Deliberate self-harm has increased significantly in recent years amongst children and young people. Recent figures suggest 13% of young people may try to harm themselves between the ages of 11 and 16, with a 70% increase in the number of young people attending A&E because of self-harm. Examples of self-harm include cutting on the arms or other body parts, over-dosing or self-poisoning, burning, skin picking or hair pulling. In the time I have worked for local mental health services, I have seen an increase in the number and severity of self-harm incidents amongst young people. Sadly, this is alongside ever-increasing pressures on local mental health services, leaving many parents struggling to know where to turn for support. Despite a growing awareness of these difficulties, there remains a number of myths out there about self-harm. For example, many people worry that self-harm is always associated with a desire to seriously harm or end lives. This is not the case amongst many young people who self-harm. In addition, many consider self-harm to be “attention-seeking” in nature. Again, a significant number of people who self-harm are extremely secretive about this coping strategy and will go to great lengths to prevent those around them finding out. As a result, published figures are likely to massively under-represent the issue. If you are a parent or work with young people, it is worth knowing some key signs to look out for:
- Secrecy, withdrawal and a tendency to ‘bottle up’ difficult feelings
- Covering up arms and legs even on warm days, avoiding changing in front of others
- Unexplained cuts or bruises
- Presenting as low in mood, change in demeanour, change in sleep or eating patterns
- Expressing a sense of hopelessness, helplessness, high levels of frustration or anger, difficulty looking towards the future
- Expressing high levels of self-criticism or disgust
- Finding typical self-harm apparatus around including razor blades (from sharpeners or razors), knives, needles or stored up medication (such as painkillers).
Self-harm is typically associated with low mood or depression. However, it can also be seen amongst young people struggling with anxiety, high levels of stress, shame or poor self-esteem. It is often seen amongst young people struggling with relationships or sadly, amongst those who have experienced abuse or loss. However, for each young person, self-harm can represent something quite different. It can serve a different function, occur in different contexts and be triggered by different events.
So how can we make sense of self-harm behaviours? If you have never felt this way, or felt the pull towards harming yourself, it can be extremely difficult to understand and empathise with. It can be tempting to get cross or feel sceptical towards underlying feelings. Of course, this is understandable when you are worried about your child, but also makes it much more of a challenge to offer helpful support. There are many different reasons behind self-harm:
- An expression of overwhelming emotions such as frustration, despair or helplessness
- Self-punishment because of self-criticism, or feelings of unworthiness and shame
- As a way of seeking relief from stress, pressure, ruminative thoughts or powerful feelings
- A lack of more adaptive or effective ways of managing and expressing feelings
- As a way of letting others know they are struggling, perhaps eliciting care in the only way they know how
- As a way of translating unmanageable feelings into tangible pain, to regain a sense of control
- To identify with a peer group, or as a result of peer pressure
- For a minority, it can be used as a way of managing relationships; either drawing others in, or pushing them away.
- For young children in particular, it is often a way of communicating frustration when struggling to communicate in other ways.
- In some cases, it can be a means to causing serious harm or to end their life. Often in these circumstances it can be to try and just make their suffering stop, with dying by suicide seeming to be the only option in that moment.
If you trying to support a child who self-harms, it can be so worrying and difficult to know how to help. Self-harm behaviours should be taken seriously, both in terms of risk to themselves, but also as an important indicator of poor emotional well-being. Specialist professional support should be sought. Alongside this, offering an understanding and empathic response is key to supporting them in opening up about how they are feeling. This is often far easier said than done as we can very quickly become organised by our own worry. While safety planning around the self-harm behaviour is an important part of supporting them, it is also important to offer a non-judgemental ear and a sense of wanting to understand and help. What makes them most likely to self-harm? How do they feel afterwards? What else could help in the moment? Remember to try and avoid lecturing, or jumping too quickly to problem-solving. Self-harm is likely to be a symptom of distress so offer comfort first. Giving your child a sense of being able to talk about such a difficult thing will allow you to then work together to keep them safe and seek appropriate help.
If you are concerned about any of the above, seek help through your GP or for a free discussion contact firstname.lastname@example.org. A full assessment of your child’s difficulties can be conducted. A psychological formulation will be reached allowing focused and individualised support to be offered. Understanding and talking about such difficulties is a difficult but important first step. As a parent of a child struggling with self-harm, support and advice will be offered to you, and you will be included in any treatment or support plans. In the event of significant self-harm or a real concern about keeping someone safe, contact your GP, local out-of-hour service or attend A&E.
It is worth noting that self-harm is also prevalent amongst adults, with an equally varied meaning and function to individuals. Help and advice can be sought through the same means so please do get in touch if this is something you would like to discuss further.