Self-harm, what is it & how should you handle it?

Are your kids engaging in or at risk of Self-Harm? What is it, how do you know it’s happening, and what do you do if it is?

by Kaylie Reynolds (LMFT) based on opinions derived both from personal clinical experience and evidence-based research.

Self-harm is a frequent topic or theme in today’s world - it’s often discussed in social groups and addressed in political discourse, depicted in television and movies for entertainment, and it may even be something you have experienced personally. But what is it, really?

What is self-harm?

Self-harm refers to someone engaging in intentional and deliberate behaviors that cause physical harm or pain to oneself. This can be both Nonsuicidal self-injury (NSSI) and Deliberate self-harmful behavior with suicide ideation and/or the intent of committing suicide. Common forms include cutting, burning, hitting oneself, or other methods aimed at causing injury.

Recognizing signs of self-harm is crucial, so let’s talk about it:

• Physical indicators of self-harm
  These include big reactions resulting in a physical explosion in the form of hitting oneself or an object, unexplained injuries and scars, wearing inappropriate clothing for the weather to hide marks, someone who has frequent "accidents," and is hiding sharp objects like razors and scissors. 

• Emotional and behavioral signs
  May include mood swings, changes in habits, withdrawal from others, expressions of hopelessness, and secretive behavior. 

• Verbal signs
  Ranges from indirect statements like "you wouldn't understand" to direct expressions of a desire to hurt themselves.

When we know someone who is engaging in or at risk for self harm, it can be scary and cause the desire to react in fear or panic. Try your hardest not to panic. Responding with empathy and support is essential. It's important to approach the topic with sensitivity, listening without judgment, and offering reassurance that they are not alone or wrong for how they feel. Above all, maintaining open communication and showing unconditional support are key ingredients to helping children and adolescents navigate through this challenging and likely scary experience. 

We’ll talk about how to respond to self-harm in children a little later on in this article, but first, let’s take a look at why children might turn to it

Understanding Self-Harm in Children

You may find yourself questioning why someone would want to intentionally and deliberately hurt themselves? While there isn’t a simple answer or reason, in my experience, those who self-harm are seeking some form of control in an otherwise uncontrollable situation. 

Some common reasons they may be seeking control include:

• Coping with Emotional Pain
  Self-harm can be a way for young individuals to manage intense emotions such as sadness, anger, guilt, or anxiety that feel overwhelming and uncontrollable.

• Seeking Relief
  The physical pain caused by self-harm may provide a temporary distraction from emotional turmoil or numbness that they are experiencing, and is a pain they are in control of inflicting

• Communicating Distress
  For some, self-harm serves as a way to communicate their internal struggles or a cry for help when they lack other means of expressing their feelings. 

And how can you tell if someone is at risk for engaging in self harm? Risk factors that may contribute to self-harm in children and adolescents include:

• Mental Health Disorders
  Conditions such as depression, anxiety disorders, borderline personality disorder, or eating disorders significantly increase the risk of self-harm behaviors.

• Trauma
  Experiencing trauma, such as physical or sexual abuse, neglect, or witnessing violence, can lead to self-harm as a maladaptive coping mechanism.

• Bullying
  Being bullied at school or online can contribute to feelings of low self-esteem, isolation, and hopelessness, which may increase the likelihood of self-harm.

• Family conflict or dysfunction
  High levels of family conflict, parental substance abuse, or inconsistent caregiving can create stressors that contribute to self-harming behaviors.

Misconceptions about self-harm

When self-harm shows up in things like movies or shows or talked about, it’s more often than not accompanied by inaccurate messaging and portrayals, resulting in some pretty big misunderstandings and misconceptions about self-harm. Here are some common but inaccurate beliefs about self-harm and people who engage in it:

• People who self harm are “attention-seeking”
  Self-harm is often misunderstood as attention-seeking behavior. While it may sometimes be visible to others, the underlying distress and emotional pain driving self-harm are genuine and require compassionate intervention. No one harms themselves just for attention, one might need to understand what attention they desire and why they feel that way.

• Self-harm is “just a phase”
  Self-harm should not be dismissed as a phase that will naturally resolve over time. It is a sign of significant emotional distress and should be taken seriously to prevent escalation and address underlying issues. Assuming someone who self-harms will grow out of it or stop on their own is a dangerous thought process with potential devastating consequences.

• People who self-harm always have “suicidal intent” when they hurt themselves
  While self-harm and suicide can be linked, self-harm is not necessarily a suicide attempt and does not mean there was suicide ideation behind the action. However, ALL SELF HARM should always be assessed seriously, as it can sometimes escalate to suicidal behavior.

Understanding these reasons and risk factors helps in recognizing signs early and intervening effectively. Providing support, empathy, and professional help is crucial in helping kids find healthier coping strategies and address the underlying issues contributing to their self-harm.

How to Respond to Self-Harm in Children

Responding to a child who is harming themselves requires an extreme amount of sensitivity, empathy, patience, and proactive support from parents, caregivers, and other supportive adults and friends in their life. Here are some steps you can take to address the situation effectively:

1. Approach calmly and non-judgmentally: It's essential for parents to approach their child calmly and without judgment. This helps to create a safe and supportive environment for the child to feel comfortable opening up about their experience and feelings.

