The term self harm conjures graphic images in our heads of brutally cut wrists with seeping open wounds, and rightfully so. Self harm is exactly this and more. Best described as deliberate self harm, this is when an individual deliberately inflicts an injury or pain upon themselves. The most frequent self-harm sites are the hands, wrists, thighs, and stomach, although self-injurers may hurt themselves anywhere else on the body.

Forms of self harm

There are different ways people intentionally harm themselves. The behavior can include:

• Cutting arms, legs, or torso
• Burning skin
• Picking at wounds to prevent healing
• Pulling out hair
• Hitting yourself
• Any other behavior that you may inflict on yourself to cause pain

Sadly deliberate self harm is yet another condition that has a significant impact on our youth; even more concerning is that it is on the increase.

Why do people cut themselves?

There is much discussion around why adolescents harm themselves, but there’s no definitive answer. Each teen’s reason for inflicting injury upon themselves is as different as the next person’s. However, the consensus is that young people who engage in self-harming behavior are experiencing intense emotional feelings that they have limited or no ability to control.

They are using deliberate self harm to numb the intense emotional pain they’re experiencing. And as difficult as it is to understand when working with young people who engage in this behavior, they too are often unable to explain why they hurt themselves. Other than the fact that they simply wanted to stop feeling a certain feeling.

Young people who self harm may do it regularly to cope with the raft of emotions and feelings they deal with daily. Their injuries can range from superficial to extremely dangerous, requiring immediate medical attention. Some years ago, I taught a bright young woman who was crippled by mental health issues. Despite all the support she accessed and available to her, life was tough for her to endure at times. To cope, she cut herself. Her teachers, including myself, had been made aware of this and were asked to be vigilant.

If a known cutter came in wearing long sweaters on a hot summer day, we knew it was not an indication of a physically sick child but rather another day of emotional pain. The sweater was their way of telling us that they were struggling emotionally and hiding their graphic work. There is a lot of shame associated with cutting and despite being desperate for people to know they’re struggling, they don’t want people to know exactly what they are doing.

One morning, Sarah* (not her real name) tracked me down before class. She called my name and pulled up her sleeve, waving her injury-riddled arm under my nose. I remember it distinctly. Deep dents in her beautiful pale skin. Each cut representing another feeling, another painful reminder of what was hurting her. I worked hard to contain my horror and fright and quietly escorted this vulnerable young girl to the front office, where the ambulance and parents took her to the hospital. Sarah’s parents were used to the drill. Their daughter was struggling with mental illness and self harm was her extrinsic reward.

Why is self harm bad?

For some teenagers who continually use self harm as a means to deal with their emotional pain, it becomes part and parcel of their illness. Sometimes an emotionally vulnerable kid will only cut once when they’re faced with something so difficult and they feel they have no other way to respond. Sometimes their emotional struggle is peer pressure; they want to show that they do it too. Treating self harm must involve treating the reasons for the emotional pain or mental illness.

Is self harm a mental illness? It is important to remember that deliberate self harm is not necessarily an indicator of a specific mental illness or an indicator of pending suicide. But rather a behavior that one must explore to find out why it is happening.

A lot of discussion and research suggests that the feelings associated with self harm can become addictive; the teen can turn to it to soothe any emotional upheaval. Whatever the pattern of this behavior, the way we respond should always be the same. Someone who uses pain-based behavior such as self harm requires medical attention and support. While the injury is not to be ignored and often cannot be overlooked given the damage caused, we must constantly explore the reasons why the child undertook the behavior.

Experts warn against people using the term “trend” or “epidemic” when discussing the notion of DSH, but it is behavior that is certainly being reported as on the increase. Studies have shown that in the last 15 years, the incidence of self harm has quadrupled. As many as 16% of our teens internationally are engaging in this activity.

This is very frightening stuff, but we could look at it differently. We could put a positive spin on it and attribute this behavior to the fact that we’re not seeing these young people anymore as “difficult.” But instead, as a young person silently screaming out for support and intervention with their mental health issues. So ironically, the rise in reported rates may be a good thing in the sense that it suggests more people are now asking for help and getting the support they so badly need.

