Self-harm: Why does this happen?

May 15, 2018
Self-Harm | Texas Children's Hospital
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For many people, the idea of self-harm is confusing. Most parents will feel upset, hurt and frightened when they learn their child is self-harming. They worry about their child’s safety, reflect on the signs they must have missed and might feel a sense of failure or shame that it’s happening to their family.

Self-harm has a very long history within human culture, but self-harm as a symptom of distress for young people in the United States has definitely been on the rise over the past 20 years. Generally, young girls or women are more likely to try self-harm, but this behavior will often be more severe and persistent when boys engage in it. Self-harm can be associated with specific mental disorders (i.e. depression, anxiety, trauma, substance abuse, psychosis) but can also occur at times of sudden extreme distress.

It comes in many forms, but the most common include scratching, cutting or burning skin. Some might self-harm where the marks are easily visible – but others will use areas on the body hidden from sight. Many young people might “try” self-harm a few times in moments of extreme distress, but don’t continue to engage in the activity. Others might find that self-harm does help them manage extreme emotions, and the activity might become more consistent as a way to cope with distress for this much smaller group of adolescents.

It’s important to recognize that self-harm is not equal to suicide. Oftentimes, a young person trying self-harm is doing it in an attempt to manage emotions, not to die. There is however a link between chronic self-harm and suicidal thoughts/actions, so self-harming behavior should be addressed directly, seriously and compassionately.

What should I do if I discover my child has engaged, or is currently engaging, in self-harm?

First, take a deep breath and consider if you need to talk first with another trusted adult (spouse, friend) regarding your emotional reaction to the news before discussing with your child. Initial reactions might end up coming off as scary or challenging to your child, and can make an open conversation more difficult.

Next, do your best to ask compassionately but honestly about how your child is feeling, especially if you’re going to address self-harm. Diving right into questions about when, where, why and how many times will put your child on the defensive, making trust more difficult to establish.

Consider the below dialogue as an example scenario.

“Andrea, I wanted to talk with you for a few moments about the marks I saw on your arm the other day. Can we do that please? I’d like to understand more about what’s going on for you right now.”

Expect your child to resist – be prepared. You might allow them to move the time of the conversation, but not for days.

“Give it a rest, mom, it was no big deal. I just scraped my arm on the doorframe. I’m waiting to hear back from John, so I can’t talk right now.”

“Well, I can wait until after you speak with John. But, I’m concerned – so do your mom a favor and talk with me in let’s say 30 minutes. I’ll be in the kitchen. “

“Fine, whatever,” says Andrea in an annoyed, frustrated tone.

Do your best to not pre-judge, and stay curious about how they’re doing emotionally.

“Andrea, I really do want to know how you’re feeling. It seems as if there has been a lot more pressure lately with school and choir. Can you tell me more about what that has been like?”

Once you have a better sense of their emotional state, you can then begin to ask more directly about the self-harm.

“So your choir teacher has been tough on you lately. That sounds really awful. Is there any link between how bad you’ve been feeling and the scratch on your arm?”

Expect your child to resist again, and be prepared by staying calm. Resist arguing and making statements of certainty. If the scratch was self-harm, you’ll only manage to solidify the statement and get pushed further away from your goal of understanding and helping.

If you’re child agrees (not admits – this isn’t a police interrogation) self-harm might somehow be linked to emotions, you can work to establish your desire to help with their emotional distress, not the self-harming.

This can be very challenging, as most parents want some type of assurance that the self-harm behavior will stop. This makes perfect sense, but moving towards actions directly related to self-harm is generally self-defeating.

“Andrea, I think I understand how bad you’re feeling. You felt so bad that scratching your arm helped to relieve it somehow. How can I help you manage the stress you’re under? What can we do?”

Of course, a final plan must be put in place for a child to stop engaging in self-harm, but parents will harm their position if they make the entirety of the approach about halting a behavior. You can comment on the behavior without invalidating their distress.

“Andrea, I think I kind of see how the scratch helped from what you’ve told me. Thank you for sharing this pain with me – I know it wasn’t easy to do. I can say I don’t like the idea of you hurting yourself when you get this upset. I want to help you as best I can with your stress. Can we work together on helping you with all of this? You know you can always come to me and I will help you.”

Certainly, if your child is struggling with emotional distress and engaging in self-harm, you don’t want to help your child all by yourself. The dialogue above is an entry point for engaging your child on a difficult topic. Locating a mental health professional will likely be the next step along the way toward help.

The good news is that intervention can be helpful. For some adolescents, psychotherapy will be sufficient. For others, a combination of approaches that might include medication for an underlying disorder might be helpful. There are no medications approved to treat the “symptom” of self-harm. The best way a parent can move their child onto a path of recovery and resilience is to be compassionate and to seek to understand the underlying emotions that lead to the decision to engage in self-harm.

You can learn more about Psychiatry and Psychology at Texas Children's by following these links. 

Post by:

Laurel Lyn Williams, DO

Laurel L. Williams, D.O. is an Associate Professer in the Menninger Department of Psychiarty & Behavioral Sciences. She is the Director of Residency Training for Child and Adolescent Psychiatry Fellowship. Clinically, Dr. Williams is working within Texas Childrens Hospital in collaboration...

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