Content Warning: Please be advised that the following blog addresses self-harm and suicide, topics that some readers may find triggering. If you or someone you care about needs help with self-harm or suicidal thoughts of any kind, please contact the JED Foundation by calling 1-800-273-TALK (8255) or texting START to 741-741 for a free, confidential conversation with a trained counselor. They are there to help you 24/7.
It is no secret that the past two years have been very trying and that our tweens and teens have not escaped unscathed. A myriad of disruptions and uncertainties have resulted in increased mental health crises among all of us, including our youth. Already elevated anxiety and depression rates have increased.
Another behavior that is all too common in teens is engagement in self-injury. Non-suicidal self-injury (NSSI) is the self-inflicted injury to body tissue without suicidal intent. People who engage in NSSI often do so by cutting, scraping, or burning their arms or legs and hiding the marks afterward. This behavior is often perplexing and scary for all involved, especially parents, teachers, and friends.
However, with some education and understanding, we don’t have to be scared to face self-injury head on and we can help our children find healthier coping mechanisms in the face of distress.
Why would a child ever purposely harm themselves? Are they trying to kill themselves?
When a parent learns that their child cut themselves on their arm on purpose, they often assume it was suicidal in nature, overreact and rush that child to the emergency room. This is not always the correct response because, by definition, NSSI is engaged in for reasons other than to kill oneself. While sometimes a person may engage in a suicide attempt by cutting their wrists, non-suicidal self-injury serves other functions. People who engage in NSSI often report doing so for means of emotion regulation. People also report using it to bring oneself from an overwhelmed, very angry and out of control feeling to a calmer one; the act of NSSI releases endorphins in the brain that causes a sense of release and calm. Others report engaging in NSSI for more interpersonal reasons, such as using it as a way to communicate with others when they don’t have the ability to express themselves with words. And still others report harming themselves as a means of self-punishment in the face of self-hatred.
Most youth who engage in NSSI are struggling with high levels of overall stress, anxiety, and/or depression.
Their coping mechanisms are overwhelmed and for one reason or another (sometimes it can be seeing a friend do it or someone in the media) they turn to NSSI similar to how people may turn to alcohol or drugs.
How would I know if a child is hurting themselves?
Sometimes a child will tell their parent about the self-injury, but not always. Warning signs of NSSI are similar to those of mental health crises in general, including depressed, irritable or angry mood, change in relationships, decreased school performance, withdrawal from activities, feeling bored and apathetic, and / or a change in appetite and sleep. Additionally, signs specific to NSSI include a child not wanting anyone to see their body, wearing long sleeves or pants when it is warm, wearing lots of bracelets to cover their wrists, and, of course, visible scars.
What do I say to a child if I learn they are hurting themselves?
Learning a child is harming themselves can be scary and overwhelming. Often, I see parents react in one of two extremes: some overreact, become extremely upset, and rush the child to emergency treatment, while others under-react, assume the behavior is just a phase, and basically ignore it. Both extremes result in invalidation and harm to the child and the relationship.
The sweet spot is to react in a matter of fact and loving way. A child is engaging in NSSI because they are hurting and likely feeling anxious or depressed. Offer them your concern and support.
Reassure them that there are many resources out there that can help them feel better. I do recommend that parents or caregivers, in a matter of fact way, ask the child if they are having thoughts of suicide or if the self-harm was a suicide attempt. If there is any concern about suicide risk, then emergency assessment at a hospital is warranted.
How do I find help for a child engaging in NSIS?
The very good news is that we are understanding self-injury more and more and there are many effective treatments and resources out there. The main psychotherapy approaches to help tween and teens stop engaging in self-injury are Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and Interpersonal Psychotherapy.
Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and Interpersonal Psychotherapy will help a child better understand the reasons underlying the self-injury, use healthier coping skills for managing intense emotions, and teach interpersonal communication skills to allow for improved relationships.
I recommend the child see a therapist: a clinical psychologist, licensed clinical social worker, or licensed mental health counselor, for an evaluation and treatment plan. In the case that a child is suffering more severely such that they aren’t able to function, are having trouble getting to school or activities, are crying often, or the self-injury is quite severe, a visit with a psychiatrist for medication may be warranted as well.
For more information about self-injury please visit Cornell University’s Self-injury & Recovery Resources.
About the Coach
Dr. Colleen Jacobson.
Colleen is a licensed clinical psychologist and professor with over 20 years of experience in researching, teaching and counseling young adults. Leveraging tricks and trades of psychotherapy, Dr. Jacobson teaches and supports Robin students on how they can more effectively cope with life issues and mental health challenges to live their best lives.
Meet Colleen