Self-Harm Behavior: Knowing What to Look for and What to Do

​Self-harm occurs when a person intentionally hurts himself or herself. In children, this behavior may first occur during the transition from childhood to adolescence. Around this time, adolescents begin to think more about their feelings, pay more attention to how their peers respond to them and worry about whether they are fitting in. When things aren't going well in these areas, children may resort to self-harm (usually cutting) to express frustration, anger or other emotions.

When parents discover their adolescent is self-harming, they become deeply concerned and often wonder if their child is thinking of suicide. But self-harm and suicide are two distinct concerns, and self-harm does not always imply a child is considering suicide.

As a parent, it's important that you can identify the signs that your child might be engaging in self-harm behaviors and learn strategies that can help you address or prevent these behaviors.

Why Do Children Hurt Themselves?

Understandably, parents want to understand why their son or daughter is self-harming. Here are three of the most common reasons why children and adolescents hurt themselves:

• Belonging. Children who engage in self-harm may feel a sense of belonging when they are with peers who also self-harm. For example, these boys and girls may talk about cutting or take pictures of their cuts and share them through social media. This shared interest can create a sense of acceptance that they find appealing.
• Emotional pain. Some adolescents may self-harm to manage or express emotional pain. Research has found that adolescents who self-harm to manage emotional pain report that they feel better after cutting. Those who self-harm for this reason may hide it because they don't want anyone to know they are doing it.

What Are the Signs of Self-Harm?

Signs of self-harm may include isolation, staying up much later than the rest of the family, taking long showers, frequent disappearance of sharp objects or other objects that can be used for cutting, wearing long sleeves all year long and wearing several bracelets at once. Other behaviors include not wanting to show one's skin, telling others about self-harming and sharing pictures of cuts or wounds through social media.

The two main kinds of self-harm behaviors are direct and indirect. Direct behaviors include cutting with sharp objects (razors, knives or scissors), burning with a lighter or hair straightener, hitting, scratching, etc. Indirect behaviors include risky sexual behavior, unhealthy eating habits that can lead to an eating disorder, alcohol and drug use, etc.

How Can Parents Address Self-Harm Behaviors?

• Have open discussions. Self-harm can be difficult to discuss. Once you've discovered your child is doing it, you should avoid lecturing or asking “interrogation"-like questions. While you may be experiencing strong emotions, expressing them in an angry or accusatory way can overwhelm your child and possibly make matters much worse. Using a neutral, caring tone of voice to talk with your child and find out why the self-harm behaviors are happening is usually a great first step toward developing a solution.  
• Maintain routines, rules and expectations. Allowing your child special concessions may inadvertently teach him or her that self-harming is an effective strategy for getting needs met or avoiding rules and expectations. Keeping routines and expectations consistent demonstrates that you believe your child can fulfill expectations and manage disappointment.
• Avoid talk of suicide. While talking with your child, it is important to avoid suicide terminology and to not assume he or she is having suicidal thoughts. That being said, ensure your child is safe and take him or her to the emergency room if you have any concerns about serious self-harm.

Managing Behavior and Moving Forward

• Maintain balance. It is important to maintain a balance between being concerned and overreacting. Every adolescent needs privacy and benefits from opportunities to earn their parents' trust. Requiring body checks and other invasive strategies may further complicate your relationship with him or her.
• Monitor access to sharp objects. Have your adolescent check out and turn in sharp objects such as knives or razors after using them.
• Reward good behavior. Reward your child when he or she uses effective coping strategies. Your praise and recognition encourages your child's improvement and involvement in daily life activities.

Self-harm often occurs within the context of other concerns such as depression, anxiety, risk-taking, eating disorders or oppositional behavior. If these concerns are interfering with your child's relationships, interest in activities and academic performance, talk with your child's primary care physician about a referral for behavioral health services.

Additional Resource 

• Stopping the Pain: A Workbook for Teens Who Cut and Self Injure by Lawrence E. Shapiro, Ph.D.

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