2. Express concern and support: Start the conversation by expressing care and concern for their well-being. Use "I" statements to convey your feelings without placing blame. For example, "I've noticed some marks on your skin, and I'm really worried about you. Can we talk about what's been going on?"

3. Ask open-ended questions: Encourage dialogue by asking open-ended questions that allow the child to share their feelings and experiences. Avoid yes/no questions and instead ask questions like, "Can you tell me what's been bothering you lately?" or "How are you feeling when you feel like harming yourself?"

4. Practice active and reflective listening:: Listen attentively to their responses without interrupting or offering immediate solutions. Reflect back what you heard to clarify a proper understanding of what they’ve shared. Validate their emotions and let them know you are there to support them. To show you understand, empathize with statements reflecting on the experience shared, "It sounds like you've been feeling really overwhelmed."

5. Avoid criticism or minimization: Refrain from criticizing their behavior or minimizing their feelings. Statements like, "You shouldn't be doing this," or "It's not that bad," can shut down communication and make the child feel more isolated.

6. Discuss professional help: Give credit and praise for them being able to open up and share with YOU. Being able to share with one person is a huge first step and needs to be recognized. Then take time to emphasize the importance of seeking professional help, such as therapy or counseling. Assure them that speaking to a therapist does not mean they are "crazy" or "bad," but rather it's a positive step toward feeling better and learning healthier coping strategies. It’s okay to admit you’re just a parent, and this being a time for expert support based on your care and concern for them.

7. Offer supportive resources: Research local support groups, after school programs, therapists or counselors who specialize in working with children and adolescents. Offer to help them schedule appointments and accompany them if they feel anxious about going alone.

8. Encourage alternative coping strategies: It’s important to work with them to brainstorm and practice alternative coping strategies that can help them manage their emotions in healthier ways. This might include journaling, physical exercise, mindfulness techniques, or engaging in creative activities.

9. Create a self-care safety plan: Work with the child to develop a self-care safety plan for times when they feel overwhelmed or have strong urges to self-harm. This plan should include contacting a trusted support person, using distraction techniques, or engaging in calming activities and alternative coping strategies. This plan should also include a plan to stay safe when self-harm feels like the only thing they can do. This might include an agreement to place a pillow on the desk before they bang their head, giving them a safe place to punch like a cushion or mattress, and providing safe means of self harm like slapping a rubber band on their wrist or squeezing ice cubes. 

10. Follow-up: Keep the lines of communication open and regularly check in with the child about how they are feeling and whether they are finding support helpful. Celebrate their progress and provide ongoing encouragement.

Creating a Supportive Environment

Creating a supportive and nurturing environment for a child who self-harms is crucial for them to feel safe and understood. Such an environment allows them to comfortably express their emotions and provides an opportunity to discuss your care, concern, and desire for alternative coping strategies that can help reduce the risk of further harm.

This may not be easy. As previously mentioned, someone who is self-harming is often seeking a sense of control over an uncontrollable situation and may be resistant to change or feel unable to express their feelings in another way. Here are some strategies to help build trust and encourage open communication within the family. 

• Regular Check-ins: Establish a routine for regular check-ins with your child to discuss their feelings and experiences.

• Family Meetings: Hold family meetings to provide a platform for everyone to express their thoughts and concerns in a safe and supportive setting.

• One-on-One Time: Set aside dedicated one-on-one time with each child to strengthen your bond and show that you value their individual needs and feelings.

Once a safe environment has been established, it’s important to explore alternative healthy coping skills and ways to manage their emotions. It’s important to work with them to brainstorm and practice alternative coping strategies that can help them manage their emotions in healthier ways. This might include harm reduction tactics, journaling, physical exercise, mindfulness techniques, or engaging in creative activities.

It is also extremely important that parents and caregivers take care of their own emotional and mental well-being though their own self-care practices.

Similar to an airplane emergency, you need to “Put on your mask first before helping others.” If you are not taking care of yourself, it will be hard for you to take care of anyone else and provide the level of support needed. Parents and caregivers should also seek support from friends, family, or professionals to manage the emotional struggles of caring for a child who self-harms. 

By implementing these strategies, families can create a more supportive environment that promotes healing and understanding, while also ensuring that parents are equipped to handle the emotional demands of this situation.

All in all, creating a supportive environment involves fostering trust, open communication, and providing practical strategies for coping and emotional management. By prioritizing both the child's and their own well-being, parents can play a vital role in helping their child navigate through self-harm and develop healthier ways of coping with life's challenges.

Wrap-up

Self-harm is a widely discussed topic, but not always fully understood. We hope we’ve provided clarity on what self-harm is, the risk factors that may lead to it, signs that self-harm may be occurring, and how to support someone who is thinking about or is already engaging in self-harm. While our initial reaction might be one of panic or fear, it’s essential to respond calmly and empathetically and to create a supportive environment.

As parents, caregivers, and supportive figures, prioritizing the child's well-being is crucial, especially when they’re struggling with self-harm. Seeking professional help when necessary is a vital step in ensuring they receive the appropriate care and support. Remember that with patience, understanding, and unwavering support, you can help your child navigate these difficult challenges. By fostering a nurturing environment, you are not only aiding their immediate recovery but also helping them build resilience for the future. Together, you can overcome this, one small step at a time.