The Secret World of Self-Injury- How parents can help their adolescents

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“My daughter has been taking handfuls of over-the-counter painkillers and has been cutting herself,” my friend blurted out to me as she and I were in the middle of our ski trip.

I instantly felt a rush of sadness, empathy, and concern. I immediately went right into my “doctor mode ” & began asking questions about her childhood. How frequently she cuts herself, her past and current relationships, her hobbies, and whether these intentional overdoses are linked to suicidal ideations.

“She never takes enough pills to have her stomach pumped; but she knows just how much Ibuprofen she needs to elicit a trip to the emergency room. Her therapist believes she is acting out because she felt that she was abandoned as a child. There has also been mention of borderline personality disorder. “

I immediately homed in on the mention of borderline personality. Individuals who have borderline personality disorder are 55-85% more likely to engage in self-harm behaviors.

Shedding light on self-harm behavior

I had a roommate in college who engaged in cutting, and I have seen this a lot in my adolescent patient population. But for whatever reason, cutting and other self-injury behaviors are not commonly discussed within the media, on college campuses, or in high school classrooms. Parents are shocked when they discover their son or daughter is engaging in these behaviors.

Approximately 14 percent of adolescents are estimated to engage in self-harm behaviors. Clinically referred to as non-suicidal self-injury; self-harm is the act of physically inflicting pain on oneself without the intention of dying. Cutting is the form of self-injury that is portrayed most often in the media .

Using physical pain to express emotions

Individuals will use sharp objects to carve into their skin (most commonly in the legs, arms, and stomach) to elicit feelings of physical pain as an unhealthy coping mechanism to relieve feelings of guilt, internal pain, shame, anxiety, and worthlessness. This physical pain induces a sense of calmness and relief and, for some, even a rush of euphoria. This instant gratification and sense of relief are quickly replaced by feelings of guilt and shame, perpetuating the vicious cycle of the urge to self-harm once again. In a sense, self-harm is similar to addiction.

This behavior can be fueled in part by drugs and alcohol ; which are also unhealthy coping mechanisms to numb internal pain. As a result, a substance use disorder can go hand-in-hand with self-harm behavior.

The link between suicide and self-injury

As a parent, watching your child engage in self-harm behavior can be one of the most gut-wrenching and frustrating experiences. Most parents do not understand why their child is drawn to this behavior. They worry that their child can be severely harmed from their physical injuries or, even worse, take their own lives.

Although self-harm behaviors can indeed result in complications such as nerve damage and wound infections, they do not always coincide with suicidal ideation. However, research shows that individuals who engage in self-harm behavior have an increased risk of suicidal ideations and suicidal attempts in the future.

According to an article in the journal PLOS ONE, “among those with a history of NSSI, 70% have attempted suicide at least once and 55% several times. The risk of death by suicide is highest during the first six months after an NSSI episode and tends to fall later on.”

Because of the increased risk for suicide attempts within this six-month window, individuals must seek professional treatment immediately to prevent suicidal ideations. Unfortunately, most individuals who engage in self-harm behaviors are teenagers and adolescents, and access to care for these age groups is quite difficult (50% do not seek help at all, and only 20% ask for medical treatment).

So how can you, as a parent, help your teenage or adolescent child who is struggling with self-injury behaviors?

• Remain calm, stay connected with your son or daughter, and offer any support you can. It is important not to judge or place any blame . This can result in unwanted harmful feelings that can lead them to continue to engage in self-harm behaviors.
• Educate yourself on self-harm behaviors and get yourself and your adolescent into therapy to discuss underlying triggers and treatment strategies. Self-harm behaviors may be related to low self-esteem, borderline personality disorder, eating disorders, past trauma, poor parental attachment, emotional neglect, or abandonment. Finding the right therapist can be a trial-and-error process, and it may take meeting with a few different therapists before you can find the right “fit.” Having a strong therapeutic alliance is the highest predictor of success rates for mental health and substance use disorders. 
• Remember, this is not your fault. Parents tend to blame themselves for anything that goes sideways with their child. Individuals with borderline personalities are more likely to engage in self-harm behavior; and these individuals can be very manipulative when it comes to interpersonal relationships, sometimes blaming the parents for what they are going through. Self-harm behavior, whether it goes hand in hand with borderline personality disorder or develops due to other underlying triggers, is not caused by one factor. There are usually multiple underlying reasons for this type of behavior in your son or daughter.
• Be patient. Treatment takes time, and underlying triggers must be treated before recovery. There are no medications or magic potions that can make this behavior go away. Therapy may take weeks to months before there is any improvement. The ultimate goal is for your child to find healthy coping mechanisms . To deal with their internal triggers and stop engaging in self-harm behaviors; however, the immediate goal is to keep your child safe and out of harm’s way.

March is Self-Injury Awareness Month. It is dedicated to educating the public and raising awareness about self-harm while supporting those who are affected by it.

Other times, I look at my scars and see something else. A girl who was trying to cope with something horrible that she should never have had to live through . My scars show pain and suffering, but they also show my will to survive. They’re part of my history that’ll always be there.

―Cheryl Rainfield,

 Scars Blog author : Kristen Fuller, M.D., is a physician and a clinical mental health writer for Center For Discovery. 

Blog article reproduced after appropriate permissions from original author. Link to original article https://www.psychologytoday.com/us/blog/happiness-is-state-mind/202002/the-secret-world-self-injury