I have a fifteen year old daughter. She is a bright student from all these years. She started cutting her wrist, thighs and other body parts since a year. From childhood, she was a non obedient kid, but from last few months it has been increasing. It has come to my knowledge that she is being bullied and teased at school.  I tried talking to school management but she is still unhappy. She has drastic mood swings which are resulting in hurting herself. I believe that she is doing it to get sympathy or attention. What do I do about it? Help me?

 

I don’t want to kill myself. I just wanted some of the hurt and all of the pain to just go away. (Rachel, teenage student)

Self-harm, or inflicting physical harm onto one’s body to ease emotional distress, is not uncommon in kids and teens. There are many forms of self-harm, including cutting, scratching, hitting and burning. Many kids and teens who self-harm also struggle with depression, anxiety, eating disorders, physical abuse or other serious concerns or psychological disorders.

 

Self-injury is commonly defined by scientists as "deliberate discrete destruction of body tissue without the intent of suicide and do it to cope with life." it’s absolutely opposite of what really suicide is. Over the last couple of decades, more young people appear to be pulling out razor blades and lighters in order to injure themselves. Their intent is not to die, but to inflict harm, a behavior known as non-suicidal self-injury.

 

Several recent studies have found that 17-28 per cent of teens and young adults say they have engaged in such behavior at some point in their lifetimes. People usually start self-injuring in early adolescence, between the ages of 11 and 15. Main reason for this is that they are not only going through problems in relationships at this age but also with their brain and bodily changes. 

 

In early adolescence, part of the brain involved in emotion, the amygdala, and part of the brain involved in higher thinking, the cortex, are not fully connected, and as a result, they don't communicate as well as they do later in life. Indeed, experts say most people engage in self-injury as a way to cope with their emotions, particularly negative ones. And most self-injurers report that it works – it calms them and brings a sense of relief. 

 

These soothing feelings are most likely result from the release of endorphins, brain chemicals that relieve pain and can produce euphoria. Self-harm is an addictive behavior. People use this behavior to feel better in the shorter run as some people use drugs. 

Matthew Nock, a professor of psychology at Harvard University, has come up with four main reasons for engaging in self-injury, both personal and social. His model, which he recently discussed at the APA meeting, suggests that people self-injure to:

  • relieve tension or stop bad feelings;
  • feel something, even if it's pain;
  • communicate with others to show they are distressed;
  • get others to stop bothering them.
There is also evidence that people are more likely to self-injure if they have a negative body image coupled with strong negative emotions and poor coping skills.

 

Warning Signs

Warning signs that someone is injuring himself or herself include:

  • Unexplained frequent injury including cuts and burns
  • Wearing long pants and sleeves in warm weather
  • Low self-esteem
  • Difficulty handling feelings
  • Relationship problems
  • Poor functioning at school or home
Background of Self-Injurers

  • Children of average to high intelligence, and has low self-esteem.
  • Nearly 50 per cent report physical and/or sexual abuse during his or her childhood.
  • Many report (as high as 90 per cent), that they were discouraged from expressing emotions, particularly anger and sadness.
Reasons for Behaviors

Self-injurers commonly report they feel:

  • Empty inside
  • Over or under stimulated
  • Unable to express their feelings
  • Lonely
  • Not understood by others
  • Fearful of intimate relationships and adult responsibilities 
Myths about self - injurious behaviors: 

People who self-injure are manipulative. Self-injury is more about relieving tension and distress than it is about manipulating others. Although some individuals report starting the practice as a means of getting attention from someone, very few report this as a primary reason for continuing the practice. It’s a cry for help. 

 

Self-injury is just attention-seeking

Many people feel that self-injury is clearly an attention-seeking act. But we need to see the intent – if someone is injuring him/herself for attention then that person clearly needs that attention. Self-harm is a cry for help and the person desperately needs  help. 

 

But the majority of people who engage in self-injury, however, go to great extremes to hide their cuts, scars or burns. Although not overtly attention-seeking, hidden self-injury is still a symptom of underlying distress and it merits attention from others who are in a position to help. 

 

All people who self-injure have “Borderline Personality Disorder.” People who engage in repetitive self-injury have reported being diagnosed with depression, bipolar disorder, anorexia, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, and/or anxiety and panic disorders. “There is a strong relationship between depression and high-risk behaviors,” says Pamela Cantor, PhD, a psychologist and lecturer at Harvard Medical School. Many who self-injure may not have any diagnosable disorder at all; a recent study found that almost half of college students with current self-injury behavior show no other identifiable mental illness.

 

What can parents do?

Don't ignore the behavior, and don't panic - self-injury can be treated.

  • First learn about self – injurious behavior. If you have clear knowledge about these behaviors, it becomes easy for you to support your child in his/her recovery.
  • Build a trusted relationship. Listen to what your child says and how he/she is feeling. 
  • Have patience. Don’t over react; don’t put pressure to talk with you; when they are ready, they will share with you.
  • Show unconditional love and support. Take a non- judgmental stance. You need to listen to your child without trying to correct, problem solve or suggest, just confirming with them what we are hearing.
  • If your son/daughter is at immediate risk of any potentially life threatening behavior (i.e., suicidal thoughts or actions) take him/her to the hospital.
  • Keep your child busy. Encourage and engage in physical activities. It actually produces the same chemical surge that self injury does. Encourage to volunteer for any social cause or involve themselves in activities of NGOs.
  • Does not focus on self -harm, try to understand underlying distress.
  • Don’t trivialise or dismiss their worries.
  • Help child to identify their feelings and find better and healthier ways to deal with their emotions. Help them to learn to control emotions.
  • Help your child to identify their unhelpful thoughts (like “nobody loves me”) and replace them with more positive thoughts.
  • Develop social skills. Help child to communicate better so that they can handle conflict sand get support from others instead of using self -harm. 
  • Help your child to identify triggers that are leading to self- harm. Teach your child to manage them.
  • Helping teen to find better ways deal with stressful situation by improving problem solving skills
  • Don’t beg or threaten the child to stop self – harm. Talk to them; encourage them to seek professional help.
Seek professional help

Because of the complexity of self-injuring behavior, it can be very helpful to seek professional assistance to work out why your child is self-injuring and how you can support them. You may also need help coming to terms with what's happening prior to or while you are supporting your child. Speaking with a professional can help you understand your own emotions as well as develop a plan of action for supporting the young person.

 

Current research indicates that cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) etc. are some of the effective ways of treating self-injuring behavior. These therapies teach the child how to identify and challenge faulty and rigid thinking, and change the resulting unhealthy behaviors.

 

Avoid:

The following behaviors can actually increase your child’s self-injury behaviors.

  • Yelling
  • Lecturing
  • Put downs
  • Harsh and lengthy punishments
  • Invasions of privacy 
  • Ultimatums
  • Threats
Avoid power struggles. You cannot control another person’s behavior and demanding that your loved one stop self-injuring is generally unproductive.

By:N Radhika Acharya