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Self-harming behaviour in children and adolescents

Cutting respectively self-harming in youth
©: ArtemFurman.com - Fotolia

It's the biggest horror for all parents: if they notice that your child hurts himself - with knives, needles, lighters or other objects. You are powerless and most of the time you are unable to locate the reason for this behaviour. Since this self-harming behaviour often has very deep rooted causes, paying attention and talking to the affected children, usually, does not get parents very far. To complicate matters, still, at this day and age and in this country (Germany) self-harm is still a taboo. Valid information and especially clear instruction as how to deal with this situation are rarely to be found.

Do you need in all of those cases a doctor or psychologist? Are there any preventative measures for self-harming children and adolescents?

To answer these questions, we first need to define what self-harming behaviour is and what are the reasons and motivations behind this behaviour.

What is self-harming behaviour?

The classic example of self-harming behaviour: the child cuts himself with a knife in his arm on a regular basis. Over time, scars form, which in turn often opened up again, using a knife. However, this is only one possible form of self-harming behaviour. Generally, self-harming behaviour is a term that summarises actions where the person subjects himself to harm. Other names for it are "auto-aggression", " suicidal tendency " and "self-mutilation".

Also, there are several forms of indirect self-harming behaviours such as the refusal to eat (hunger-strike, bulimia, anorexia) extensive alcohol and drug use or deliberately unprotected sex. However, with those activities the consequences of the self-harming behaviour are only visible over time, while cutting is visible immediately.

In recent years, several attempts have been made to classify self-harming behaviour. The following scheme prevailed:

Severe self-harm: all self-inflicted injuries, which leave permanent tissue damage, up to self-amputation.
Superficial or moderate self-harm: all self-inflicted injuries, which leave no or only slight traces and are not life threatening.
Stereotype self-harm: all self-inflicted injuries, which are carried out over a long period and always, in the same way, for example, hitting the head against a wall.

Recognizing self-harm

Anyone who thinks that self-harming behaviour can easily be identified is entirely wrong. Sufferers are often true masters at hiding and hushing their actions. Therefore, parents, friends and relatives have to be very vigilant if they suspected self-harm in young people. For example, does the child during the warm season suddenly wear long sleeved clothes? Does the child refuse to go to the beach or the pool? Does the child withdraw and lock himself in his bedroom? All this may be signs of self-harming behaviour.

Reasons for self-harming behaviour

Self-harming behaviour especially in children and adolescents is always an expression of intense stress and acts as a kind of valve to try to get rid of this stress. This extreme stress may result from one or several reasons. For example, family breakups, child abuse, isolation and many more. Often the self-harming behaviour proves to be short-term to give the person a way out of this extremely stressful situation. Hence, the person will fall back on this behaviour in increasingly less stressful situations. This creates a vicious circle of tension and subsequent relaxation, which is difficult to escape.

mental problems and self-harming
Mental problems - the cause of self-harming in children and adolescents?
©: Tatyana Gladskih - Fotolia

Stereotype self-harm is often rooted in a mental disorder, especially the so-called borderline syndrome. The sufferers show specific abnormalities in their behaviour, i.e. violent mood swings, poor control of aggression and reduced intellectual capacity. Prone to stereotypical self-inflicted injuries are particularly sensitive and emotionally unstable people. This “routine” of self-harm gives them a (false) sense of security and support in their lives. Children and teens that hurt themselves are likely to perceive mostly positive emotions while engaging in this particular behaviour. For example, rest and relaxation. They also enjoy the (false) sense, of seemingly having maximum control over their bodies.

As a parent, how do you respond appropriately in the face of self-harm?

Most parents experience a sense of overwhelm, power- and helplessness upon finding out about the self-harming behaviour of their child. Above all, it is important not to lose your nerves and jump into blind activism. The immediate call for a clinician or a psychiatrist most likely will trigger a rejection- and defence response in the affected person. Phrases, such as “Why are you doing this to your parents” won’t give you the desired results. On the contrary, they will drive the child into further isolation.

Present yourself in the understanding of the situation and be not afraid to admit that you are at a loss. This will take the pressure off the person for immediate action. Let you child know that you still trust him and that you would like to understand his reasons for this behaviour. Find an appropriate way to communicate with your child.

It is also important to strengthen the self-confidence and self-esteem of the child. You can do this with sincere praise and recognition for achieved success. Even the smallest progress should be rewarded accordingly.

Possible preventive measures

Because of the different forms of self-harming behaviour, the symptoms are sometimes hard to detect. This, of course, makes it even more difficult to put preventative measures into place. To predict when a child or teenager will engage in self-harming behaviour is almost impossible. The only thing you really can do is to put general risk reducing measurements into place. For example, to help and strengthen the child’s self-esteem and help him to a better social integration. This can be achieved through the following implementations: group discussions, educational campaigns, stress and emotion coping programmes, problem-solving skills training and relaxation techniques.

Enlist professional help

Your first contact could be Lifeline or any other crisis helpline when you suspect your child is self-harming. However, there are also special assistance networks and websites available. Usually, those places will refer or recommend experts in the area. (I.e. a psychotherapist).

Recognising self-harming children in the youth group

For youth workers, this is an even harder task than it is for parents. First of all, you do not have the luxury to just focus on one child at the time and secondly you lack the deeper, emotional reference to the possibly affected child or young person. Nonetheless, there are indicators, which may point to a self-harming behaviour. Besides those above mentioned signs in the youth group you might also observe that the child isolates himself from others, is slightly irritated and repeatedly emotional absent.

Cuts on arms or legs of a young person also could indicate self-harming behaviour. Similarly, the young people in your care might talk about this issue. If you listen, carefully you might pick up the one or other pointer.

As already discussed above, blaming the child (how could you) are not helpful. Make sure your demeanour is positive; the young person will intuitively pick up if you are not genuine. It is crucial that you take the young person seriously, take time for them, be patient and listen attentively. Express your concern and offer the young person help and support. Keep in mind and also accept that they young person might refuse your help. Nevertheless, give him the feeling that you want to help him, that you will make the time and that he can come to you at any time.

I think it is important that we learn to understand the causes and background of this self-mutilating behaviour. I would like to sum up the key points briefly:

Causes:

Guilt of the young person - I'm always to blame, it’s all my fault
The young person does not believe in himself (can’t do anything right, I’m nothing, a no-one)
Family problems (separation of parents), lack of love, affection and attention
Inner emptiness
Missing conflict management skills, little mental or psychological stress capability when the young person feels overwhelmed

Causes of self-harm:

Self-punishment
The mental or psychological pain discharges during cutting or hurting oneself. A false sense of relaxation occurs.
Attention or a cry for help

Observations:

Girls are more affected (Girls are more likely to direct their aggressions against themselves while boys might take them out on somebody else).
Young people try to hide their injuries – unless they are serving as a cry for help or to get the missing attention.

Ways to help:

Find a counselling service which can give you tips on how to get into a conversation with the person concerned.
Talk to the person carefully, offer help and encouragement, and get advice how to deal with this situation, if possible take the young person to the counselling service.

Years ago I had a teenager in my youth group whose friend repeatedly cut himself. He was very desperate and did not know what he should do. Unfortunately, I do not know what has become of him. However, I advised him to talk often to his friend, encourage him and seek professional help. It will take a lot of patience.