Many, many times over the past few years I’ve been confronted with a child or adolescent who has been injuring themselves. Many cut, some burn, yet others revert back to the “head banging” commonly seen in infants and toddlers or other methods of self-injury. The most common method is cutting, and the most common places are on arms, stomach and thighs – places easily concealed. Girls and boys engage in this almost equally, but in my experience girls are far more likely to share with you that they are self-injuring. And every year more and more kids are engaging in self-harm. It’s becoming disturbingly common in the preteen and teen years.
One common thing I have noticed in many of the children who are engaging in self-injurious behavior ) is that they are lacking in coping skills. They have so many stressors in their lives, but little to no good ways of coping with the stress. Many children who engage in self-injury have told me that they are hurting themselves so that they can feel better. One young lady expressed it succinctly: “When I am cutting I feel the pain, and then it’s over. It helps.” Then when asked what her coping skills were, she looked at me like I was stupid and told me that cutting was her coping strategy. There were no others. This young lady expressed what many other kids have told me: they have no way to cope when they’re emotional, and cutting works. It’s not good, most kids will agree, but it works for them.
Another common thread for kids who self-injure is a history of trauma of some sort. Many children who self-injure have experienced some form of abuse: either physical, verbal or sexual. PTSD is a common diagnosis for kids who self -injure. Depression seems to be highly correlated with self-injury, as does anxiety. Children who self-injure also seem to be more likely to have issues surrounding substance use and eating. It is not uncommon for a child who is struggling with anorexia or bulimia to also be self-injuring. Boys are more likely to hurt themselves when they are engaging in substance use.
One truly scary thing about self-injury is that it does have a bit of a contagious nature. It is not uncommon for one child to tell me they are self-injuring, and then to name off a group of their friends who are also self-injuring. More than once I have been alerted to a child self-injuring because a parent looked at their phones and noticed that they have been posting pictures of their injuries to Instagram, Facebook and Twitter. The parent then becomes justifiably concerned, contacts me, and when talking with the child we learn that most of their friend circle is engaging in self-injury, and all of them are aware of it. They even self-injure together at times – even while face-timing. This contagion effect is one reason it is generally best that these students do not get treated in a group setting.
Treatment does work – although for some children it can take a good deal of time and effort. One thing that I highly recommend for all children who engage in self-injury is to learn some of the skills in DBT or Dialectical Behavioral Therapy. This therapy is a form of Cognitive Behavioral Therapy (CBT), and is an evidence based therapy that has shown to be very effective. It focuses on learning skills, such as mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness. I use these techniques within the standard CBT framework and have found good results. But wouldn’t it be great if we didn’t need to treat these kids? If somehow we could put a halt on this increasing epidemic of children hurting themselves? Prevention is something that we can do. You don’t need to be a counselor or psychologist to do this either – parents are the first line of defense.
Children need to learn coping skills, how to relax, how to be mindful, and how to get along with others. It seems like some of those things are basic – but they’re not. Mindfulness is something I stress with my clients; in fact, we open and close every session with a mindfulness exercise. Being mindful helps to slow us down, and helps us to appreciate the good around us. When kids become stressed, and make reckless decisions, they are not being mindful (or in “wise mind” as it is called in DBT). An overly emotional child makes poor choices. However, a child trained in mindfulness may be able to, by habit, drop into mindfulness just long enough to calm themselves down and make a better decision.
Another way to prevent self-injury is to increase social connectedness. Many of these kids have told me that they are lonely, that they have no true friends, that they have nobody to talk to. They cannot pinpoint an adult whom they can be honest with or go to if they need help. To these kids the world can be a dark and lonely place. Again, some of the DBT skills can be useful in prevention – especially learning interpersonal effectiveness. Kids need to learn how to communicate effectively with others. Some kids just don’t understand how social interactions work, others just need more exposure. The best thing we can do is to help the children learn experientially. Take them out, encourage them to join a club, bring them to church or scouts from a young age so that they will have those social experiences. In this world of technology it’s too easy to let the box of choice (be it your TV, computer or phone) become your primarily social outlet. This is not healthy for us, and it’s really not healthy for kids. They need to be out there learning and interacting.
Kids also need to know who they can go to if they’re struggling; and they need to know that it’s OK to have emotions. Too many kids are told to “suck it up” and “be tough.” Other kids know it’s OK to have emotions, but need someone safe to let them out to. Sometimes mom and dad are scary to talk with: if the emotion is so overwhelming them, they may be concerned that they will scare their parents with it, or that somehow mom & dad will be, themselves, injured by exposure to this strong emotion. Kids need to have other adults in their lives whom they can reach out to. Even my own kids know that it’s OK to share with Gramma or their uncles if they need to talk and can’t talk about it with me. All kids need a network of people, “it takes a village” has been a common parenting quote simply because it’s true. Build your village!
Thinking along social lines, keeping in mind the contagiousness of self-injury, please be aware of what social media your child is ingesting. Keep an eye on their accounts – make being your friend a prerequisite of having a social media account. Encourage them to think about what they see, and to come to you if there is something that they have encountered that they are concerned about. Also encourage them to think about what they see in the media – how things are depicted in movies and songs. There are plenty of songs that discuss self-injury; ask your child, I’m sure they can name at least one. Likewise, it’s often portrayed in books, movies, and magazine articles. Point out to your kids that you are aware of this, and that you will be monitoring what they watch, read & listen to. And then follow through on this.
Lastly, parents, we also need to create some room to let our children escape from the stressors of life. They don’t need to be scheduled every night of the week. Kids need time to be kids. They don’t need to get an A on every test, in every subject. Creating a lifestyle full of high expectations and without time to relax is a recipe for stress (and burnout). Don’t get me wrong – I’m not saying not to have expectations for your children. I’m merely saying that you need to consider how much stress your child can really handle, and make sure that you incorporate downtime and fun activities for your children as well.
Self-injury is a scary thing to think about, and most parents are not aware their child is engaging in this activity, although research indicates that somewhere from 10-20% of all children will engage in self-injury. Prevention is key, and learning these healthy habits can only help your children as they progress through life. Reach out for help when you need it, and don’t be afraid to ask questions! There is not a counselor working with adolescents who has not seen this phenomenon, and most will be able to help you through it.
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