Five things to know when your child has engaged in Self-Injury By: Anna Bohlinger, PhD Candidate, MS, LMFT

Hello! My name is Anna Bohlinger, and I’m a therapist in the PrairieCare system. I’ve been working in adolescent mental health for about ten years, and during that time, have gotten to know a lot of teenagers and their families who are affected by self-injury.*

As a Ph.D. Candidate at the University of Minnesota, I also study self-injury and family relationships, especially ways that families can work together and get the best care for their child, while taking good care of themselves. This is a list of the top five things I think you should know when your child has engaged in self-injury.

1.  Self-injury does not always equal suicide.  Most of the time when kids and adults engage in self-injury, they are not doing it with the goal of killing themselves. (And some kids self-injure once, decide it’s not for them, and never do it again!)

At the same time, self-injury is definitely a significant health event. Always tell your child’s healthcare providers about it when it occurs, especially if it’s the first time. Along the same lines, always give needed medical care; if a wound won’t stop bleeding, go to the emergency room to see if stiches are needed, if an older wound looks infected, bring them into primary care. Common sense stuff.

After taking care of basic medical needs, start thinking about mental health care. Many times, seeing a therapist weekly can adequately treat self-injury, especially if this is a new behavior. Other times, higher levels of care like partial hospitalization, day treatment, after school programs, or even inpatient hospitalization is needed, depending on what all is going on for your child. If you have a therapist, follow up with them. If you don’t have a therapist, consider setting up a needs assessment to get a good recommendation.

It is important to note that while self-injury doesn’t always mean suicide, people who have self-injured are at a higher risk than others of eventually have thoughts of suicide or even attempting suicide later on. Any threats or concerns about suicide should be taken seriously and treated at your closest hospital’s emergency room.

2. Self-injury communicates. Self-injury serves a number of important functions for people who do it, and one of the big ones for many people is communication. Self-injury communicates to others just how badly they are hurting and sometimes in a pretty gruesome way. Be there for your kid (which can be really hard when it happens a lot!) and try to understand their pain.

3. Self-injury works! (Kind of.) You know how I said in #2 that self-injury serves functions for people? In addition to communication, there is really good evidence to suggest that self-injury serves other functions including: making kids feel better (less emotional turmoil and/or stopping unwanted thoughts or memories), making environments more calm (decreasing arguing or other family or friend conflict), and most surprising to me, actually decreasing physical pain (by initiating a physiologic shock response). If your child has used self-injury frequently in the past, it’s not surprising to hear that they might feel ambivalent about stopping – it works really well in-the-moment!

Of course, self-injury is a risky health behavior: it’s associated with lots of other problems down the line (often the least of which is scarring). Everyone hopes that their kids will have more healthy coping skills into adulthood. And at the very same time, it’s really common for people to feel ambivalent to stopping self-injury, if not outright opposed.

4. Parents can help kids. You are your child’s most important resource for recovery. All of the research, science, clinical instincts, and professional support in the world can only go so far, and more often than not, the love, compassion, attention, structure, and care that you bring to your child’s life are the activating ingredients of the strongest evidence based practices. Some of the best ways that you will help your kid is by staying emotionally available, taking care of their needs (which sometimes do include hospitalization, and for self-injury, almost always include therapy), and taking care of yourself.

5. Good treatment is available. Always remember that self-injury is a symptom. Often a big, surprising, and sometimes scary symptom, and a symptom just the same. Treating the underlying reasons for the self-injury is often best done by a therapist and doctor. There are evidence-based practices for self-injury, which means that there are particular ways to treat this symptom that work most of the time, with most people, regardless of other things about their lives. Dialectical Behavioral Therapy (DBT), for instance, is one of the best ways to treat self-injury among people who do it very often. There are other good practices that may be more effective depending on what is going on with your child.

After taking care of immediate medical needs, if you don’t have a mental health provider, consider calling PrairieCare to set up a free needs assessment. One of our trained needs assessment counselors can get to know you and your child and help you get going in the right direction. Solid treatment is available, and your kid can feel better!

*Important note: What is self-injury? Self-injury is defined by researchers as including any on-purpose, non-socially sanctioned tissue destruction, done without the intent of suicide. The reason I am specific about that is because there are a lot of ways to hurt yourself, but the facts I shared above are not necessarily applicable to all of the ways you could hurt yourself. So in terms of what the science says, not eating to hurt yourself would not be “self-injury,” getting a tattoo would generally not be “self-injury,” and compulsive gambling would not be “self-injury.” All of these things might be harmful in some contexts, but the things we know about “self-injury” may or may not apply.

1 Comment
  • Diane Slama Posted March 14, 2016 4:41 pm

    Thank you for your insights concerning self-harm. My 21 year old daughter started cutting herself when she was 15. She learned about it in school while eating lunch with a group of girls in the lunchroom. One girl told everyone about how it made her feel better. My daughter got diagnosed with ADD at the age of 16 also. I read an interesting article in Additude magazine (a magazine all about ADD) about how high a percentage of girls who have ADD also self-harm. Thankfully, my daughter no longer cuts herself. She is still struggling with depression, anxiety, and ADD (she does not take medication for ADD because it makes her feel tense). I love her dearly-however I am exhausted living with all of this.

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