Challenging the stereotypes

And what about the stereotype that self harm is more common in girls than boys? Well, as with all stereotypes, it is another myth that needs to be challenged too. Our boys are engaging in self harm as frequently as our girls, just that in many cases, it looks different. Remember the pain-based behavior we talked about earlier on?

Our young men punching walls, breaking things, and putting fists through windows are trying to regulate big emotions and looking for ways to take away the burdensome pain they can’t control or fathom. It is most certainly not helpful for them to repeatedly hear that it is a “girls’ issue” when they too are struggling with their mental health issues and very big emotions that they can’t yet regulate.

There’s also growing concern that the internet fuels kids’ interest in “taboo” subjects such as self-harm. With young people having access to the internet in almost every corner of their lives, it’s not surprising that they turn to it to find out more about self harm. Online sites out there portray self harm in many different ways, some too graphic to contemplate. And it is the kind of information that our teens are seeking out.

The internet’s potential to offer support is undeniable. However, we’re learning that while many teens engage in these sites with positive outcomes, some use them to find out more about self-harming methods and how to do it. Other darker places seem to normalize self-harm, making it difficult to seek help offline. Despite the behavior being labeled “attention-seeking,” that is a cry for help and must be recognized for what it is. A young person struggling with some aspect of their life and just doesn’t know how to deal with it.

How to help someone who self harms

We have spent much of this article addressing self harm in young people, but we must also turn our attention to the very fact that it could be our own child. The horror of finding out that they’re experiencing something that drives them to hurt themselves just does not bear thinking about, but statistics and reality tell us a different story. The likelihood of any of us facing this is real.

Our teens face a whole world of issues that did not exist when we were young and in many cases, they have limited capacity to deal with them. So how do we deal with deliberate self harm if it crosses our path and hits close to home?

• Treat the wound first. Take care of self harm burns, cuts, or deep wounds, but remember that you’re not just treating the physical injury but also a teen struggling with issues that they really need help with.
• Discussions around “stopping” the behavior are futile unless you offer alternatives to self-harm. Mental health experts advise that looking at behaviors that may provide distraction is very useful. These include: calling a friend, looking after a pet, having a bath or shower (ensuring there are no razors), doing physical activity, or watching suitable TV.
• Strategies that encourage your teen to relax and self-soothe are also good to explore. These may include listening to calming music or podcasts, engaging in breathing exercises, doing yoga, or doing a mindfulness activity.
• Help them redirect the pain to other activities. Activities such as drawing the pain, writing about their anger or pain in a journal or a short story, or scribbling on white paper with a red pen or drippy red paint are good examples.
• Give them strategies to replicate the pain or appearance of pain. While these strategies above may help, how do we support the individual who craves the sensation of pain without them engaging in deliberate self harm? Some of the ideas include rubbing an ice cube where a cut would normally be, wearing a rubber band around the body part where the cutting happens and snapping it against the skin when they feel like cutting, or taking a soft felt tip pen and simply drawing red lines where the cutting would typically happen.
• I would strongly suggest that you do not attempt to tackle this in isolation. There is a lot of support out there, including your doctor, adolescent mental health specialists, and support websites and groups.

It takes a village

Like any retraining that we do with our kids, it takes time, energy, and love.

Finding out your child is self-harming is confronting and frightening. As parents, we feel hurt, confused, scared, and helpless. It is important to remember that we can get our children help. There is really great help out there. Remember Sarah, who I discussed earlier in the article? I can tell you that Sarah is a well-adjusted young woman. She’s found strategies and activities to support her struggles with mental health through the loving support of family and friends.

Scarring is also complex and sensitive to solve alone. Self harm scars are often associated with feelings of regret and guilt, social stigma, body image disturbance, and the need to hide them. A multidisciplinary approach will best manage your child. The team of experts can combine expertise to address the unique physical and psychological needs of your teen.

Raising children and addressing all their needs and difficulties is not a journey we should endure alone. There is a “village” of experts and people to support you if you find that your child struggles with their mental health and turns to self harm. Please use them and remember you are not alone. You’re not dealing with a problematic, naughty, or attention-seeking young person. You are dealing with your child, who needs your love, support, and guidance to help them learn and understand how to manage the difficulties they are facing.