Self-Injury……The Taboo of Adolescents
If you are reading this you are either the parent or caregiver of a child that you think or know may be self-harming or you may just be reading for information but for whatever reason this article will hopefully make you more aware of the signs but also why someone self-harms.
Something that is not well known is that self-harm is now one of the top mental health problem facing adolescents today and it is more prevalent in females. Looking at the Australian Bureau of Statistics 2012 the evidence they have collated suggests that 6-7% of Australians aged 15-24 years with self-harm for at least a 12 month period. Without appropriate treatment this can become a lifetime maladaptive coping strategy with much higher rates of 17% of females and 12% of males aged 15-19 years continuing to self-harm. (Mind Frame) These statistics don’t include the many adolescents that never report their self-harming activity. What many do not understand is that this is not a diagnosed medical condition and in the majority of cases, with appropriate treatment, self-harm can be treated.
The reason that supports the lesser number of male self-harmers has a lot to do with how adolescents internalise their problems. If males have a fight with their friend they will tend to blow off steam at the gym or go for a run but females have the tendency to internalise their problems and renumerate over and over until they can work the problem out.
This is where self-harm can come into play where the adolescent is so overwhelmed with issues they see no way out of and have no ability to make sense of. You may find it strange but if you ask an adolescent that is self-harming what it is that they are upset or distressed about they generally are unable to give you an answer.
This is because the only way they can feel any emotion that makes sense to them is the actual self-harm. They generally feel that they cannot express their anger, sadness or frustration to their loved ones for fear of hurting them emotionally so they self-harm instead. The actual act gives a singular emotional response that they understand. Self-harm = pain. Whereas in cases of abuse, they are left with a multitude of emotions that don’t make sense. Abuse = pain, confusion, guilt, depression, self-loathing etc.
Once they are in therapy it becomes a slow process of working through each issue until you get to the real cause of the self-harm. This does not happen quickly and must be done with professional support and help.
I recently read Jodi Picoult’s book “Leaving Time “ (2014) where she writes about a child aged 13 years old who lost her mother at age 3 years and takes you this child’s journey to find her mother. There were two passages that made me think of this article and also several past clients.
‘Memory is linked to strong emotion, and that negative moments are like scribbling with permanent marker on the wall of the brain.’
This is something that each client I have worked with who has self-harmed says to me in one way or the other. They just see the negative and it is all they can see.
‘Eventually you stop getting close enough to people to let them become important to you, because then you don’t notice when they drop out of your world. I know that sounds incredibly depressing for a thirteen – year – old, but it beats being forced to accept that the common denominator must be you.’
This is another statement I have heard many times over. Not word for word but it always gets back to them honestly believing that everything is their fault each and every time.
So what is self-harm? Self-harm is a destructive behaviour as it is an intentional act to harm their own skin by either cutting, burning, pulling out hair, scratching and reopening old wounds to name most of them but it is not limited to these. It is done to cope with the unbearable emotional pain that they individual is suffering. It is a recurrent act where they receive an immediate physical experience ‘pain’ and a euphoric ‘high’ that makes sense to them. Oddly enough that euphoric feeling comes from the endorphins that the body naturally releases when the body is injured. Is self-harm a suicide attempt? In most cases no but if left untreated self-harm can lead to suicide. Self-harm in one sense actually keeps them alive by feeling ‘ok’ for those few minutes. Most adolescents that are curious about self-harm will usually try it once and decide very quickly it is not something they want to continue.
The old saying of when you’re a child all you want to do is grow up and when you’re an adult has some bearing on how adolescents feel. In the mid-teens you want to be seen as grown up and often family and friends around the teen start to treat them as an adult and don’t realise that even though they have grown up they still do not have all the complex strategies adults have to sort through problems and emotions. When too much responsibility and adult conversation is thrust upon an adolescent they feel pressures that adults don’t in the same situation. They add layers that we as adults know not to do anymore such as a common problem of parents and caregivers talking about what their child will do as a career and if they are going to university. Most self-harmers are perfectionists so when they hear a parent of caregiver talking about university options this becomes all consuming.
Am I going to fail? I am going to fail. I am just going to disappoint my parents? Then that will hurt my parents. What will happen if I only get my second choice? Then everyone will know I failed. That means I am dumb like I thought I was because of that A-. I shouldn’t have done ballet. I’ve let myself down and now my parents know I am a failure. I’m never going to have the career I wanted. I’m just so stupid. I should have picked different subjects. Are those the subjects that Mum wants me to do? See, I am going to let the family down now.
These are the phrases I have heard when working with clients that self-harm. You reading them as an adult can already see that there are many variables in there that they have no control over and that many of their concerns are false but this shows that they have yet to build up an adult skill set to breakdown and make sense of problems and emotions.
