Early Warning Signs
Signs and symptoms of self-injury might include:
- New cuts, scratches, bruises or other unexplained wounds
- Excessive rubbing of a specific part of the body or area creating a burn
- Wearing long sleeves or long trousers, especially noticeable in hot weather
- Fidgeting with their sleeves or trousers
- Possessing sharp objects
- Problems with interpersonal skills and relationships
- Persistent questions about personal self, such as “Why am I even here?” “Who really cares about me anyway?”
- Behavioural, emotional and rational instability,
- Tendency to be impulsive and unpredictable especially with strangers and unfamiliar settings
- Statements about feeling helpless, hopeless or worthless
Methods of self-injury
Self-injury commonly occurs in private and familiar settings, but is usually conducted in a controlled and sometimes ritualistic way that can leave shapes on the skin. Some examples of self-harm could include:
- Burning ( through excessive rubbing, with cigarettes over a naked flame, or by heating up sharp implements)
- Carving words or shapes on the skin
- Hitting or punching
- Piercings on the skin using sharp objects
- Pulling hair out
- Persistently “picking at” a wound to stop the healing process
There are certain areas of the body that are targeted more than others, most frequently targeted are the arms, legs and front of the torso but all areas of the body can be. People who self-harm can and have used more than one method to harm themselves.
Becoming agitated or frustrated can cause upsets and these can trigger an urge to self-harm. Many people self-harm only a few times and then stop. But for others, self-injury or self-harm can become a long-term, repetitive behaviour.
When a child self-harms
If you have a child who is self-harming, you may initially have feelings of shock, closely followed by feelings of fear and uncertainty. If your child or sibling has mentioned to you that they are self-harming or talking about self-harming you need to take this seriously. Although you may feel that you could be breaking their confidence, self-harm is too serious an issue to ignore or to manage on your own.
You can start by talking to your child by asking them how long they have felt this way, do they think their actions bring any lasting relief. You could ask why they self-harm and they may not know why, but opening up the door for them to talk to you will offer you key information to help you to suggest a visit to your local GP who is in a position to offer an initial evaluation or a referral to a specialist team.
It stands to reason that yelling, getting upset at your child, making threats or levelling accusations at them won’t achieve anything; however showing them genuine loving concern for their health and well-being will.
When to seek additional help
If your child is injuring themselves in any way, even if only in a minor way, you should reach out to someone who you can trust for help. Any form of self-harm is an early sign of larger issues; these issues won’t resolve themselves and as such need to be addressed.
Talk to someone you trust — such as a friend, loved one, health care provider, church leader or a school official — someone who will help you take the first steps toward success. While you or your child may feel ashamed and embarrassed about their behaviour, you can find supportive, caring and non-judgemental help from many local support groups.
How did we get here?
There’s no single or simple cause that leads to someone self-harming. In general terms a non-suicidal self-injury is usually the result of your child’s inability or immaturity as to how they are to cope with psychological pain but in a healthy way.
Another possibility is that your child has a difficult time regulating, expressing or understanding emotions. However the mix of emotions that trigger self-injury is highly complex. For example, there may be feelings of worthlessness, loneliness, panic, anger, guilt, shame, rejection, failure, fear, self-loathing or unsure sexuality.
Through self-injury, the person may be trying to:
- Manage or reduce severe distress or anxiety and provide a sense of relief
- Provide a distraction from painful emotions through physical pain
- Feel a sense of control over his or her body, feelings or life situations
- Feel something — anything — even if it’s physical pain, when feeling emotionally empty
- Expressing internal feelings in an external way
- Communicate feelings about depression or distressful feelings to the outside world
- Being punished or perceiving faults that are not theirs to own
Certain factors may increase the risk of self-injury, including:
- Age. Most people who you hear about self-harming especially in the local media are teenagers and young adults; although some people in other age groups may also self-harm. Teens and other volatile individuals face increasing peer pressure, loneliness, and conflicts with parents or other authority figures.
- Life issues. Some people who injure themselves can be from a neglected, abused (sexually, physically or emotionally) background, or may have experienced other traumatic events. They may have grown up and still remain in an unstable family environment, or they may be young people questioning their personal identity or sexuality. Some people who self-injure are socially isolated.
- Mental health issues. People who self-injure are more likely to be highly self-critical and be poor problem-solvers. In addition, self-injury is commonly associated with certain mental disorders, such as borderline personality disorder, depression, anxiety disorders, post-traumatic stress disorder and eating disorders.
- Excessive alcohol or drug use. People who harm themselves often do so while under the influence of alcohol or recreational drugs.
- Self-harm can also be because of a variety of complications, these include:
- Worsening feelings of shame, guilt and low self-esteem
- Infection, either from wounds or from sharing tools
- Permanent scars or disfigurement
Although self-injury is not usually a suicide attempt, it can increase the risk of suicide because of the emotional problems that trigger self-harm. And the pattern of damaging the body in times of distress can make suicide a possibility. It is important that through discussions you can uncover what if any are the risks to suicide.
Although some people may ask for help, sometimes self-harm is discovered by family members or friends. Or a doctor doing a routine medical exam may notice signs, such as scars or fresh injuries.
There’s no diagnostic test for self-injury. Diagnosis is based on a physical and mental evaluation. A diagnosis may require evaluation by a mental health provider with experience in treating self-injury.
A mental health provider may also evaluate you for other mental illnesses that may be linked to self-injury, such as depression or personality disorders. If that’s the case, evaluation may include additional tools, such as questionnaires or psychological tests.
There’s no one best way to treat self-injuring behaviour, but the first step is to tell someone so you can get help. Treatment is based on your specific issues and any related mental health conditions you might have, such as depression.
