became my cry for help when words could not do it for me. I don’t think I would have stopped if my coach hadn’t noticed. She picked up on the warning signs and identified the problem. Only then did I get the help I so desperately needed but could not ask for.” - Jessica, age 15
Perhaps you are reading this chapter because your teen self-injures, or maybe you know someone else that does. Maybe you are reading it because you have suspicions that your child is engaging in self-harming behaviors. In any case, I would like to applaud your willingness to examine the problem and identify the severity of your child’s situation. With self-injury is becoming as widespread as substance abuse and eating disorders, it is not uncommon for most people to know someone who struggles with this problem. Yet parents generally have little information as to what they can do to help. The first step is identifying the problem and simply acknowledging that it exists.
In the past 18 years, I have worked with more individuals who self-injure than I can count. What was once thought of as a teenage phenomenon is now recognized as a struggle faced by individuals of all ages. It may surprise you to know that the incidence of habitual bodily harm is approximately 1% in our country. With a reported 2 million cases in the United States alone, it is clear that this disorder has become rampant and affects a diverse population. This number is growing at a fast rate and there is evidence it is beginning to occur among younger and younger individuals.
While some of the individuals that have walked into my office have been as young as nine, it is still more common among teenagers. If left untreated, this behavior often continues into adulthood. In addition, the longer the individual struggles with the problem, the harder it is likely to be for them to stop the behavior. Therefore, getting help as soon as possible is very important. This is a serious problem that should be treated aggressively when first identified.
Warning Signs
There are several signs that may indicate an individual is engaging in self-injurious behavior. One of the biggest red flags is when the individual always wears long sleeves and pants, even when the weather is warm. Another red flag is frequently unexplained or justified injuries such as scratches, cuts or burns. Amber recalls how she attempted to hide her self-harm from people at school. She states, “My solution was long sleeves and pants, and at soccer practice I cleverly used a sock which I said was a sweat band.” In addition, she remembers having to explain why she had scratches on her body. “I made up crazy stories about my cat to answer some of the questions,” she recalls.
Other warning signs include low self-esteem, a feeling of being easily overwhelmed, difficulty maintaining stable, healthy relationships, and trouble functioning at school, home or work. Although all of these factors may be symptoms, they are not, in and of themselves, direct indicators that self-injurious behavior is present.
Giving Voice to Pain that has No Words
Those who self-injure are desperately trying to give voice to pain that has no words. The origin of this pain is different for each individual. As mentioned in the previous chapter, these reasons may include tension reduction, self-punishment, a sense of belonging, and the desire to “feel alive” or conversely a way to “numb” their pain.
Understanding the specific reasons an individual is self-harming is essential in order to achieve a successful recovery. However, one thing that self-injurers tend to have in common is their unwillingness or inability to verbally express emotional distress. Therefore, gaining insight and knowledge about why your child engages in self-injurious behavior may not be easy. In fact, most kids are unwilling to talk about this behavior and keep it a secret, particularly from their parents.
To make matters even more complex, often self-injury is a symptom of a more serious mental illness such as Post Traumatic Stress Disorder, Borderline Personality Disorder, Major Depression or Bipolar Disorder. If this is the case, treating the underlying illness is highly recommended as it will lead to improved psychological well-being and aid in the recovery process for self-injury. However, parents will not necessarily know if there is an underlying mental health issue until their child is evaluated by a professional. This evaluation usually does not occur until there is acknowledgement of the problem.
Although self-injurious behavior is usually concealed rather than flaunted, it has received enough attention in the media to make the topic less “taboo” and therefore more frequently discussed. Perhaps these barriers were first broken down years ago when Hollywood stars such as Roseanne Barr and Johnny Depp as well as royal favorite, Princess Diana, admitted to the behavior. Fortunately, recognition of this problem has led to an increase in treatment intervention.
Acknowledging the Problem
The first step in treatment and recovery is acknowledging that there is a problem. This is not always easy to do. Your teen may experience great confusion, guilt, and shame for her actions. Admitting that there is a problem and seeking treatment demonstrates courage and great strength. The teen can be proud of herself for taking that first step in recovery. You, as parents, can be proud that you supported your teen in doing so.
Although self-injury is much better understood today than it was in the past, it is still accompanied by myths and stereotypes. Unfortunately, admitting to the problem means risking these misconceptions. For example, the fear of being labeled “suicidal” commonly prevents admission of the problem. As discussed, for the most part, individuals who self-harm do it to cope with distressing emotions, not with the intent to commit suicide.
In addition, the fear of being referred to as a “cutter,” which then follows with labels such as “psycho,” “borderline,” “Goth,” or “emo,” commonly inhibit identification of the problem. These labels often lead to disrespect and rejection from others. For example, Sarah is the senior class president at her local high school. She recently admitted self-injuring to some of her classmates. In turn, several of them questioned her leadership capability. Rhonda is the chief editor of her high school newspaper. Some of her classmates noticed the multiple scars on her forearm, and began treating her differently. One eventually asked her how many times she tried to kill herself and if she would ever hurt anyone else. When her teacher found out, he questioned her ability to perform her duties for the paper.
It is no wonder that many self-injurers hide this problem. For the same reasons, parents also often deny that a problem exists. Parents are understandably protective of their children. They certainly do not want their child to experience the pain and humiliation of a negative label as well as mistreatment from others. So they join with their child and avoid discussion of the problem.
Many parents will even go to great lengths to steer clear of topics they know are upsetting to their child, in an effort to minimize their child’s distress, and make them less likely to self-harm. In this example, parental intentions are good. However, the outcomes usually are not. Attempting to help your child feel better by helping them ignore or avoid their own distressing emotions often backfires. There is no lesson in it for them. Children need to learn how to manage their distress in healthy and functional ways. Otherwise, their distress may become too difficult to ignore and eventually lead them to negative coping methods (e.g., self-injurious behaviors, eating disorders, substance abuse, violence, etc.).
Another reason parents often deny there is a problem is because they see their children’s behavior as a reflection of their own parenting abilities. If you read this sentence and it stung a little, you are not alone. I know many parents who have struggled with acknowledging their child’s self-harm because they worry that it will somehow signify that they have failed as parents. The reality is that self-injury is a coping mechanism and a choice. Your child needs support, understanding, and guidance to help her get back on track and away from something that can be both psychologically and medically