There are many reasons that self-harm occurs but the common thread is that the individual is unable to express their feelings and emotions in any other way and they use their body to show and feel the pain. Sometimes it’s about keeping a connection with an abuser, which to an adult does not make sense but it again highlights the adolescents under developed coping strategies. If they are self-harming due to a home based issue it is often that they have no-one safe to which they can talk to or seek help from. This is where the Kids Help Line has become a fantastic support for many children and can often prevent self-harm as they have a safe outlet. Kids Help Line 1800 551 800.
Many teens will hide their self-harm as although it brings them a temporary relief at the time it quickly becomes something they are ashamed of, feel disgusted in themselves which leads to guilt. They will start in places that can be hidden by clothes and generally cut, burn, scratch their inner thighs and inside of their arms. Unfortunately self-harm becomes a compulsion and something that they have to do in order to keep going. In a strange way self-harm keeps them alive by them feeling ok for those few minutes each day.
So what are the warning signs for you to look for? Unfortunately although I will list the most common signs it needs to be noted that someone who is self-harming may or may not fit all the categories. I have seen clients that only fit a few criteria whereas others have displayed all the signs. You need to remain vigilant as a parent or caregiver if you suspect your child maybe self-harming.
- Perfectionists – this fits with the majority of self-harmers and they generally have very high expectations of themselves even if they are not perfectionists.
- Family Dynamics
- Abuse both physical and psychological
Depression – when you are suffering from depression you only see the negative things happening around you and this compounds the self-abusers problem
- Peer group pressure at school
- Isolation and continual relocation which limits making strong social links
- Anxiety and Obsessive compulsive behaviour (OCD)- the need to have every aspect in their lives in order e.g. books facing the same way, pencils lined up on their desk, ritualised behaviour
- Unexplained frequentinjuries that don’t ‘fit’ with a normal injury
- Clothing being worn that is inappropriate to weather conditions
- Low self-esteem -this is often a sign missed within perfectionists as most people assume their self- esteem is high as they excel in things
- Poor functioning at school -this seems to contradict the perfectionism but when the load is too much to carry it will start to affect their school
- Drug and alcohol abuse and binge drinking
- Self-harm kits – self-harmers will often have a kit that helps them control their self-harm such as Band-Aids, cotton buds and disinfectant. Self-harm kits have a deeper meaning as it is the way the self-harmer takes care of themselves after the event. It’s almost like a ritual especially with abused children by caring for themselves when they were not cared for by others.
- Extreme change in moods and impulsive behaviour
- School (including bullying)
- Abnormal sleep habits
- Self-expression – is different again to self-harm such as wanting piercings or tattoo’s is generally just about self-expression. It is however important to let adolescents know the impact of piercings and tattoo’s on their long term career path and that it is something that can scar their body for life. Females especially will tend to shy away from self-expression once they realise what a tattoo is going to look like on their body in years to come. Extreme self-expression maybe a sign of self-harm though and needs to be addressed. The other difference with self-expression is that it becomes self-harm if they are doing it to have pain caused and to get a ‘high’ from the pain.
There is treatment and help available if they want to stop which the majority do. Most will feel that they can’t stop but deep down they know they want to. Currently in Australia after the age of 16 years parents and caregivers cannot give authority for their child to receive help. After the age of 16 consent must come from the self-harmer so picking up on this early is critical as many will refuse treatment if given the choice.
My preferred action plan is seeking a referral from your GP under Medicare to a Psychiatrist so any other mental health issue can be ruled out. Then onto a referral from your GP to a psychologist. They will manage the individual but also develop a plan for the family. It is quite useful for the parents to see either the same psychologist or if the client prefers a different psychologist so the family can support their recovery with the right strategies. It may take some time to receive assistance but there are things you can do to support them straight away.
- Painting, collage, sculpture and drawing – any artistic act or art therapy group that gives them something to do with their hands. Make sure you give them the option of not showing you everything if they don’t want.
- Diary – journaling is fantastic therapy but may not always be an option with prying eyes. Set them up an online secure journal so they can really get their feelings out
- Beading – making elastic beads to go around their wrists gives them something to play with or flick against their skin instead of cutting
Even though these strategies and ones that the treating psychologist or psychiatrist will employ do not give the same ‘high’ and or have the ‘euphoria’ of self-harm they are healthy options and ones that they self-harmer can employ long term. Therapy will challenge their thinking and change the way they look and deal with issues giving them a new set of coping strategies to employ. Still the most simple strategy you can employ is to remember that even though they are teenagers they are still children at heart.
There is a myriad of research and support available on the internet in regard to self-harm but I cannot emphasise enough how important it is to get professional help for the individual as with help they can stop. Just try to make your child understand that there isn’t something wrong with them and that there is a way to help them make sense of their feelings but in a much healthier way.
Kids Help Line(5 years – 25 years)-1800 551 800
Lifeline – 131 114
SANE Australia Helpline (support and carer help)- 1800 187 263
Men’s Line Australia – 1300 78 99 78
Headspace – 1800 650 890
Beyond Blue – (also support for Aboriginal and Torres Strait Islanders) 1300 224 636
Child Abuse Report Line – 131478