• Self-harm can come in many forms, and sadly rates among young people are on the rise

  • Child and adolescent therapist Lizzie Prince shares her experience and insights from working with young people

  • If you are worried about a young person in your life, find a therapist here

As a therapist who works with children and young people, I often come across clients who self-harm. Perhaps you’re reading this as a parent or carer, reeling in shock, having just found out from your child’s school that they are self-harming, or as a young person who has discovered your friend is hurting themselves. Seeing someone you love suffer is heart breaking.

In my experience, parents’ and carers’ initial reactions when faced with the reality that their child deliberately injures themselves are, understandably, disbelief, horror, fear and bewilderment. Unfortunately to the young person, this often appears to them as anger and leads them to shut down communication. Unsurprisingly, this issue can evoke a lot of fear and emotion in those who come across it. In this piece, I want to give a brief overview of this commonly misunderstood issue and how you can support those who self-harm.

First I must expose the most common myth around self-harm, that those who do it are suicidal. It is not necessarily the case that those who self-harm have intention of ending their life. It sounds contrary, but the harming is usually what keeps them alive. This is because self-harm is usually a coping strategy, albeit an unhealthy one, to block out overwhelming feelings. In short, it can stop feelings from becoming so overpowering that suicide seems the only escape. However, those who self-harm are more at risk of suicide than those who do not, particularly if their underlying problems aren’t resolved. (Knightsmith, 2015).

That self-harm is an attention seeking behaviour is another misconception. Self-harm is generally done in secret, is a cause of great shame and guilt for the sufferer (compounding their misery) and can remain hidden indefinitely. Sufferers may choose areas of the body that are rarely seen such as the top of the thighs. Yes, some sufferers may appear to not hide their wounds, but that does not equal “showing them off”. I believe passionately that all behaviour is communication and that a person whose injuries are visible is screaming out that they are struggling with life.

So what is self-harm? People usually think that self-harm is someone cutting themselves, but there are many other ways of hurting yourself including

  • Burning
  • Biting
  • Alcohol and drug abuse
  • Head banging and hitting
  • Taking personal risks, such as having unprotected sex
  • Picking and scratching
  • Pulling out hair
  • Disordered eating, both overeating and restrictive diets
  • Overdosing and self-poisoning (NSHN, 2008)

When faced with these behaviours for the first time, I think who wouldn’t feel scared and out of their depth! I must point out that some people self-harm unaware that they are doing it, for example someone who pulls out their hair when stressed or someone who overeats when upset may be completely oblivious to what they’re doing.

Self injury affects all genders, ages and ethnicities regardless of income. What I find worrying is that schools are reporting more cases of self-harm among primary and pre-school age children. Children can really struggle with raw emotion and overwhelming feelings and their inability to understand what is happening can manifest in self-harm. It’s their genuine attempt to cope with life. Young children’s behaviours tend to include biting, bruising and hair pulling (Ferguson, 2018).

By its nature self-harming is a secretive behaviour, so it’s difficult to be exact about numbers, but my fellow counsellors anecdotally report that they are seeing it more and more in young people. Understanding that self-harm is a way of dealing with overwhelming emotions makes it easier to comprehend. There are many reasons why people hurt themselves, but the more common reasons include:

  • Feeling stressed
  • Feeling deserving of punishment
  • Wanting to gain feelings of control
  • Wanting a sense of release
  • Wanting to feel alive or real
  • Blocking out all emotion or feeling (Knightsmith, 2015)

I feel that it’s important not to focus on the self-harming itself, because it just means that the sufferer hasn’t found any other strategies to relieve their mental and emotional stresses.

Early intervention is important in all emotional and mental health issues, as the sooner the support can be given to the young person, the better the likelihood of resolving the issue. So, what signs can you look out for? Scratches and burns, for example, that appear more than once and don’t seem to fit your child’s day to day experience can raise red flags. Perhaps cuts that keep appearing in the same place can ring alarm bells, especially if your child appears a bit cagey about what caused them.

How to support a child or young person who self-harms? 

On finding out that your loved one self-harms, the most important thing is not to overreact. I know that this is easier said than done, but panicking that your child is either suicidal or an attention seeker will probably make them feel misunderstood and unwilling to talk to you about it.

You will probably want to know why they are hurting themselves. This is a reasonable, but ultimately unhelpful question. A better response would possibly be to acknowledge their unhappiness and to ask how you can help. Being calm, non-judgemental and supportive is the more positive approach. Having supportive family and friends is the best resource for anyone in mental or emotional distress. Please don’t be tempted to blame yourself for their self-harming, it’s not helpful for you or your child. There are many reasons for a child’s mental distress, such as feeling confused over their sexuality; the best thing that you can do is to try to be as compassionate as possible.

Together you can look at other strategies for relieving the emotional or mental distress. This may not be easy, and they may not want to stop in the short term, but 90% of adolescent self-harmers will find other ways of dealing with their distress before adulthood (Bell, 2013).

On a practical level, it’s all important to make sure that they know how to look after their wounds to prevent infection; to keep their implements and wounds clean (soap and water does the trick). When I worked at a school, I used to have loads of alcohol wipes in my drawer. If they let you, keep an eye on their injuries.

As I’ve said, self-harm isn’t really the issue, it is the overwhelming feelings of unhappiness or distress that is the problem. Having a loving and supportive family can be enough to help a young person through this difficult and challenging time, but life can get in the way for others, even with the best will in the world. Whatever the situation, you may feel that your child needs extra support from someone outside the family with whom they can share their feelings and difficulties, such as a counsellor.

It can be beneficial for someone who self-harms to see a counsellor. It can be a relief to share feelings with someone who is separate from their family and school and who is not caught up in their emotional upheaval. Often the young person feels guilt and shame for their behaviour, they can feel calmed sharing their feelings with someone who is accepting of them. This can be the first step towards recovery and of dealing with problems in a healthier way. While you’re here at Welldoing.com, why not look through the counsellors with your loved one and support them through that first step together.

Further reading

The benefits of therapy for young people

1 in 4 young women have mental health difficulties

Young women, perfectionism and suicide: is there a connection?

Does social media harm teens' mental health?