Self harming & young people A PA R E N T ’ S G U I D E BY ALEXANDRA WILSON (AMHSW; CSW; MAASW; BSW USYD)
Deliberate self harm can be a scary and confronting issue for many parents, and it can be difficult to know how to respond if you have discovered, or suspect, your child is self harming. Firstly, it’s important to understand what deliberate self harm (DSH) is (and what it isn’t). DSH is sometimes called non-suicidal self injury. It is important to understand that DSH and suicidal behaviours are different and have different reasons for arising. That being said, it is important to note that DSH behaviours in an individual increase their risk of suicide, particularly if the DSH has been going on for some time. Examples of DSH are behaviours such as cutting, scratching (breaking the skin), burning, hair pulling, head banging, punching self and any other intentional behaviour designed to cause intentional injury. The intention behind DSH is not to end one’s life – that is where it differs from suicidal behaviours. Some young people may experiment with DSH and do not continue because they find it does not give them a desired emotional effect. However, for some people, they find DSH serves a useful purpose of either giving them a sense of emotional relief or, providing distraction with physical pain – which feels like relief from emotional pain. It can be hard for those who have never engaged in DSH to understand why others would do it – but think about things you might use to distract yourself
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ON T H E C OA S T – FA M ILIES
from emotional distress. For example, how many of us indulge in a drink after a stressful day at work? DSH serves the same purpose, but the underlying distress is usually much higher. One of the biggest barriers to treating DSH is the broad misunderstanding of the behaviours. There can be a lot of shame and stigma associated with these behaviours. Often DSH is treated by focusing just on the behaviours, for example devising ‘safety plans’ which do nothing to address the underlying emotional pain. We need to understand DSH is the symptom – the real problem is very high distress in a person who feels they have no other options for how to deal with it. What tends to happen over time with DSH is that it escalates. The behaviours will usually become more frequent and severe. This escalation occurs due to reduced tolerance to emotional distress. When a young person first starts to engage in DSH, they have usually been experiencing high distress for quite some time. Given their practical resources and level of development, they may struggle to identify ways to manage their distress, and find DSH provides quick, effective relief. The young person’s brain learns that DSH is an effective way of avoiding distress, so they start to use it more frequently. What happens over time is that their tolerance to distress goes down. Less severe triggers will result in DSH, and for some young people they will end up feeling they need to engage in DSH just to get through a normal day.
This reduction in distress tolerance is a big problem because distress is an inevitable part of life! We need to teach young people how to increase their tolerance to distress, particularly those facing stressors in their lives which may increase the levels of distress they experience (eg. trauma, mental or physical health issues, family dysfunction, bullying etc). THE DO’S AND DON’TS IF YOU SUSPECT DELIBERATE SELF HARM: DON’T Completely freak out! This is completely understandable if you discover your child has been engaging in DSH. However, it’s important to not get distracted by the behaviours, and instead understand and address the underlying problem (high emotional distress). DO Try to understand why they have been self harming. What does it do for them? Ask lots of open and non–judgemental questions. DON’T Be afraid to ask questions about suicidal thoughts. Ask them directly if they have been having any thoughts of wanting to end their life. If the answer is yes, that’s the time to immediately get in contact with crisis services who can do a thorough risk assessment. DO Contact a crisis service or mental health service immediately if you suspect or have evidence of suicidal thoughts in your child. Do not delay or wait to see if it passes. Call the Mental Health
