When I first meet the parents of a child or teen who self harms or self injures, I am confronted by fear, distress, sadness, confusion and anger.
Parents describe the torment of knowing that their child deliberately hurts themselves.
They always ask, why? Why does my child, cut, bite, burn, scold or scratch themselves? How did this happen to my child? And most importantly, can you stop it from ever happening again?
Parents describe feeling alone with the problem, feeling that every attempt to support and help has made the matter worse.
Mums and Dads can feel powerless to assist. Sometimes they are pulling in opposite directions, as family tensions begin to rise.
Parents are concerned about how to protect or shield the brothers and sisters of the teen who is hurting themselves. For some, that protection is too late. They are worried about copycat behaviours or having a “bad influence” in the home.
The first and most important part of our meeting is to lose the blame.
Parents often start the conversation with, ‘what if’ or ‘if only’.
This is usually followed by a list of things that they could have done differently. Worked less, stayed together, been more permissive, more strict, not changed schools; the list is different for each family and yet similar in so many ways. Parents often blame themselves.
However, it’s important to remember that 14-20% of children will self-harm at some point.
The reasons for doing so vary greatly.
Children and Teenagers who self-harm, cause injury to themselves, or cause permanent changes to their appearance are often described by others as ‘emotionally sensitive‘. A fact that may have been noticed by family members, teachers, or health care professionals.
Occasionally the young person will have taken advice from mental health professionals, paediatricians, or family doctors. Difficulty sleeping, extended or prolonged co-sleeping, difficulty with foods (particularly picky eaters, avoidance of particular textures or colours) or weaning, difficulty making and keeping friends, impulsive, extended or prolonged ‘tantrums’, causing damage at home or school or hitting out at others are often reasons that advice is sought.
Other difficulties include in more-than-the usual sibling rivalry, persistent arguments at home, difficulty being left for short periods or young people described as excessively ‘clingy’.
Most Non-suicidal Self Harm begins in the teenage years, usually around 13/14 years old.
While Non-Suicidal Self-harm has no one cause, we can note its prevalence in young people with other mental health challenges.
As adolescence approaches and the period of early adulthood, some young people may be diagnosed with either a Mood Disorder or a Personality Disorder.
Borderline Personality Disorder
Borderline Personality Disorder is linked to an increased risk of self-harm and self-injury.
Cutting on the arms, abdomen and thighs are regularly seen in young people and teenagers who are challenged by the emotional instability, which can accompany Borderline Personality Disorder.
While teenage girls and young adult females are more likely to be diagnosed with BPD; boys and young men are also diagnosed, though less frequently, with BPD.
Why does my teenager self-harm?
Is a question that is asked by every affected parent.
Teenagers describe many scenarios in which they have self-harmed. They may include arguments with friends, the ending of a romantic relationship, a problem at home or school, being bullied, feeling ‘fat’, feeling alone, feeling abandoned or rejected, feeling unsettled, changing schools or moving home. These are just some of the events that preceded an episode of self-harm.
There can, of course, be many others.
Some young people will self-harm on a few occasions, maybe copying others or experimenting with the sensation. For others, self-harm will become more frequent, more troubling and more alarming for those around them.
Self-harm is not always linked to suicidal thoughts.
However, it’s a step in that direction; teens who engage in more dangerous and life-threatening behaviours often start with self-injurious behaviour.
While Self harm does not always indicate that your child or teenager has end of life thoughts, it is essential to consult a medical doctor or mental health professional for evaluation and assessment.
Self-harm is an indication of distress.
Often young people describe feeling overwhelmed. Sometimes they describe feeling ‘numb’. Often they describe feeling little or no pain when they self injure. Some young people may cry for long periods, describe feeling worthless, helpless, lonely, unloved, unwanted or sad.
Teenagers may also describe feeling angry, harm following a period of rage or an explosive episode. Adolescents may detail a feeling of control. They need to be in control of their feelings or needing to release the pain. Psychological pain can present through physical injury.
Young Children and teenagers who have a history of Adverse Childhood Experiences or Childhood Trauma may be more susceptible to episodes of harming themselves.
Some parents, carers or teachers may avoid exploring the reasons behind the self-harming behaviours as they feel that self-injury is a ‘cry for attention’. Just as you would not leave a baby to cry for hours on end without love, care and nurturing and meeting the young child’s needs, we need to respond appropriately to a young adult in distress.
Love, care, consistency, nurturing, boundaries and experienced assistance is essential.
Teenagers describe using self-harm to minimise emotional pain. Some young people describe using self-harm strategies to prevent feelings of despair and end of life thoughts. Others describe harming themselves to feel ‘something’. These young people describe an intense feeling of loneliness and emptiness. They can often detail how they ‘feel better’ as soon as the self-injury has happened in a release of an emotional void.
Teenagers also describe cutting, burning or other harming behaviours do articulate the degree of pain that they feel inside. It’s a way of describing the power of the emotion, often when they think that they are not able to find the right words to do so. These young people often feel unheard or feel that they are not understood at home, with friends or at school.
Anxiety and fear can also be a feature leading us to an episode of self-harm. Teenagers describe hurting themselves to prevent attending or taking part in a future event that fills them with dread.
