Ask the Therapist: Is My Teenager Self Harming?

Recent studies in the US show that one-third to one-half of teenagers have engaged in some type of self harming behavior.

𝒷𝓎​ Lara Hollway, MSW, RSW

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What is self harm?

Non-suicidal self injury, or “self harm” is the act of deliberately causing harm to one’s body through cutting, burning, or other means. The injuries are typically minor, can leave scars, and are usually not life-threatening. Recent studies in the US show that one-third to one-half of teenagers have engaged in some type of self harming behavior[1].

Why do people self harm? Is there treatment for self harm?

Self-harm is usually not a suicide attempt. People who self harm are often feeling overwhelmed and in pain, and hurting themselves often feels like the only thing they can do in that moment to make the emotional pain go away. Unfortunately, the release of emotion that self harm offers is short lived and usually immediately followed by feelings of guilt and shame. This can create a cycle of self harm: emotional pain/shame -> overwhelm -> self harm -> short term release/relief -> feelings of guilt/shame.

Counselling, especially with a counsellor experienced in working with people who self harm, can help to identify triggers, work through pain, and develop alternative coping skills. Medication may also be helpful in helping to manage some of the intense emotion and underlying distress that is leading to the self harming behavior.

Is my teen self-harming?

Signs and symptoms of potential self harm can include:

• Scars, often but not always in patterns, and usually on the arms, thighs, or front of the torso
• Fresh cuts, scrapes, burns or bruising in unusual areas of the body (i.e. not the elbows or knees)
• Sudden shift in clothing to always wearing long pants/shirts even in hot weather
• Mood changes, depression, feelings of hopelessness and impulsivity

What should I do?

If you know or suspect that your child or teen is self harming, the first thing that you need to do is to notice your own reaction. What are you feeling right now? Are you feeling panicked? Angry? Sad? Numb? Confused? It is so important to notice and acknowledge your own reaction because your teen is already likely overwhelmed and feeling shame. Adding your panic, anger or fear to this mix will only amplify the emotions, and not help to ease them. Once you have noticed and named your reaction, sit with it for a moment and decide what you need to move through this reaction and into a place where you can be a support for your teenager. Managing your own emotions in the face of your teen self harming is incredibly hard work. I would encourage you to reach out for support to a counsellor or a family doctor if you are feeling overwhelmed. Then, once you feel more grounded, talk to your teen.

Tips for talking to your teen about self harm:

• Choose your moment. Self harm is not a life-threatening emergency, even though it can feel like one. Take the time to choose a private moment when both parties are feeling at least moderately calm.
• Start by letting them know that you love them and you are here for them, in whatever words feel right to you.
• It is often helpful to be direct: “I saw cuts on your arm, and I am worried that you are hurting yourself. Would you be willing to talk to me about this?”
• Give them time to process and react. They might be feeling startled and vulnerable, and need time. Ask if you can talk more in a few hours, or tomorrow.
• When they are ready, explore the emotion behind the self harm, rather than dwelling on the action of the self harm. “Can you tell me about how you’re feeling lately?” or even “What triggers you to self harm/hurt yourself?”
• Check in around suicide. “Are you feeling suicidal? Would you tell me if you were feeling suicidal?”
  • If your teen is feeling suicidal and is feeling unable to commit to safety/staying alive, ask if you can drive them to the hospital. If they refuse, call 911 or your nearest emergency number.
  • If your teen is feeling suicidal but is willing to commit to safety/staying alive, ask them if you can book them a counselling appointment or an appointment with their family doctor. Continue to check in with them about suicide, potentially creating 24 hr safety plans until they are willing and able to commit to safety for longer periods.
• Don’t assume that self harm is behavior that they are planning on stopping. Remember that people self harm because they are trying to cope, and until they have other healthier coping tools, they may feel the need to continue to self harm.
• Ask them if they would be willing to talk to a family doctor or counsellor. Do they need help or support scheduling the appointment?

When is self harm an emergency?
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If you believe the self harm injury is potentially life-threatening, call 911 or your nearest emergency number immediately. Signs of potentially life-threatening injuries can include bleeding that spurts or won’t stop, injuries to the face or throat, or burns that are near major blood vessels.
 
[1] Nonsuicidal self-injury among "privileged" youths: longitudinal and cross-sectional approaches to developmental process.
Yates TM, Tracy AJ, Luthar SS
J Consult Clin Psychol. 2008 Feb; 76(1):52-62.