Self-Injury Awareness Day (SIAD), is an annual global awareness event designed to draw public attention to self-harm and to help those who struggle with it. In support of this effort, Effective School Solutions (ESS) would like to offer some guidelines for parents and caregivers who strive to keep children safe in the face of numerous challenges.
It is no secret that parents today have many reasons to worry about their children and adolescents. Many students are still struggling to recover from pandemic-related learning loss and from the effects of social isolation. The extensive use of the internet and social media has disrupted children’s lives in many ways: e.g., they get less sleep and physical activity, have fewer face-to-face social interactions, are exposed to potentially harmful content, and are more vulnerable to unseen predators. The youth mental health crisis is very real, with higher rates of depression, anxiety, suicidal thinking, and self-harming behaviors. And, to make matters worse, we are living at a moment in history that generally feels less safe because of a global health crisis, gun violence, wars and terrorism, financial instability, an environment of intense cultural and political strife, and decreased confidence in society’s institutions.
Against the backdrop of these stressors, the thought that one’s child might be deliberately self-harming can be devastating. With that in mind, ESS offers the following information to guide and reassure parents that the behavior is understandable and, more importantly, treatable.
Self-Injury Awareness Begins with Understanding Definitions and Prevalence
Self-harm, also known as Non-Suicidal Self-Injury (NSSI), is a serious public health concern for teens and young adults. Although distinct from suicidality per se, it is typically associated with suicidal ideation, anxiety, and depression, all of which have dramatically increased in this population in recent years. Self-injurious behavior can have numerous causes/functions, but it is essentially a disorder related to difficulties with emotional regulation. It typically begins in early to mid-adolescence, between the ages of 12 and 16. Estimates suggest that almost two million Americans engage in self-harm, with approximately 17% of the population resorting to this behavior at some point during their lifetime. As reported by Mental Health America, “recent studies have found that one-third to one-half of adolescents in the US have engaged in some type of non-suicidal self-injury, although some studies put the rate at 13 to 23 percent.”
NSSI is defined as direct and intentional self-inflicted bodily pain or harm that includes cutting, burning, scratching, biting, head-banging, punching walls, ingesting harmful chemicals, and skin-picking. The behavior itself does not have suicidal intent, that is, it is not motivated by an intent to die. Both boys and girls engage in NSSI, although rates vary by age and method. Boys are more likely to hit themselves or something else, while girls are more likely to cut, pierce, or carve skin. By the 9th grade the rate of girls engaging in NSSI is 3 times higher than it is for boys. As is true for suicidal thoughts and behaviors, the risk for self-harm is particularly high for children who identify as LGBTQ+.
What Causes Self-Harm?
The reasons for self-harm are varied, but as summarized in a recent Psychology Today article there are four major categories:
- To feel pain that counteracts the sense of being emotionally numb or dissociated, experiences that are frequently reported by those with histories of abuse or trauma. NSSI is a way to feel something, to not feel disconnected or “dead” inside.
- To inflict a form of self-punishment for those who feel guilty or unworthy, to find temporary relief from these painful feelings. The inability to recognize one’s inherent worthiness can stem from adverse childhood experiences such as neglect, abuse, bullying and other traumas that lead individuals to conclude that others abused or mistreated them because they just were not good enough.
- To distract from unwanted or seemingly intolerable thoughts and feelings such as loneliness, anger, or depression. Individuals who have difficulty tolerating painful emotions and memories may seek to avoid them because they have not developed healthy distress tolerance skills.
- To regulate any internal emotion or state that an individual feels unable to cope with or understand. Self-harm appears to function like a release valve, but the relief is only temporary and is often followed by feelings of guilt and shame, thus contributing to a continuing cycle of self-harm and other mental health symptoms.
Self-harm is not a mental health diagnosis in and of itself, but rather is a behavior that manifests as a symptom of several mental health disorders, including depression, bipolar disorder, anxiety, eating disorders, and borderline personality disorder.
