By Eric Metcalf, MPH
Many kids and teens cope with upsetting thoughts and life challenges in a way that worries those around them: They hurt themselves.
Experts call this nonsuicidal self-injury. People who injure themselves in this way damage their bodies, but they’re not intending to hurt themselves badly enough to die from the injury.
Common ways that people injure themselves include:
- Cutting or scratching their skin
- Burning their skin
- Biting themselves
- Punching walls, doors or other objects or punching themselves
- Rubbing their skin until they leave a mark
Although some types of more socially accepted self-expression involve pain and permanent marks, such as tattooing, piercing and earlobe-stretching, these don’t typically count as forms of self-injury.
Young people who self-injure are often struggling with painful emotions. In some cases, they go on to show suicidal behaviors. If you’re concerned that your child or teen is self-injuring, here’s how to recognize the signs and seek help.
Who’s Self-Injuring And Why?
Self-injury isn’t an uncommon concern. Researchers have estimated that roughly 8 percent of pre-teens have done it. Roll the clock forward a few years, and 12 to 23 percent of teenagers may have self-injured.
Some factors that can influence young people to injure themselves include:
- A history of being abused, such as physical or sexual abuse
- A history of being neglected
- Having turmoil in their lives
- Other mental health issues such as depression, anxiety, post-traumatic stress, drug or alcohol abuse, or an eating disorder
People self-injure for many reasons. In some cases, it provides a sense of relief from difficult emotions like anger, stress, shame, anxiety or sadness. They may feel emotionally numb and the injury helps them “feel” something. Or they may want to fit in with friends who self-injure.
Sometimes people hurt themselves because they’re seeking punishment for something they’ve done or thought. Or they may want someone to notice that they’re struggling. If they feel relief from the issues that are bothering them, they may turn to self-injury again because it becomes a reliable source of comfort.
The Link Between Self-Injury And Suicide
Mental health experts are still learning about the possible link between self-injury and suicide. These appear to be different issues, especially in terms of what the person is trying to accomplish.
People who harm themselves are trying to cope with bothersome emotions so they can go on with their lives, even if it’s with an approach that’s not regarded as healthy. People who commit suicide, however, do so because they’re trying to permanently escape their discomfort. But even when young people aren’t planning to kill themselves with these injuries, this activity may suggest that they’re at higher risk of suicidal thoughts or attempts.
For starters, self-injury is a sign that someone is struggling emotionally. People who injure themselves may be trying to cope with depression or a sense of hopelessness, which are concerns that people who attempt suicide also often have. As they injure themselves, they may also develop a higher pain tolerance, which could make death seem less scary.
In addition, the reasons people injure themselves can change over time. Some may switch back and forth between self-injury without the hope of death, and self-harm with the goal of suicide.
What Research Shows About Self-Injury And Suicidal Behavior
In a study published in the journal Archives of Pediatrics & Adolescent Medicine in 2007, researchers who interviewed more than 3,000 college students found that 40 percent of the participants who’d engaged in self-injury had also had suicidal thoughts or behaviors.
Research reported in the October 2012 issue of the Journal of Consulting and Clinical Psychology followed 399 teens starting in ninth grade and found that those who self-injured were later at higher risk of suicidal thoughts or attempts.
In yet another study, published in 2013 in the journal PLoS One, researchers looked at a group of young adults who had injured themselves. They estimated that about two-thirds fell into a category marked by less self-injury and a lower risk of suicidal behavior. Another 20 percent had injured themselves more often, yet didn’t seem to have a high risk of suicidal behavior. But the third group — which accounted for 13 percent — had injured themselves frequently and appeared to be at a high risk of suicide.
Some people who harm themselves only do so once or a few times and then stop. People who hurt themselves often have no desire to end their lives. But these studies suggest that if you have a loved one who’s harming him or herself, it’s important to have a mental health provider assess the reasons why they’re doing it.
Signs Of Self-Injury And What To Do
Sometimes the signs of self-injury may be obvious. Other times, you may have to do some detective work to discover if your child is harming him or herself. Look for:
- Cuts, scars, bruises or other visible markings – These may not look like the result of an accident. For example, a cut may look unusually straight or markings may be grouped together.
- Unusual clothing or bandages – You might not notice signs of self-injury if they’re on places normally covered by clothing, such as the abdomen or upper thigh. But if your child insists on wearing long sleeves in the summer or doesn’t want to go swimming, for example, or is wearing bandages, these may suggest an attempt to cover up signs of self-injury.
- Strange explanations – If your child keeps reporting that the same type of incident is causing repeated cuts, bruises or scrapes, self-injury might be the actual cause. This may be even more likely if the pattern of injuries doesn’t seem right, like a bike wreck that caused a cut but no scrapes or a fight that only left bruised knuckles.
- Online signs – The Internet offers video-sharing sites, discussion groups, and other avenues for kids and teens to talk about self-injury. While these can provide help in stopping the behavior, they can also offer encouragement.
Your child may learn from these online interactions how to conceal self-injuries. They may also begin to see self-injury as a normal, reasonable way to deal with painful emotions after encountering others who do it. As a result, your child’s browsing history on a computer or cell phone might provide clues about self-injuring behavior.
If you discover that your child is self-injuring, experts recommend taking a calm approach without judging. Try not to act startled or shocked, and avoid trying to make your child feel guilty or ashamed.
Arrange for your child to see a mental health professional, ideally one who’s familiar with self-injury. It’s important that you and your child find out why he or she is engaging in these behaviors and learn healthier ways to cope with difficult situations and painful emotions.
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