This week’s question centers around youth engaging in self-harm. A parent writes:
I watched one of your recent Youth Risk Behavior Survey presentations and was taken aback by the data around self-harm: 80 middle and 111 high schoolers are hurting themselves, on purpose. As a parent of teens, this is bewildering to me. Please help me understand what is happening here.
Self-harm, while not the same as suicidal ideation, describes any behavior directed at oneself that causes some form of bodily injury.Self-harm is notclassified as a mental health disorder itself, but rather a behavior that can be connected to an underlying disorder (anxiety, depression). Self-harm is considered a “maladaptive” coping mechanism. Meaning, those who engage in self-harm, e.g., pinching, cutting, burning, picking at skin, severe calorie restrictions, etc., are doing so because it makes them feel better and/or it offers them a sense of control or relief in the face of overwhelming feelings. This is true even though the self-harm activity is not good for them.
Self-harm can serve as a release from pent-up emotions. While some youth try it once or twice, for many others, it becomes habit-forming as it releases endorphins. Youth have said self-harming offers them a way to transfer emotional pain to physical pain, which is somehow easier for them to handle. Others see it as a form of self-punishment. Some express experiencing emotional numbness, and for them, feeling pain is better than feeling nothing.
Who is most likely to engage in self-harm? Youth who are bullied, youth who feel isolated from their peers, youth who identify with a marginalized group (LGBTQ, kids of color), youth experiencing instability at home, and, as noted above, youth who have an underlying mental health disorder.
When a parent reaches out to me because they have discovered their teen (or pre-teen) is self-harming, I tell them that their child is likely experiencing emotional pain or distress. I explain that while self-harm is not considered a sign of suicidality (although if the injury is extreme, it could result in death), it is a sign that something is off, and professional help is advised. I suggest they calmly talk with their child, gently express their concern, and offer support. For example: “When I saw the cuts on your legs and arms, I felt concerned for you. Can we talk about this? Can we brainstorm ways to get you support?” One thing that is never helpful is panicking or freaking out. Wait until you are feeling calm before talking with your child. It is also helpful to validate their pain, as in: “I am so sorry that you are feeling so much (fill in the blank) pain, pressure, shame, anxiety …” Finally, I mention the importance of wound care to avoid infection.
Also, talk early and often about the importance of utilizing positive coping mechanisms as an alternative to self-harming. Help your child identify other ways to cope with feelings of overwhelm, pressure, or emotional pain. For some kids, exercise can help. For others, it’s about listening to music, journaling, creating art, hanging out with friends, deep breathing, and spending time with their pets. Establish soothing routines and set aside time for them to talk about what’s on their minds.
I share your concern that nearly 200 middle and high schoolers are experiencing enough emotional distress to engage in self-harm. These kids need the support of their families, the school department, and our community. Talking with a professional is one way through this painful morass. If you’re having trouble finding support, check out BWC’s resources: belmontwellness.org/resources/mentalhealth/
Lisa Gibalerio, MPH, is the author of the Ask Lisa column, where she answers questions from parents about how to navigate the teen and preteen years. Lisa oversees the Belmont Wellness Coalition, a program of Wayside Youth & Family Support Network. The advice provided in this column is for informational purposes only. It is not a substitute for professional care.
If you have a question for Lisa, send it to: asklisa@belmontvoice.org.