Kids and Self-Injury: What Parents Need to Know

What is self-injury?

Self-injury is the act of physically hurting oneself without the intent to die. It is a sign of emotional distress and indicates a person has a lack of healthy coping skills. The most common forms of self-injury are cutting, burning, or scratching the skin and bruising the body tissue.  Most people who self-injure start when they are teenagers.

Is self-injury a diagnosis?

Self-injury is not a diagnosis in and of itself. People who engage in self-injury are most often diagnosed with mood disorders, eating disorders, personality disorders, and/or anxiety disorders. Many who self-injure do not have a diagnosable disorder at all. Between 14 percent and 24 percent of youth and young adults in the community report engaging in self-injury at least once in their lives.

Why do people self-injure?

Youth and young adults who self-injure generally report that they do it to cope with upsetting feelings, to feel something when they are numb, and/or to express their pain. There is evidence that self-injury releases endorphins in the brain, helping people who self-injure to feel better in the short term. However, self-injury is not a healthy long-term coping skill and is a risk factor for later suicidal behavior. There is also a common belief that self-injury is attention-seeking, but in reality, most people who self-injure hide their cuts, scars, or burns because extra attention is unwanted.

Is self-injury the same as suicidal behavior?

Self-injury is NOT an attempt to kill oneself. Some people who self-injure even say they do it to STOP themselves from acting on thoughts of killing themselves. Even though self-injury and suicidal behavior are very different, many individuals who self-injure may have suicidal feelings too. If you notice these warning signs of suicide in your child, go to your local emergency room immediately, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or reach out to the Crisis Text Line by texting “START” to 741-741.

Who is likely to self-injure?

Youth who struggle to deal with negative emotions or talk about their problems are at increased risk for self-injury. Other risk factors include: not having healthy coping skills, having a mental health condition, being excluded or discriminated against by peers, and knowing someone who self-injures. It is a common myth that only females self-injure, but in fact, females and males have similar risk for self-injury.

How do youth learn about self-injury?

Many youth use social media to learn about self-injury and connect with others who may encourage self-injury as way of managing distress. Although major social media sites have policies restricting posts referring to or showing self-injury, images of self-harm may continue to pop up on sites like Tumblr and Instagram. Adolescents report there are even websites that instruct one how to self-injure with step-by-step instructions. While there are no data yet to suggest that social media directly increases self-harm, experts are concerned that social media could normalize self-injury as a legitimate coping skill among vulnerable teens.

How is it treated?

Due to the complex factors that may contribute to self-injury and the risks associated with these behaviors, treatment from a licensed therapist with experience in this area is recommended. Cognitive Behavioral Therapy and Dialectical Behavioral Therapy are the most commonly used therapies to address self-injury. In some cases, additional consultation with a physician or psychiatrist may be warranted to help treat an underlying psychiatric condition. Although some people who self-injure find success stopping on their own, most people do not grow out of self-injury without finding healthier ways to cope. Self-injury should not be viewed as a “phase” or “fad” that one will simply grow out of and should always be taken seriously when disclosed.

If left untreated, what can it lead to?

Although self-injury is different from suicidal behavior, it is still concerning because it does increase risk for suicide. Self-injury allows someone to get used to damaging his/her body to deal with distressing emotions or situations. Over time, hurting oneself can lead to increased feelings of shame and worthlessness which are also risk factors for suicide.

Is recovery possible?

Recovery is certainly possible! Because self-injury is often used as a coping mechanism, recovery can occur when individuals are provided effective alternatives to manage their emotions. Of course, a youth needs to be motivated to stop self-injury for the road to recovery to begin. Motivation can be low when people feel they only have one tool to manage their pain. A skilled therapist will help youth who self-injure evaluate the role self-injury plays in their lives, challenge the idea that only self-injury can reduce distress, build self-confidence to choose healthier coping skills, establish clear emotional support networks, prepare for possible relapses and celebrate success along the way.

If your child is having suicidal thoughts, take him or her to your local emergency room immediately or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Do not leave your child alone until you see a mental health professional. Let them know you will get through this together.

What signs of self-injury should I look for in my child?