Treating self-injury behaviour can take time, hard work and your own desire to recover. Because self-injury can become a major part of your life, you may need treatment from a mental health professional experienced in self-injury issues.
If the self-injury behaviour is associated with a mental health disorder, such as depression or borderline personality disorder, the treatment plan focuses on that disorder, as well as the self-injury behaviour.
Known as talk therapy or psychological counselling, psychotherapy can help you:
- Identify and manage underlying issues that trigger self-injuring behaviour
- Learn skills to better manage distress
- Learn how to regulate your emotions
- Learn how to boost your self-image
- Develop skills to improve your relationships and social skills
- Develop healthy problem-solving skills
Several types of individual psychotherapy may be helpful, such as:
- Cognitive behavioural therapy (CBT), which helps you identify unhealthy, negative beliefs and behaviours and replace them with healthy, positive ones
- Dialectical behaviour therapy, a type of CBT that teaches behavioural skills to help you tolerate distress, manage or regulate your emotions, and improve your relationships with others
- Psychodynamic psychotherapy, which focuses on identifying past experiences, hidden memories or interpersonal issues at the root of your emotional difficulties through self-examination, guided by a therapist
- Mindfulness-based therapies, which help you live in the present, appropriately perceive the thoughts and actions of those around you to reduce your anxiety and depression, and improve your general well-being
In addition to individual therapy sessions, family therapy or group therapy also may be recommended.
There are no medications to specifically treat self-injury behaviours. However if your child is diagnosed with a mental health condition, such as depression or an anxiety disorder, your doctor may recommend antidepressants or other medications to treat the underlying disorder that’s associated with self-injury. Treatment for these disorders may help you feel less compelled to hurt yourself.
In addition to professional treatment, here are some important self-care tips:
- Stick to your child’s treatment plan. Keep appointments and take prescribed medications as directed.
- Recognise the situations or feelings that might trigger a desire for your child to self-injure. Make a plan for other ways to distract or to get peer support.
- Ask for help. Keep your doctor’s phone number handy, and tell them about all incidents related to self-injury and your child’s interaction with the family and friends.
- Take care of yourself. Learn how to include physical activity and relaxation exercises as a regular part of their daily routine. Eating healthy and exercising regularly has the same effect on serotonin levels (happy hormone) as mild to moderate anti-depressant.
- Take appropriate care of wounds if your child is injured Call a relative or friend for help and support while you are managing a wound. Don’t share instruments used for self-harm as these increases the risk of infectious disease!
Coping and support
If your child needs help in coping, consider the tips below. If there’s a focus on thoughts of suicide, take action and get help immediately.
Coping tips if your child or loved one self-harms, these include:
- Connect with neighbours friends and family who can support you so you don’t feel alone. For example, reach out to a neighbour,family member or friend, contact a support group, or get in touch with your doctor.
- Focus on websites that support recovery. Avoid websites that glamorize self-injury.
- Learn how to express your emotions positively. For example, to help balance your emotions and improve your sense of well-being, go for a walk, be physically active, practice wellness techniques, practice relaxation techniques
- Search out information. Learning more about self-injury can help you understand why it occurs and help you develop a compassionate but firm approach to helping your child to stop this harmful behaviour. Know the strategies and relapse prevention plan your child may have developed with their therapist.
- Don’t judge or criticize. Judging, being critical, shouting, being threatening or accusative may well increase their risk of self-injuring behaviour. Alternatively offer support, praise small efforts made encourage them to express their emotions healthily and affirm your time together.
- Let them know you care. Your child is so important to you so it’s imperative that you remind them that they’re not alone, that you’re always available to listen and talk. Be aware that you may not change their behaviour, but your loving and affirming support will help them identify coping strategies and viable treatments.
- Support their plan. If prescribed, encourage your child to take any medication which will help to combat anxiety, stress and depression. The importance is to attend all appointments.
- Find external support. See if there are local support groups for parents, family members or friends of people who self-harm as these groups are a good platform for you to be open and honest about how yu feel and the impact this is making on your life and the life of your family. It is so cathartic to talk to people who’ve gone through what you’re going through with your own child or children as they understand and can advise from a point of experience and know-how.
- Take time for you. Remember if you get ill who is going to manage the situation and you? It is really important that you take time-out to do the things that you enjoy doing. Go out to the cinema, visit friends, go for a coffee and a girlie chat! Remember also to get plenty of rest as well as keeping physical active as you will need to continue to be alert and observant to those subtle signs that signify change.
There is no sure way to prevent your child from self-injuring behaviour. But reducing the risk of self-injury includes strategies that involve both individuals and communities — for example, parents, schools, medical professionals, supervisors, co-workers facilitators and coaches.
- Identify children most at risk and offer help. For instance, those at risk can be taught resilience and healthy coping skills that they can then draw on during times of distress.
- Encourage expansion of social networks. Many children who self-harm feel lonely and disconnected. Forming connections with other children who don’t self-harm can improve relationship and communication skills.
- Raise awareness. Adults, especially those who work with children, should be educated about the warning signs of self-injury and what to do when they suspect it. Educational programmes and group discussions such as the Uberheroes programmes are very helpful strategies especially when applied to help with early intervention and prevention altogether.
- Promote programmes that encourage peers to seek help. Peers tend to be trusted friends even when they know a friend is in crisis. Programmes that encourage youths to reach out to each other and to adults may chip away at social norms that support secrecy.
- Offer education about media influence. News media, music and other highly visible outlets that feature self-injury may nudge vulnerable children and young adults to experiment. Teaching children critical thinking skills about the influences around them might reduce the harmful impact.
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