Self-Harm in Kids and Teens

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The thought of a child is engaging in self-harm can be upsetting for parents and families. It can be difficult to tell that a child is engaging in self-harm, so it is important to be familiar with the warning signs and to seek help from a professional if you suspect your child may be struggling. The mental health experts at CHOC can help identify and treat self-harm in kids and teens.

What is self-harm?

Self-harm, or self-injury, is the deliberate act of causing oneself physical harm without any attempt to die. A distinguishing factor of self-harm is the direct intention to inflict pain on oneself. Often, self-harm is related to mental health issues such as depression, eating disorders or anxiety.

Self-harm comes in many forms, with cutting being the most common form of self-injury. Unfortunately, self-harm is prevalent and common in many children and teens today.

What is the difference between suicide and self-harm?

The main difference between self-harm and suicide is the intent. With self-harm, the intention is to inflict pain on oneself, while suicide is to end one’s own life. While there are similar emotional triggers, self-harm acts as an attempt to cope with their feelings and experience relief. Suicide is a way to end pain; those who attempt or complete suicide often feel hopeless, worthless and like things will never get better.

What are the types of self-harm in kids and teens?

Self-harm, or self-injury, can manifest in various ways; some are visible, or direct, and some may be hidden, or indirect. Some common forms of direct self-harm include:

• Cutting
• Punching oneself
• Scratching
• Burning themselves
• Carving words or symbols into the skin
• Inserting objects under skin, such as a pencil or paperclip
• Snapping rubber bands on the wrist

Hidden, or indirect, self-harm is done in ways that cause harm or are unhealthy but are not seen, such as:

• Smoking cigarettes because it harms the lungs
• Skipping meals
• Skipping medicine that can help them
• Picking a scab repeatedly to cause damage
• Involvement in an abusive relationship

While some acts may seem small, any act of self-harm with the intent to damage should be taken seriously.

What are signs of self-harm in kids and teens?

It can be difficult to know when a child or teen is engaging in self-harm or self-injury. Self-harm behaviors are often done in private, and the intent to self-harm might not be noticeable. Signs and symptoms of self-harm behavior can vary and may include:

• Spending a significant amount of time alone.
• Relationship challenges with friends and family.
• Withdrawing from once-loved activities.
• Impulsive behaviors.
• Classifying injuries as “accidents.”
• Wearing long sleeves or pants, even on hot days.
• Bruises.
• Scars.
• Cuts.
• Broken bones.
• Feelings of hopelessness.
• Emotional instability.
• Depression.
• Increased anxiety.

Note that the above behaviors do not always mean a child or teen is self-harming.

Why do kids and teens self-harm?

Emotions and trauma can be difficult to handle at any age, let alone as a child or teen in developmental stages of life. Sometimes, these feelings are overwhelming and get in the way of everyday life, leading to a need for relief. There are many reasons why kids and teens might self-harm, including:

• Generating Relief: This can help to shift focus from emotional pain to physical pain. When someone engages in enough damaging self-harm, they can create a natural high of a pain-relieving chemical, endogenous opioids. When this occurs, it can feel like it temporarily takes the pain away. The more one does it, the better the sense of relief feels.
• Social Signaling: They are trying to communicate they need help but are unsure how to use their words. This can also mean they are trying to show how much pain they are in, so someone can understand the depth of their emotions.
• Social Isolating: Their way to communicate that they feel they are not good enough, in an attempt to push people away.
• Self-Punishing: They feel they deserve to be punished because they believe they are a bad person, a disappointment or that their issues cannot be fixed.

How is self-harm treated in kids and teens?

Seeing a mental health professional is best to get a treatment plan that is suited for the child or teen. Here are some common treatments:

• Psychotherapy: Talking with a therapist can help identify the self-injuring trigger and develop coping skills to overcome these issues.
• Medication: There is no medication to directly treat self-harm tendencies. If there are underlying mental health disorders associated with the self-injury, a doctor may prescribe medication.
• Play Therapy: A method of therapy that uses playing to work through psychological issues.
• Intensive Outpatient Program (IOP): The IOP at CHOC is an outpatient, mental health treatment program for high-school teens with moderate to severe symptoms of anxiety, depression or other symptoms related to a mental health condition.

In addition to professional treatment, here are some important self-care tips to help during recovery:

• Maintain your treatment plan.
• Discover situations that could trigger self-harm tendencies and make a plan to help cope in these situations.
• Take care of yourself physically, mentally and emotionally.
• Seek medical treatment if needed.

How can parents help kids and teens who self-harm?

Learning your child is engaging in self-harm can be devastating and overwhelming. An important first step in helping your child through this difficult time is increased communication. If your child is comfortable with sharing, listen to what they have to say and allow them a safe space to express themselves. Be cautious of getting overly mad or upset, as this can make your child or teen less likely to share their hardships and feelings. Try your best to maintain a neutral and caring tone. Listen to their needed support, and plan to meet with a mental health professional.

Relapse is possible during self-harm recovery, but it is important to remind your child or teen that it is part of their recovery journey and does not mean they failed. Remember that during recovery, balance is pivotal. Try not to be invasive or to take away privileges as punishment, as this can push kids and teens away. Instead, show them your support by doing more activities together, having daily conversations or simply allowing them to feel their emotions. No matter the outlet, your role will play a vital part and can help limit their self-harming.

Get advice from CHOC experts on making your home safe for a suicidal or self-harming child.

Resources for Self-Harm Help

• Crisis Text Line: Text HOME to 741741 to connect with a Crisis Counselor. Free text support 24/7. 
• Mental Health Guides

Learn more about the pediatric mental health services at CHOC to start the process of self-harm recovery. Find a Pediatric Psychologist