An issue that has been of increasing concern to Kids Helpline counsellors over the past 10 years has been the number of young people who disclose self-injuring behaviours, during counselling sessions about other problems.
People use different words to describe this behaviour. In this paper we will be using self-injury.
What is self-injury?
Kids Helpline defines self-injury as deliberate, non-life threatening self-effected bodily harm or disfigurement of a socially unacceptable nature. Those who engage in self-injury are deliberately doing physical harm to themselves in ways that are not intended to end their lives.
The predominant forms of self-injury disclosed to Kids Helpline counsellors are cutting the skin of arms or legs and/or deliberate overdoses of both prescription and over-the-counter medications not designed to be fatal. Other behaviours such as burning or picking the skin or pulling out hair can also be termed self injury, but are not nearly as common as the first two. Kids Helpline recognises that self-injury is different from suicidal behaviour, but some young people who self-injure are also suicidal or can become suicidal.
Why do people self-injure?
Self-injury can be understood as a means of coping with overwhelming and inexpressible emotions. Self-injury often becomes a compulsive behaviour that perpetuates deep shame, guilt and self-hatred. It is a deeply addictive experience and the dangerous nature of the activities means that death can occur even when the young person is not intending to kill themself.
How often is it happening?
As self-injury has no consistent definition in the general community (the term self-harm is often also used, but with slightly wider meaning), it is difficult to estimate how often it is happening. At Kids Helpline, the rate of young people reporting self-injuring behaviours is increasing. In 2008, self-injury was reported 7,710 times. In 2009, this had risen to 8,166 reports, with 15% of all counselling type contacts reporting these behaviours.
Research suggests that 5-6% of the general population of young people deliberately self-injure each year in Australia. Although we don't know exactly how many young people are engaging in this behaviour, it is clear that self-injury is being spoken about more frequently these days throughout youth communities such as schools and universities. It is also evident that many more research studies are being carried out in order to better understand what helps and what doesn't.
How can you know if it is happening?
Sometimes a parent or carer is the last person to know when their child is self-injuring. Young people tend to confide in a close friend first, whom they commit to secrecy. This often leaves 'the friend' fearful for the safety of the person engaging in self-injury, but anxious about losing their friendship if they tell an adult who could help.
A small number of young people publicly display their self-injury, either by discussing it generally, showing their scars or by self-injuring in public. However, most young people who finally disclose this behaviour to a Kids Helpline counsellor say they have been keeping it a secret from those in their immediate environment. They may cover their cuts or scars by wearing long sleeved shirts or jumpers and long pants even in warm weather. Or, if they regularly take overdoses of medications such as paracetamol, they may hide from their parents in their bedroom, 'sleeping it off'. This particular form of self-injury is very dangerous as unlike other self-injuring behaviours like cutting, there are no outward scars to communicate the young person's distress until serious damage has occurred to the liver and kidneys. If parents find a packet of Panadol pills in a schoolbag, young people tell Kids Helpline they can easily pass them off as being for legitimate headache or period pain.
Below, a Kids Helpline caller relates their experience of self-injuring with over-the-counter medication:
"I don't know how many I really take. But every day when I feel not so good...Normally just Panadol I guess and sometimes other stuff like Nurofen, whatever is in the cupboard I guess, or my schoolbag" ( Kids Helpline caller, age 13).
Why do young people self-injure?
Self- injury is different for everyone who does it. Some young people tell Kids Helpline they do it to:
- get relief from overwhelming negative emotions such as anger, frustration, sadness or loneliness
- help them to feel 'something', when they would normally feel numb or 'not really alive'
- punish themselves - some young people carry a belief from past trauma or abuse that they are essentially 'bad' and need to be punished
Various mental health disorders can also include self-injuring behaviour. It is important that your child is screened for such disorders when seeking assistance.
What is the impact on young people and their families?
Young people who self-injure
These days, self-injury is more commonly spoken about amongst young people; however, this has not necessarily reduced the stigma attached to it in the wider community. The conflicted nature of the emotions driving the behaviour causes enormous ambivalence in the young person. This frequently means that the self injuring person's attempts to get help may stop mid-stream and relationships with those who are trying to help may subconsciously be sabotaged.
When parents are finally 'let in' to their child's secret, they often have feelings similar to grief and loss reactions, including:
- fear and anxiety
These feelings often occur along with other strong emotions such as:
If you are in this situation, it is important to give yourself permission to feel any emotion that comes up as no emotion is ‘wrong’. . Also, accepting your emotions is a good way to model healthy reactions for your child However, it is also important not to act based on these first reactions, but to take time to process strong emotions (away from your child) and then come back and build a collaborative plan of action with your child. It is also important to understand that no one is to 'blame' in this situation.