Maybe exams are coming, a performance or an event which they feel unable to ‘get out of’.
A smaller but significant group, engage in self-harm behaviours that are related to a co-occurring psychiatric diagnosis, flashbacks, psychological disturbance, obsessive and compulsive behaviours or other factors; such as hallucinations. Voices can be very disturbing for young people.
Teenagers who hear voices may feel that they must comply with the wishes or commands of the voices that can feel very real.
In all cases, a comprehensive psychiatric evaluation is essential. Dr Rasyid Sulaiman, Medical Director and Lead Consultant Psychiatrist at The Wave Residential Programs for Teenagers and Young Adults, advises parents,
These voices can be relentless, harsh and critical of the young person.
Is self-harm is a cry for attention?
When I talk to teenagers who self harm, they have often been cutting, burning or utilising means of causing self-injury in secret. In many cases, a considerable amount of time has passed with nobody knowing.
This is contrary to the myth that self-harm is nothing more than a cry for attention from caregivers.
Adolescence is a time when young people become more private and less keen to discuss emotions openly.
Often confiding in friends, teens can be frequently heard explaining, ‘only my friends understand me’.
Parents who discover self-harm describe feeling alarmed. They feel that they need to watch over their children and teenagers much more closely.
The effects of NSSH have increased the attention given and proximity to the child. Parents can feel manipulated. What may have started as a secret has changed the relationship between parent and child. Parents can feel guilt and shame. It is quite likely that the young person feels that too.
Non-suicidal Self Harm always needs to be explored with a professional.
You may notice old scars. You may be confronted with fresh wounds.
Finding out that your child self-harms is difficult. It’s tough to accept. Finding out that others know that you self harm is tough too.
I am often told by both parents and the young people themselves; that ‘it’s just a scratch’ or ‘it’s not so bad’.
The results of some cutting and burning may be superficial and not require emergency medical attention; advice should always be sought from a mental health professional, psychiatric team, paediatrician or residential treatment centre specialising in young people.
On some occasions, an injury caused by self-harm can require immediate medical attention. Some teenagers will need to attend an emergency department. If the injury is serious or you are in any doubt, you should call an Ambulance or head straight to the nearest Accident and Emergency facility. In some instance, you will be met by the mental health team, a Counsellor, Psychologist or Psychiatrist.
How to know when a teenager requires more intensive treatment in an adolescent residential treatment program
- If your teenager or young adult is demonstrating behaviours at home that puts the safety of the adolescent or family members at risk of harm.
- If the behaviour at home feels unmanageable or is escalating in duration or severity.
- If the cutting, burning or other behaviour increases in frequency.
- If the family and support network feels burnt-our, exhausted and unable to manage
- If there is violence towards others.
- If the family fears for the well-being of siblings or other children if the family.
- If there are regular visits to the Emergency Department or Paediatrician
- If there are thoughts or mentions of suicide Or suicidal thoughts.
- If outpatient sessions are no longer supporting/holding the young person
- If there are co-occurring psychiatric diagnosis that require a higher level of care.
Can children and teenagers who self-harm be helped to stop cutting or burning?
Teenagers and Children who self harm can become stuck in a cycle.
The cycle of self-harm that allows them to feel relief in the moment but prevents them from developing adequate real coping skills and problem solving for life.
Young people can become trapped in black and white thinking styles and rigid patterns that compound the unhelpful and highly charged thoughts that they have. ‘I am rubbish’, “I can never get better’, ‘It’s all my fault’, ‘I am stupid’, ‘I am a failure’.
Left untreated, cutting, burning or other self-harm can continue across the lifespan.
To begin the healing process, teenagers must cross the barriers of stigma and build an honest and trusting relationship.
Exploring subjects that young people feel are taboo; takes both bravery and commitment to healing.
Dialectical Behaviour Therapy
DBT or Dialectical Behaviour Therapy is an evidence-based therapy that is successful in the treatment of Non-Suicidal Self Harm. It is also useful in the treatment of emotional, sensitive young people and those diagnosed with Borderline Personality Disorder. Created by Marsha Linehan, DBT is the preferred modality in programs at The Wave Clinic.
Teenagers engaged in DBT who have been self-harming, injure themselves less often, with less severity and a lower rate of Emergency department admissions.
Teenagers and adolescents are seen to show considerable improvement in 3-6 months of intensive DBT treatment.
Most teenagers and families report that young people also benefit from a reduction in generalised distress, overall psychological concerns; depression, anxiety and emotional dysregulation.
There is no doubt that finding out that your teenager is deliberately injuring themselves, is one of parentings biggest challenges. With the right support, intervention as early as possible and a willingness to embrace changes, it can and does get better.
I am fortunate to work with young people who have recovered, where self-harm is now a ‘thing’ from the past.
Fiona Yassin is the International Clinical Director at The Wave Clinic. An Accredited Clinical Supervisor (UNCG), Child and Family Trauma Therapist, with extensive experience in the treatment of young people challenged by Eating Disorders and Borderline Personality Disorder.
Fiona is a Fellow of APPCH, FDAP and IAEDP member and is currently studying CEDs.
Cutting: Understanding and overcoming self-mutilation. Steven Levenkron