As parents, we expend a lot of energy and time ensuring our children’s safety, so it’s hard to fathom that your child could be intentionally causing pain to feel better — but that’s the impetus behind cutting, burning and other self-inflicted wounds.
Technically referred to as “non-suicidal self-injury,” this behavior is not yet officially recognized by the American Psychiatric Association as a psychological disorder, but it is under further study as its prevalence continues to rise.
Unfortunately we estimate 15 to 20 percent of adolescents engage in self-harm, and college students are at even higher risk, with up to 30 percent involved in self-injuring.
It’s an act often done in secret — and those who do it sometimes go to great lengths to conceal the evidence. When confronted, they often deny the action because they feel shame or guilt. Don’t take a denial as truth, however. Parents must be vigilant if they suspect a child is self-injuring because although in a majority of cases it is considered non-suicidal behavior, there is an association between self-injuring and suicide.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the American Psychiatric Association, there are certain criteria that we look at to classify behavior as true self-injury — and it involves more than just cutting. It could also be hitting or punching an object to inflict self-injury, extreme scratching, skin carving or burning the skin.
Frequency is also a factor in diagnosis — a person must have engaged in self-injury for at least five days out of the past year, with the anticipation that the injury will result in bodily harm.
Those more at risk, and triggers
I’m often asked why someone would intentionally self-injure. The answer is another of the criterion we look for — that the person expects to get relief from debilitating negative emotions. As hard as it may be to understand, people who self-injure view this as a way to manage their pain and feeling of emptiness. The act of harming might give them a sense of control over their body.
Adolescents with a mental health disorder such as depression, anxiety, an eating disorder or borderline personality disorder may self-injure, but this behavior can also show up in youths that don’t have any diagnosed mental health issues. Social pressures, feelings of emptiness, being overwhelmed with life — all these things can be potential triggers.
However, each child is different, and there are no universal causes or treatments that we can say work for everyone.
There are signs you can look for that may indicate something is wrong. Do you notice any scars or fresh cuts in the legs, arms or stomach? Look around your child’s room and bathroom — are there sharp objects such as razors or knives? Also look for mood changes and behavioral changes such as isolating from family and friends that might be a sign of depression, refusing to put on a swimsuit or wearing long sleeves in the summer.
If you think your child is self-harming
How can you talk to your child if you suspect she is self-harming? First, check your own attitude — don’t talk if you are angry, and don’t be judgmental or harsh in your words. Be calm; ask how your child is feeling before self-injuring and how it helps to feel better. Validate their feelings, not the injuring behavior. Do not engage in a power struggle or isolate the child; instead, try to encourage activities and social interaction that can benefit the child.
Offer reassurance, but don’t back down from household rules and consequences. Your adolescent needs those to thrive.
Do your best to model healthy coping with life’s challenges and encourage open communication in happy times and stressful moments, too.
Therapies that teach problem-solving skills and coping strategies offer the best hope, along with treatment aimed at any specific mental health conditions that are diagnosed. Among such evidence-based treatments are cognitive behavior therapy and dialectical behavioral therapy, which help replace negative feelings with healthy, positive ones and teach coping mechanisms and behavioral skills. However, further studies are needed.
If may be that you need to talk with a professional for insights into handling the situation. You could ask your child if it’s OK for you to talk with the therapist alone, or seek out your own counselor.
Curing self-injury is not a quick process and problems that lead to self-injury have to be addressed. However, if children can develop healthy ways of dealing with emotions and get the right treatment if a mental health disorder is present, many are able to stop hurting themselves and start coping in healthy ways.
Lidija Petrovic-Dovat, M.D., is the director of the Child and Adolescent Anxiety and Depression Program, Penn State Health Milton S. Hershey Medical Center.