You may benefit from seeking professional help and support to deal with your own feelings, and how best to manage what is going on for you and your family.
What can parents do?
An issue as complex as self-injury cannot be adequately covered in a short article such as this. However the message we want to give you here is that self injury requires an active response - one that inquires into the issues driving the behaviour and acknowledges the potential for self injury to progress to suicidal behaviours.
- DON'T IGNORE the behaviour, and
- DON'T PANIC - self-injury CAN be treated
Other things you can do are:
Seek professional help
Because of the complexity of self-injuring behaviour, it can be very helpful to seek professional assistance to work out why your child is self-injuring and how you can support them. You may also need help coming to terms with what's happening prior to or while you are supporting your child. Speaking with a professional can help you understand your own emotions as well as develop a plan of action for supporting the young person.
Current research indicates that Dialectical Behaviour Therapy (DBT) is an effective way of treating self-injuring behaviour. It teaches how to identify and challenge faulty and rigid thinking, and change the resulting unhealthy behaviours.
There are also many books about self-injury written for parents or carers that can provide further information on seeking help for your child, you and your family. See the listings at the end of this article to find out where you can go for further help and information.
Offer support to your child
Let your child know that you want to help them in the best way you can. Tell them you have trust that, with professional assistance, they will be able to find better ways to cope with the overwhelming emotions driving their behaviour. Avoid telling your child to 'just stop it', as self-injury can be addictive and research tells us that people with addictive behaviours are unable to stop without extended periods of support.
Show belief and understanding
Tell your child that you believe in their capacity to work towards finding alternative healthy coping strategies. This will help give them the space to feel some control in the short-term - that their coping mechanism will not be 'taken from them before they are ready' - while at the same time assisting them to feel reassured by your confidence that hope lies ahead.
It is also important for your child to know that you understand and validate the emotions driving their behaviours but that you also know there are more constructive and helpful ways to process those feelings.
It is critical that you persist in letting them know that you trust and support them to find a way through this experience, no matter how long it takes and no matter how many set-backs there are along the way. If your child believes that you trust in them, they will more readily trust in themselves to find a way through.
Who can I contact for more information?
You may wish to contact your local parenting help service/s for further information.
Counselling is also available from Lifeline on 13 11 14 or speak with your GP to access face-to-face services in your local area.
Useful websites, articles and books about self-injury:
- Australian Government Department of Health and Ageing - http://www.livingisforeveryone.com.au/
- Australian Government Health Insite - http://www.healthinsite.gov.au/topics/Self_Harm
- McVey-Noble, Merry E., S. Khemlani-Patel, F. Neziroglu, 2006 ‘When Your Child Is Cutting- A Parent's Guide to Helping Children Overcome Self-Injury’; New Harbinger Publications, Inc; Oakland.CA
- Reachout - http://au.reachout.com/find/articles/deliberate-self-harm
- Sane - http://www.sane.org/information/factsheets-podcasts/211-suicidal-behaviour-and-self-harm
- Schmidt, Ulrike and Kate Davidson, 2004; Life After Self-Harm- A Guide To The Future; Brunner Routledge, East Sussex
- Vivekananda, Kitty; ‘Integrating Models of Understanding Self-Injury’, Psychotherapy in Australia, Vol 7. Number 1. November 2000, 18-29.
- De Leo Diego and Heller TS, 2004 ‘Who are the kids who self-harm? An Australian self-report school survey’. Medical Journal of Australia 181 (3) 140-144
- Woodward, Ros; ‘Knowing You're Alive’: Students and Self-harming behaviours'; Journal of the Australia and New Zealand Student Services Association: Number 29, April 2007
- McVey-Noble, Merry E., S. Khemlani-Patel, F. Neziroglu, 2006 ‘When Your Child Is Cutting - A Parent's Guide to Helping Children Overcome Self-Injury’; New Harbinger Publications, Inc; Oakland.CA
- Moran P, Coffey C, Romaniuk H, Olsson C, Borschmann R, Carlin JB, and Patton GC: "The Natural History of Self-Harm from Adolescence to Young Adulthood: A Population-based Cohort Study" The Lancet, Early Online Publication, 17 Nov 2011; doi: 10.1016/S0140-6736(11)61141-0
- Brent D:Nonsuicidal Self Injury as a Predictor of Suicidal Behaviour in Depresses Adolescents. Am J Psychiatry 168:5, May 2011: 452-454
- Kerr PL, Muehlenkamp J and Turner JM; 'Nonsuicidal Self-Injury: A Review of Current Research for Family Medicine and Primary Care Physicians' Journal of the American Board of Family Medicine; March-April 2010, vol 23, no 2, 240-259
Published: 29 July 2010