Because many youth who self-injure hide their scars and do not wish others to know about this behavior, noticing signs of self-injury can be hard. The following warning signs can alert parents that self-injuring may be occurring:

  • Unexplained cuts, burns, or bruises, typically on the arms, legs, or stomach
  • Wearing bandages frequently
  • Finding razors, sharps, knives, or other items that could be used to self-injure
  • Wearing long-sleeve shirts or pants in warm weather
  • Unwillingness to participate in activities that require less clothing (e.g., swimming)
  • Wearing wrist bands, multiple bracelets, or wide-band leather bracelets to conceal cuts
  • Expressions of self-loathing, shame or worthlessness
  • Withdrawing from family and friends

It is important to look for all of these warning signs if you suspect your child is engaging in self-injury. Although many youth who self-injure isolate themselves from others, some continue to hang out with friends and family and appear happy.

How should I talk with my child about self-injury?

  • Address the issue as soon as possible. Self-injury rarely resolves on its own.
  • Be aware of your own emotions. Parents who learn their child is self-injuring may feel a wide range of valid feelings: anger, sadness, shock, anxiety, and/or guilt. If your emotions are running high, it is not the right time to talk.
  • When you’re calm, start by telling your child what you have noticed and why you are concerned.
  • Validate your child’s feelings. This is different from validating your child’s behavior. You do not have to agree with self-injury as a coping tool to be emotionally supportive.
    • Listen non-judgmentally. Let your child speak freely without reacting while he/she is talking. Then offer your thoughts.
    • Speak in a calm and comforting tone.
    • Offer reassurance that you will get through this together.
    • Think about how you wanted adults to react when you were a teenager who was emotionally distressed.
  • Do not pressure your child to talk. If you’re feeling anxious, your child probably is too. Self-injury is an stressful topic for everyone. And if your child is self-injuring, it can indicate your child has difficulty verbalizing his/her emotions. Let your child know you are available to talk and bring up your concerns again at a later time.
  • Get your child professional help from a licensed therapist with experience treating self-injury.

 

For more information about Nationwide Children’s Hospital’s Behavioral Health services, click here and to hear more about self-injurious behavior and treatments, listen to our PediaCast.

References:

Caicedo, S. & Whitlock, J.L. (2009). Top misconceptions about self-injury. The Fact Sheet Series, Cornell Research Program on Self-Injury and Recovery. Cornell University, Ithaca, NY

Franklin, J. (2014). How does self-injury change feelings? The Fact Sheet Series, Cornell Research Program on Self-Injury and Recovery. Cornell University, Ithaca, NY

Leonard, K. (2015, May 29). Is social media making self-harm worse for teens? Retrieved from http://www.usnews.com/news/articles/2015/05/29/is-social-media-making-self-harm-worse-for-teens

National Alliance on Mental Illness. (n.d.). Self-harm.

Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Self-harmPietrusza, C. (2010). Recovering from self-injury. The Fact Sheet Series, Cornell Research Program on Self-Injury and Recovery. Cornell University, Ithaca, NY

Self-injury Outreach and Support. (2015, October 17). Self-injury – a general information guide. Retrieved from http://sioutreach.org

Whitlock, J., Minton, R., Babington, P., & Ernhout, C. (2015). The relationship between non-suicidal self- injury and suicide. The Information Brief Series, Cornell Research Program on Self-Injury and Recovery. Cornell University, Ithaca, NY

Whitlock, J., Eckenrode, J., & Silverman, D. (2006). Self-injurious behaviors in a college population. Pediatrics, 117, 1939-1948.

Elizabeth A. Cannon, LPCC
Elizabeth is a clinical mental health counselor with years of experience working with children and families in the school and community setting. Her interests include eliminating mental health stigma, social justice, and family-centered care. She also has experience working in adolescent suicide research in the Center for Innovation and Pediatric Practice at Nationwide Children’s Hospital. Currently, she is a Suicide Prevention Specialist in the Center for Suicide Prevention and Research as well as an outpatient clinician for teens with anxiety and mood disorders at Nationwide Children’s Hospital.
John Ackerman, PhD
John Ackerman, PhD, is a clinical psychologist in Behavioral Health and Suicide Prevention Coordinator for the Center for Suicide Prevention and Research (CSPR) at Nationwide Children's Hospital. He directs community, school, and hospital efforts to educate others about the risks and warning signs of pediatric suicide. Dr. Ackerman has contributed to ongoing investigations at The Research Institute at Nationwide Children's regarding risk factors for adolescent suicide. He is also interested in how social media can contribute to suicide prevention.

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