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Self-Harm: A Sign of a Hurting Adolescent

Cutting Picture
For most people, self-harm, such as cutting, burning, scratching, and bruising is an obvious sign your teenager is hurting. Out of all the signs that point to a hurting teenager, this one usually gets attention the fastest, and parents are quick to respond. Probably the most difficult part for parents is trying to understand why their kid is engaging in self-harm, and how to stop it, with the emphasis on “stop it”. Through my experience working with teenagers and my research on the topic, I have found that parent’s reaction and urgency to stop it before truly understanding what your teen is struggling with, can drive them further to self-harm. I want to spend the majority of this blog trying to understand self-harm, that way your response will be more person centered, instead of problem centered. Due to the weight of this topic, I am also going to break out of my typical blog style, and be more academic in my use of citation.

Understanding Our Reaction to Self-Harm

For families with a teenager who is engaging in self-harm, it can be an extremely frightening experience. Much of the fear comes from the muddled relationship between self-harm actions and suicide. Family members can be left baffled by the actions of a person who is engaging in self-harm, as well as being frightened that suicide is just over the horizon. It appears to be counter to self-preservation for someone to engage in self-harm, so we worry that their impulsiveness and apparent lack of care for themselves will lead to suicide. To sum it up, I think parent’s strong reactions mostly come from not understanding what self-harm is, and the fear that suicide is the next step. Hopefully as you understand the issue more, these fears will be reduced, and you can help your teenager learn new skills.

How Common is Self-Harm?

One important thing to note when discussing self-harm is that you are not alone in your struggle to help your teenager. In their article, Cutting to Live: a Phenomenology of Self-Harm, Brown and Kimball explain that a study of high school students in both the U.S and Canada showed that 13-24% of them engaged in self-harm (2013, pg. 195), while another study states a prevalence of 17-20% in high school students (Halstead, Pavkov, Hecker, & Seliner, 2014, pg. 246). Although this does not make the action of cutting or bruising any better for your teenager, it can help you in realizing that there are many parents out there who are wrestling with the same concern you are, and that your teenager is not alone in his behavior. It also points to the fact that your teenager can get through this, but they might need some help along the way. I do think self-harm is a signal that our kids need guidance, and should not just be passed off as a “teenager phase”

The Blurred Line Between Suicide and Self-Harm

Studies have varying results, but when you look closely at why, it is clear that the definition of “self-harming” behavior used at intake in the hospital (where the majority of research is done, and those who try to commit suicide end up) does not distinguish between those who cut, and those that cut with the intent to die. If the intent is defined, the correlation becomes less threatening to therapist and parents alike. Dennis Ougrin (2012) responds to the connection between suicide and self-harm without the intent to die by boldly stating, “No study has as yet shown [self-harm] to be independently linked with a higher risk of completed suicide in adolescents” (pg. 1220). Some research has demonstrated that self-harm has actually been used to avoid suicide. That is why it is important to always assess for suicide, and not try to stop the behavior without other interventions. At this point, I would recommend having your teenager brought to a counselor so the risk of suicide can be assessed, but for a quick assessment, just ask your kid directly. “Have you thought about killing yourself”? If so, that is a good time to seek help. This blog is not meant to help assess for suicide, but to understand the correlation. My professional recommendation is to seek a professional help whenever cutting is involved.

Why is My Teenager Engaging in Self-Harm?

The answer to this question is probably the most important part of understanding self-harm; it will help us have compassion on our kids, reduce the anxiety around the issue, and give us a better mindset on how to help them. Hollander writes, “I want you to understand that your child is self-injuring because it calms him or her…to us, that’s a terrible solution. To your child, it’s one that works” (pg. 2), he then continues to provide two reasons why our teenagers engage in self-harm behaviors, “(1) to control the extremely painful and frightening experience of overwhelming emotions, and/or (2) to escape from an awful feeling of being numb and empty” (2008, p. 7). At this point, it would be helpful to understand how it helps regulate emotions, but that is outside the scope of this blog, so just know that it works, and is often connected to either control, or the release of endorphins. Self-harm is an emotional process, not an analytical one. In fact, most kids know that it is not good for them, yet the emotional drive to self-harm trumps their reasoning. If we try to reason them out of it, we will fail, and most likely overwhelm them to the point that they need to engage in self-harming behavior more. It is about emotional regulation. Sometimes that is due to heightened external experiences that drive them to the only thing that works, or it is a young person who has a low ability to regulate their emotions. Either way, we need to understand that it works. Of course, we know that we need to find another method that works, and help them move away from this extremely effective, but harmful solution. One last thing to note, and it is an important one. Studies presents different results on this, but the results are anywhere from less than 1% to 4% of those who self-harm do it for attention. In fact, often times, individuals will be cutting themselves months before someone else even notices (Hollander, 2008, pg. 15). We want self-harm to get our attention, because it does point to an area of hurt, but not in a way that our child is intentionally seeking attention.

How to Help (First Steps)

The first thing in beginning to help your child is to remember that individuals who self-harm are usually willing to give up their behavior if there is an alternative and are usually unhappy with themselves for cutting, but they do not see an alternative. In fact, most teenagers who engage in self-harm are ashamed and embarrassed by their behaviors. By highlighting how wrong it is, you only add fuel to these emotions, and again increase their feelings of being overwhelmed. If you instead sympathizing with them, you can validate what they are feeling and why they are cutting, but help them see that there are alternative methods to coping. It is also important, for those who engage in cutting, to increase their connections to family members, school, and friends (Augrin, 2012, pg. 1221). Many participants discussed feeling alone and disconnected. Learning to validate your child’s emotional responsiveness and need to cut, instead of lashing out or getting frustrated, will allow them to feel less isolated. The research shows that family dynamics can have a huge influence in a teenagers felt need to cut, so do not see it as an issue that is left for the kid to fix. Hollander expounds on this idea, giving a sensitive explanation of the family systems involvement in the adolescent behavior when he writes:
An environment that fails to help the child learn how to identify, accurately label, and modulate emotions can arise from a combination of factors in the child’s surroundings. Let me make clear that this is rarely the result of inadequate parenting. Rather, the parental strategies of reassurance and problem solving that work in most cases often backfire with these children. (2008, pg. 33)

How to Help (Second Steps)

If my child was engaging in self-harm behavior, I would immediately begin seeking professional help. Mostly because the way the family system is operating is not providing the tools or connection needed to help my child regulate their emotions. Again, as Hollander states, it is not that you are failing as a parent or there is dysfunction in the family, but the needs of the individual child are not being met. Having an outside perspective will greatly help adjust the dynamics for each family member.

Follow my Blog Series

For more signs that your teenager is hurting you can read an earlier post linked below.

Reference

Brown, T. B., & Kimball, T. (2013). Cutting to Live: A Phenomenology of Self-Harm. Journal Of Marital & Family Therapy, 39(2), 195-208.

Halstead, R. O., Pavkov, T. W., Hecker, L. L., & Seliner, M. M. (2014). Family Dynamics and Self-Injury Behaviors: A Correlation Analysis. Journal Of Marital & Family Therapy, 40(2), 246-259.

Hollander, M. (2008). Helping teens who cut: Understanding and ending self-injury. New York: Guilford Press.

Ougrin, D. (2012). Commentary: Self‐harm in adolescents: The best predictor of death by suicide? Reflections on Hawton et al. (2012). Journal Of Child Psychology And Psychiatry, 53(12), 1220-1221. doi:10.1111/j.1469-7610.2012.02622.x