Scars inside and out: Self-harming behaviours in Teens
After more than a decade of working with teenagers, colleagues and I have unfortunately seen that with the increase in anxiety and depression among teens, comes the increase in self-harming behaviours. These are some of the most common questions that parents have for me on the topic.
What do we mean by self-harming?
We are talking about deliberate behaviours that cause harm to themselves. It usually involves cutting the skin, but can also include behaviours such as biting, scratching, burning and overdosing. Research shows that teen girls are more vulnerable to this behaviour, but it affects both sexes, with some statistics indicating as many as one third to one half of the adolescent population in the US have engaged in some form of self-harming behaviour. Unfortunately, I was unable to find any SA statistics but through my own clinical work I feel that we are following similar patterns.
Does that mean my child is suicidal?
With self-harming behaviours, especially cutting, it is an understandable reaction when parents become extremely concerned, and want to know if these are suicide attempts. Typically, self-harm is more about the teen trying to manage the ‘pain’ so that they can live with the distress- a coping tool as such, but a harmful one. When there has been an incident of self-harm, the professionals will always assess for suicidal behaviour and thoughts, but it is generally not treated as a suicide attempt.
Why would s/he do that?
There is no one specific reason, rather it is a combination of factors, and understandably it will differ from person to person. While self-harming is often associated with a diagnosis of anxiety and/or depression, it is not always the case. Studies have shown that there are some common themes that emerge, but again, it can vary greatly.
Underlying the behaviour, there are some intense emotions that the teen is dealing with –ranging from feeling overwhelmed, anxious, despondent or hopeless to feeling numb, frozen, or enraged. Combine those emotions with a low self-esteem and the many different dynamics that teens are forced to juggle during this period in their lives such as family issues, school pressures, social dynamics, peer pressure, changing bodies and changing identities to name a few, and we can see why they would try find any way to get a break from their distress. In an attempt to manage the combined distress, teens have to draw on their coping tools, and sometimes they may resort to more unhealthy methods, such as self-harm, as their crutch.
Some teens harm as a way to punish themselves and some may harm to feel ‘something’ when they are feeling numb. Paradoxically, some teens harm because they feel a fleeting sense of relief in that moment, while others may harm as a way to show their inner pain, which is often so deep and well hidden and possibly use it as an indirect attempt to seek help, by physically showing us just how intense their feelings are.
As a parent, what do I do now?
Communicate: Bring up the topic with them! Even if you think there is no way your child would be engaging in such behaviour, they are aware of it. It is all over the media, unfortunately often glorified and it is all over school, with someone knowing someone who has self-harmed. Talking about it with them will NOT put ideas in their head, rather it opens the channels for discussion and support. At the same time, do not be surprised or hurt if your child denies or hides this behaviour initially. They often feel embarrassed and ashamed to discuss it.
Give it time: I know that parents often feel scared, angry, confused, embarrassed or worried about this behaviour, but you also need to be patient, with your teen and yourself. Self-harming behaviours can be addictive and habit forming and as such it may take time for the teen to find alternative coping tools, and will need support, not criticism and judgement for their behaviour.
Support them: Assist the teen to experiment with other, more healthier coping tools such as physical activity, breathing exercises and talking to a trusted friend/family member. Also encourage social connections. Often there is a lot of shame and isolation associated with self-harm and positive connections will help them feel supported.
Get professional help: This behaviour requires the appropriate resources, so it is important to consult with trained professionals who can support the teen and the family. Through individual therapy, group programs and medication, where indicated, we can address the immediate unhealthy behaviours as well as the underlying emotional distress that lead to those intense emotions.
My intention with this blog post is not to cause alarm amongst parents, but rather to highlight the subject so that we can openly engage with our teens and assist them with the emotional minefield that comes when navigating these years.
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