Self-Harm in Teenagers – What Parents Should Look For
Adolescents who engage in NSSI frequently go to great lengths to hide their behavior. Parents should certainly watch for fresh cuts and scratches, pierced skin, bite marks, and burns, but also pay attention to unexplained scars, bruises, and bald patches. Youngsters who are self-harming might wear long sleeves and other concealing clothing even in warm weather to hide fresh injuries or scars. They might be found carrying sharp objects or rubber bands (to snap against skin or to bind tightly around a limb), hiding them in their rooms or in lockers at school. Children who prefer to spend long stretches of time alone in their rooms might be using that alone time to self-harm. Accident-prone children should also be monitored: a 2021 study funded by the National Institute of Health found that there was a correlation between children’s ER visits for certain unintentional injuries and the risk of future self-harm.
Teens who are depressed and/or express feelings of worthlessness or hopelessness may be at risk for self-harm, as well as children who’ve experienced one or more traumas. Those youngsters whose moods are quite variable, who have difficulty regulating emotions, and/or who take a long time to calm down after a stressful situation might also be at risk.
Some Tips on How to Proceed if You Suspect Your Child is Self-Harming
It is natural for a parent to feel shock, anger, fear, and possibly guilt when confronted with a child’s self-harming behavior. This might elicit denial and the hope that the child will simply grow out of it, or it might go to the other extreme with a parent responding in an overly dramatic or explosive manner. While these behaviors are understandable reactions to parental distress, they are not especially helpful and might even make matters worse.
Here are some tips for parents and caregivers to consider:
- Address the issue as soon as possible. Seek the counsel of a partner/spouse, and perhaps a school based mental health professional or community provider to plan how to approach your child.
- Stay calm.
- Start with observations: “I noticed my razor was missing and I found it in your room.” “I noticed a lot of scratches on your arm yesterday when you were changing clothes.” “You’ve been having a lot of accidents lately.” “You seem to wear long sleeves and pants even when it’s really hot out.” “You’ve been really down on yourself lately.” Give your child the opportunity to offer an explanation – “What’s going on? Can we talk about it?”
- Make the link between the observed behavior(s) and self-harm. “I’ve learned that this behavior can be a sign that a teenager is self-harming. Is that what’s happening with you?”
- Express concern for your child’s physical and mental well-being; reassure him/her that you are there to help, not criticize or punish.
- If the child absolutely denies self-harm or indicates that he/she cannot talk about it yet, back off but let the child know you will return to the conversation very soon and will be extra vigilant about safety.
- No matter how your child responds, validate the feelings expressed. “I know you’re angry that I’m asking about this and that’s OK.” “It must be horrible to feel so anxious and lonely all the time.” “I hear that you’re really stressed and need a way to cope, and I also know that there are other ways besides cutting to help you deal with your emotions”.
- Remember that validating the feelings that give rise to self-harm is NOT the same as approving of the behavior. DO NOT try to talk someone out of his/her feelings. “Oh, things are not really that bad.”
- Avoid criticisms or threats.
- Ask how you can help. Offer to have your child talk with a counselor or other trusted adult to break the ice if he/she is having difficulty opening up to you.
- Assure your child that you know it can be hard to stop these behaviors and that help is available.
Help Is Available!
It is important for parents to know that as scary as this behavior can be, there are successful treatments for NSSI, most notably the specific skills taught in Dialectical Behavior Therapy (DBT). Mindfulness, distress tolerance, and emotion regulation skills in particular help individuals to stay in the moment and to recognize emotional states and tolerate distress. In addition to skill development, individual counseling is an important part of DBT, and family sessions are especially critical for teens. Parents who are aware of and can support a child’s efforts to learn and apply new DBT coping skills across many situations can hasten the progress and ensure that it “sticks”. Medications can also be considered to help youngsters who experience extreme anxiety or depression, or whose neurocognitive challenges (e.g., ADHD) make it difficult to learn coping skills.
Parents who suspect that a child is self-harming can explore the mental health services available within their child’s school and seek an assessment there. Or, if those services are limited, school-based professionals can refer families to trusted community resources for an evaluation. Parents are advised to call the child’s pediatrician for guidance and referrals as well, and to schedule a wellness check as soon as possible. Parents can also call or text the national hotline for help: Call or text 988 or initiate a chat at 988lifeline.org.
And, as is commonly included with parenting advice of all kinds: Don’t neglect your own care and well-being! Seek your own therapy and the support of family members and friends who will listen without judgement.
Resources:
What is Self-Harm? SAMHSA
Help for Cutting and Other Self-Injury Child Mind Institute
When Children and Teens Self-Harm HealthyChildren.org
