QUESTION FROM A READER: I noticed that my daughter, who is 14 years old, always wants to wear long sleeve shirts and wants to cover her wrists. The other day, I saw scars on both of her wrists and inner thighs. She talks about how other girls in school cut on themselves when they are upset, and I think she is cutting on her wrists and thighs but doesn’t want us to find out. What should we do? How can we help her?
ANSWER: It sounds as if you are in tune with your adolescent and are a proactive parent. While this article provides general information about self harm behaviors, it is not medical advice. Please have your daughter see a trained mental health professional to assess her further in order to provide you with specific treatment recommendations. The sooner your adolescent gets help, the better.
What is Non-Suicidal self injury?
Non-suicidal self injury is a behavior where someone purposefully hurts themselves and inflicts pain on their body. This does not include socially acceptable behaviors, such as getting a tattoo or piercing, or getting another form of body art.
Unfortunately, you may hear someone who self injures described as a “cutter”. This is not an accurate description of the behavior. First, self injury involves other methods apart from cutting. Secondly, the term “cutter” describes a person and their character, when in reality, self harm is a behavior and is not who someone is.
Is self injury the same as a suicide attempt?
Not all self injury behavior is a suicide attempt. One of the differences is the individual’s intention behind the self injury. There is suicidal self injury where the person’s intent is to end their life. There also is non-suicidal self injury where the individual’s purpose in committing an act is done for different reasons, such as emotional regulation, or to end a feeling of pain and suffering.
In addition, suicidal self injury is typically more severe and more lethal. Non suicidal self injury involves less severe and extreme behaviors that result in self injury to the body.
Why do adolescents self injure?
Some of the most common reasons that adolescents self injure include:
Affect regulation: adolescents can get easily overwhelmed, especially if they are dealing with depression, anxiety and inter-sonar stressors. Self injury helps them distract themselves from being emotionally overwhelmed, albeit it is short lived.
Self Punishment: adolescents may self injure to express anger and frustration with themselves.
How have Parents Reacted to adolescents who self injure?
Families are an important part of recovery from self injury. A study in adolescents found that a perceived level of family support was associated with starting, continuing and stopping of self injury. Having adolescents disclose self injury behavior is a first step toward recovery and improving familial and social support. However, it is complicated as parents are the gatekeepers to seeing a therapist and getting treatment.
Oftentimes, family members want to help. However, gauging the reaction of family members can be challenging. Your first step toward being able to help your adolescent is becoming aware of what your potential reactions are when your adolescent discloses that they self harm or when you bring that concern up to them.
Common reactions include:
Denial: It is difficult for parents to understand why their child self injures, and as a result parents tend to deny that it happens.
Anger: Adolescents struggle with being open about self injuring and, as a result, parents can become angry with their child.
Bewilderment and guilt: Parents often blame themselves for not noticing the self injury behavior earlier and feel as if they may have caused it.
Overwhelmed: Parents have to manage many different things for their household and children. Finding out about self injury can be one more thing to be added to the already overwhelmed parent.
Anxiety/fear: Parents are often afraid to leave their child alone in fear for their safety, and in fear that they may self injure themselves.
Minimization: Some parents think that self injury is a phase that will pass, and dismiss it. This can put their adolescent at risk for safety without addressing the underlying causes and mental health concerns.
Relief: Some parents feel a relief as they already suspected or feared that their adolescent was self injuring.
How to talk to an adolescent who self injures
Don’t be judgmental: Approach the discussion with an open mind. Your adolescent is likely dealing with guilt and shame around self injury. Providing a safe, supportive space sends the message that it is OK to talk about self injury so that your adolescent feels heard and seen, not judged.
Focus on the behavior of self injury, not the identity of self injury: Self injury is a behavior used to cope with stressors. It is not the adolescent’s identity. You may have heard others refer to the adolescent who self injures as a “cutter”. The term is inappropriate as it renders the self injury behavior as a character defect and further increases the shame and the guilt and decreases the chances of being able to apply an intervention. Self injury is a behavior that can be changed with learning different skills.
Don’t overreact: stay calm and collected as your adolescent talks to you about their self injury behavior. Communicate that you are concerned about them but that you are there for them and are there to help them get through it. Adolescents are themselves often scared about the emotions that they eventually cope with by self injuring.
Do use Code words: Sometimes, it can be hard for an adolescent to verbalize that they have thoughts about self injury. Finding some code words that they communicate to the parent to let them know that they need support is crucial and focuses on changing the behavior without overwhelming the parent or adolescent.
Don’t think of self injury as a way to get attention: You have probably heard others say that the adolescent is self injuring as they are “just attention seeking”. That may seem like it on the outside. However, looking into it deeper, the adolescent is dealing with difficult emotions and is feeling disconnected and looking for a way to cope. This is not to justify self-injury but to help you have more compassion and empathy towards your adolescent. They are trying to cope the best way they can and self-regulate, though it may not be the healthiest way. And that is why they need your help and support.
Use a functional model to understand self injury: Spend time with your adolescent to understand the triggers and warning signs of the self injury behavior. This would help the adolescent find healthier ways of coping with emotions, triggers, and emotionally, with self regulation.
What organizations and resources are available for individuals who self injure?
There are no general peer-support groups (such as AA) to support people who self injure. However, there are some therapy practices that are evidence-based groups who help people cope with self injury behavior.
Dialectical behavioral therapy (DBT) is an evidence-based therapy that can help individuals with impulses to self-injure.
Here are some therapists trained in dialectical behavioral therapy for your adolescent to see.
SAFE alternatives runs support groups their group and can be found at:
International Society for the Study of Self-injury
Cornell research program on self-injury and recovery
References: Self-injury: Alexian Brothers. Center for Self-injury Recovery.
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