By Carolyn G. Bernacki, DO
As a parent, it can be devastating to discover that your child is self-injuring.
Initially, you might not be able to comprehend why they would want to harm themselves and you may even be inclined to deny there’s a problem.
However, the sooner your child gets help, the greater the chance they can stop the harmful behavior and identify healthy ways to cope with their emotions.
Penn Medicine Princeton House Behavioral Health offers treatment for children and adolescents who struggle with anxiety, depression or substance use, helping them learn how to manage their emotions effectively.
What is nonsuicidal self-injury?
Non suicidal self-injury is the deliberate self-inflicted injury to one’s own body without suicidal intent. It can take a variety of forms, including:
- Cutting
- Scratching
- Carving
- Hitting, punching or head-banging
- Scraping
- Burning
Self-injury is most prevalent among adolescents, with at least one study finding that between 17 and 60% of adolescents may engage in some form of self-harm. The behavior most commonly starts between the ages of 12 and 14, though there has been an uptick in self-injury among younger children in recent years.
While self-injury and suicidal behavior are fundamentally different, they often co-occur. Adolescents who self-injure have more suicidal thoughts and more suicide attempts than peers who do not engage in self-injury. Therefore, self-injury is considered a risk factor for suicide and should be taken seriously.
What are the risk factors?
Self-harm behaviors occur more frequently in girls than boys.
Moreover, research shows that children who identify as lesbian, gay, bisexual, transgender, questioning or queer are at twice the risk of non-suicidal self-injury, in part because of experiences with bullying and discrimination.
Other risk factors include:
- History of abuse.
- Psychological struggles, including childhood trauma.
- Social and environmental challenges, such as non-supportive families.
- Having friends who self-injure.
- Biological factors.
Additionally, adolescents who experience intense reactive emotions, such as anxiety, anger, feelings of hopelessness, and self-criticism are more likely to engage in self-injury as are those who are bullied, including cyberbullying.
One study found that overuse of mobile phones was significantly associated with self-injury behaviors.
What prompts children to engage in self-injury?
One of the main reasons children engage in self-harm is to help regulate their emotions and relieve or decrease negative emotions such as anger, anxiety, sadness and guilt. Other reasons include:
- Difficulty expressing their emotions or experiences.
- Seeking relief from emotional numbness.
- Regaining a sense of control when life feels unpredictable or overwhelming.
- Self-punishment.
What are the signs to look for?
Many children who engage in self-injury try to hide their behavior. Here are some signs to look for:
- Unexplained cuts, burns, or bruises.
- Wearing long sleeves or pants, even in warm weather.
- Avoiding activities that expose the skin, such as swimming.
- Bloodstains on clothes or objects like razors, glass, or scissors.
- Sudden withdrawal or mood changes.
- Expressions of self-hatred or feeling worthless.
If you notice any of these signs, talk to your child about your concerns and consult your pediatrician right away.
What is the treatment?
Your pediatrician will likely refer you to a mental health professional who specializes in child and adolescent care for treatment.
The tween and adolescent programs at Princeton House offer a range of treatment options, including cognitive-behavioral therapy and dialectical-behavioral therapy. Dialectical-behavioral therapy helps identify what function the self-injuring behavior serves for the child and helps find healthy alternatives to achieve that function.
Treatment includes a comprehensive evaluation by a board-certified psychiatrist or advanced practice psychiatric nurse, evidence-based treatment, medication evaluation and management as needed, group and individual therapy, family education groups, and expressive therapies such as art and music.
What else can parents do?
In addition to seeking professional support, parents can help their children replace self-harm behaviors with healthy coping skills by:
- Creating a safe, non-judgmental space for communication so the child feels comfortable talking about their emotions and any problems they may be facing.
- Talking with school counselors to address any bullying at school.
- Educating themselves so they better understand the reasons behind self-harm and its triggers.
- Encouraging healthy coping strategies, such as journaling, physical activity, art, or mindful breathing.
- Being patient. Recovery from self-harm takes time and understanding.
It is also important to note that while the child is recovering, parents should remove all sharp and dangerous objects, weapons, over-the-counter and prescription medications, alcohol and other substances, and any lethal household items from the child’s access. Parents should also closely supervise and monitor their child to ensure they are not engaging in self-injury.
With early intervention, professional support, and a compassionate approach, children and adolescents can learn healthier ways to cope with their emotions. Parents play a crucial role in fostering open communication, creating a supportive environment, and guiding their child toward recovery. By seeking appropriate treatment and implementing proactive strategies, parents can ensure their children have the tools they need for a healthier future.
For more information about Penn Medicine Princeton House Behavioral Health, call (888) 437-1610 option 2 or visit www.princetonhouse.org.
Carolyn Bernacki, DO, specializes in psychiatry and is associate medical director of child and adolescent psychiatry at Penn Medicine Princeton House Behavioral Health.
