solution, can encourage self-injury.
Self-injury may:
- provide a release or distraction from extreme emotions.
- offer a child a sense of control over his or her body, feelings or circumstances.
- allow a child who feels emotionally numb to feel something, even if it’s pain.
Warning Signs
Signs of self-harm involve the seen and the unseen. Physical evidence may include cut marks, burns, bruises and scars, which can appear in patterns. Sharp objects and bloody tissues are flags, along with rubber bands (used to numb an area of the body or to increase blood flow). Rubbing one part of the body can also be an indicator. And clothing—lots of bracelets, long sleeves or long pants—may be used to hide scars and injuries.
Children who self-harm are often practiced at hiding it. They may spend long periods alone in their bedroom or bathroom, avoid activities like swimming that would reveal their wounds or make excuses for injuries. They may exhibit unpredictable behavior, impulsiveness and emotional instability, along with negative self-talk and signs of depression.
What to Do—and Not Do
Parents may not understand self-harming behavior. Why would you harm yourself? I’ve worked so hard to keep you safe and healthy. It may be natural but unhelpful to react with alarm. To avoid adding to the emotional pain that your child is experiencing, don’t:
- threaten, judge, pity, condescend, shame or “out” them.
- pressure them to talk, invade their privacy or issue ultimatums.
- punish them—but do maintain healthy discipline that lets them feel secure.
Remember that you can’t control someone else’s behavior. If you take away their self-harming tools, they may find something less safe to use. But don’t ignore self-harm. While some “outgrow” the behavior, it can escalate in others.
“Nonsuicidal self-injury [NSSI]… is the act of deliberately harming your own body, such as cutting or burning yourself. It’s typically not meant as a suicide attempt. Rather, this type of self-injury is a harmful way to cope with emotional pain, intense anger and frustration.”
Mayo Clinic
Stay calm. Ask gently if they’re hurting themselves and really listen, as uncomfortable as it may be. (You can begin a dialog via text if your child is too uncomfortable to talk.) Try asking neutral questions: How does this help you feel better? If you could name something that’s missing in your life, what would it be? Validate their feelings and acknowledge their pain. You can share your own coping strategies but let them know you’ll get help and be there for them. Create a home environment that includes family time and reasonable limits to help them feel safe. Be a patient ally in their healing.
Getting Help
There is no diagnostic test for self-harm. Treatment begins with physical and psychological evaluations to determine the severity of injuries and to identify any underlying mental health issues. For severe or frequent self-harm, psychiatric hospitalization may be needed. Medication may be used to treat co-occurring disorders like depression. But psychotherapy is usually the main tool to get to the root of emotional pain and help the child learn better coping skills.
Therapies can include:
- Cognitive behavioral therapy (CBT), to recognize and change negative patterns of thought and behavior.
- Dialectical behavioral therapy (DBT), a type of CBT that emphasizes mindfulness, regulating emotions and improving relationships.
- Mindfulness techniques, to stay in the present moment and develop accurate interpretations of others’ actions.
- Family or group therapy.
It’s important to seek help early for your child. The longer self-harm continues, the harder it is to stop; feelings of shame and guilt begin to compound already-intense emotions, and the risk for suicide increases. At Best Day, our counselors will work with you and your child to return to an emotionally balanced way of coping with life’s ups and downs.
How We Can Help You?
Best Day Psychiatry and Counseling is here to help you have a better day and find a better way. We treat a wide range of psychiatric conditions for both children and adults. Contact us today, we’re ready to help:
Fayetteville: (910) 323-1543 • Fuquay-Varina: (919) 567-0684 • Raleigh: (919) 670-3939 • Greenville: (252) 375-3322