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Author: Dr Dennis OugrinConsultant Child Psychiatrist

Suspecting your child or teenager is intentionally harming themselves is an incredibly distressing time for any parent, especially as it isn’t always obvious how best to help them.

We understand how difficult this can be and can help.


What is self-harm?

Self-harm (which includes self-poisoning and self-injury) is intentionally behaving in a way that causes harm to oneself. Although it isn’t a diagnosis in itself, self-harm is often a sign that there might be another mental health condition that needs identifying and treatment. Self-injury is by far the most common method of self-harm.

Over the last few years, there has been a great deal of reporting in the press about self-harm rates in children and teenagers. Shockingly, children as young as 3 or 4 have been recorded as intentionally harming themselves – however, the peak age for self-harm onset is during teenage years.

Often a child will self-harm for a period of time, stop and then start again. This can make it hard for parents to know what to do, as it’s common to think it is ‘just a phase’ the child or teen will grow out of.

68%
rise in reported self-harm in girls aged 13 to 16 between 2001 and 2014


Signs of self-harm in children and teenagers

Often parents find out their child is self-harming quite by accident, perhaps seeing scars or evidence of the harm or being informed by a teacher who has found out. Children often won’t choose to disclose their self-harm to their parents for fear of punishment, misunderstanding or making their parents upset.

There are several types of self-harm – whilst some may seem more ‘serious’ than others, they all need to be taken equally seriously. Often a child or teen may move to a different form of harm or the severity of the harm may increase.

Types of self-harm include:

  • Cutting
  • Poisoning (taking too many painkillers etc)
  • Burning
  • Bruising (head banging or punching things)
  • Scratching
  • Hair pulling
  • Biting

There are obvious risks around the physical complications that can be caused by self-harm – risk of infection, damage to muscles or ligaments, long-term scaring and if using drugs or alcohol to inflict the harm, damage to organs. For some children, things can get drastically out of hand and the self-harm can end in fatality, even if this was unintentional.

10%
of teens will have self-harmed by the time they finish school
Madge, N., et al (2008)


Causes of self-harm

People mistakenly think that self-harm is a cry for help or attention seeking behaviour – it rarely is and instead is often a sign of a serious mental health condition developing.

  1. Managing emotions - one reason children and adolescents self-harm is as a way of managing strong emotions – particularly if they don’t know how to talk about them (or even be able to identify clearly what these emotions are). Many will say they feel a real sense of calm and release following an episode of self-harm.
  2. Hormones - self-harm could potentially be due to the changes that children undergo during puberty – there has been ongoing research into the role that hormones have in the development of common mental health disorders such as depression and anxiety. Whilst it seems that biological changes on their own are unlikely to be the sole reason a child starts to self-harm, it may make a child more susceptible.
  3. Some of the other reasons self-harm might develop include:
  • Being bullied
  • Feeling under pressure to achieve at school/sport clubs
  • Abuse or trauma
  • Grief and bereavement
  • Mental health condition such as depression, anxiety, bulimia
  • Relationship difficulties at school or home

Self-harm and social media

The role social media has in the prevalence of self-harm has been debated in the press a great deal in the last few years. It is suggested that the pervasive nature of social media and the constant comparisons it can create, leads to great unhappiness and discontent – twice as many children reported being unhappy with their personal appearance in 2014 compared to 20081 - a time period accompanied by a large increase in the number of children who had a social media account.

It is also suggested that through social media, children and teens can become exposed to content that encourages or normalises self-harm as a reaction to stressful events2.

Whatever the cause, and often it isn’t always clear, self-harm has to be taken seriously and we always recommend seeking expert help for your child.

1The Good Childhood Report, 2016
2Daine, K., et al (2013)

The doctor obviously cared for his patients – the time and effort he took into getting our daughter to relax and feel comfortable was outstanding and has really helped her open up and learn to trust.

Sarah, Leicester


Treating self-harm

If you find out your child or teenager is harming themselves, you may be at a loss as to what to do first. It’s common and very natural to panic.

We always suggest seeking professional and expert help for your child or teen as soon as you can – it is often much easier to help your child or teen if you can get access to good quality care early on and studies have shown that children on a waiting list for treatment often experience a deterioration in their condition.

Assessment

One of the most useful steps a family can take is to get a comprehensive assessment by a Child and Adolescent Psychiatrist. This helps rule out any other mental health conditions, such as anxiety or depression. Children and teenagers who self-harm are very likely to have an underlying issue that would benefit from assessment by a clinician who understands complex mental health conditions.

Psychological therapies

There is strong evidence that therapies such as Dialectical Behaviour Therapy for Adolescents (DBT-A), CBT and Mentalization Based Therapy for Adolescents (MBT-A) are successful at reducing the risk of ongoing self-harm3.

Parenting support

Parenting support can be invaluable in teaching parents the best way of handling difficult situations, in a way that will support your child’s progress. It also gives parents a space to talk to a child behavioural expert about their experiences and frustrations – it can be very hard to talk to family and friends honestly if your child is self-harming – not only can be it be quite shocking but often parents aren’t ready to talk about it to loved ones.

3Ougrin, D., et al (2015)

Self-harm in young people is a common and distressing behaviour which is often puzzling to those around the young person. We need to take it seriously as it is one of the strongest predictors of suicide, increasing the risk at least 10-fold. I have worked with patients who self-harm for over 15 years and have researched the field for over 10. Every young person with self-harm is truly unique and nothing substitutes careful and therapeutic assessment in understanding the young person, instilling hope and engaging them with treatment. There are already effective interventions with proven efficacy in reducing self-harm but much more remains to be done in our field.
MBBS, MRCPsych, PGDip (Oxon), CCT, PhD

Consultant Child Psychiatrist
London

Dr Ougrin is a psychiatrist with nearly 10 years of clinical and academic experience specialising in child and adolescent psychiatry. He also has undertaken much research in the area of self-harm and has developed an effective intervention for...

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