Over the next several weeks, The Cheshire Herald will run a series of columns, courtesy of State Representative Liz Linehan (D-103) regarding this issue of mental health among children and teens.
This is the third installment in my series on Children’s Mental Health, in partnership with The Herald. Before we begin, a word of warning: this week’s column intimately discusses self-harm, which may be disturbing to some people. Those with a history of trauma in this regard should decide if continuing to read is right for you.
In the previous two installments, we looked at the warning signs of depression and anxiety in children and adolescents, information on calling 2-1-1 in a crisis, and listed local resources for ongoing care. Today, we examine intentional non-suicidal self-harm, which is defined as self-injurious behavior like cutting, scratching, skin picking, burning, hair pulling, head banging, hitting themselves, other forms of self-mutilation, or any way a child decides to physically hurt their body.
According to Dr. Pamela Hoffman, psychiatrist at Yale Child Study Center, kids often self-harm because either they need to attach a feeling of physical pain to an emotional pain they’re having trouble processing, or sometimes kids report that they feel “nothing” and this is a way for them to feel “something.” It’s also much more prevalent than you may think.
Doctors have seen a marked increase in self-harm over the last decade, which has then been exacerbated by the pandemic. The nonprofit Fair Health conducted a study that found a 333% increase in intentional self-harm claim reports in the Northeast among kids age 13–18, from 2019 to 2020. Dodd Middle School’s Licensed Clinical Social Worker Ben Chabak reports he has seen an increase in self-harm behaviors in Cheshire schools, as well.
So how does a parent know if their child is hurting themself? Unfortunately, self-injurious behavior can be easily hidden, often leaving parents unaware. Becoming familiar with the signs of depression and anxiety is an important first step. The same things apply — any abrupt change in behavior, self-isolation, expressions of hopelessness or worthlessness, or avoidance of friends, family, or school are all signs that a child should be evaluated by a professional. Oftentimes, when a child crosses from depression and anxiety to self-harm, parents may notice unexplained cuts and bruises, constantly covering their arms and legs even if it’s warm (inside or out), finding clothing with small blood stains, and finding sharp objects in your child’s room. According to the Child Mind Institute in New York, self-harm is often triggered by rejection from friends, family, a romantic interest, etc.
Cutting can also be copy-cat behavior inspired by videos and images on social media that show other kids cutting. If you suspect your child is engaging in self-harm, please calmly and kindly ask them if they are hurting themselves. Asking the question will not cause them to self-injure, but instead it could provide them a path to talking openly about their pain. The longer a child practices self-harming, the more they rely on it to soothe their painful emotions, so this should not be a one-time question. Instead, it should be the beginning of an ongoing, open, loving conversation, free of judgment.
When a child hurts themselves, they are screaming for help. Fortunately, there are things you can do — and things you shouldn’t — to support your child and help them find better coping mechanisms for their emotional pain.
If you find your child has harmed themself, first address any immediate health concerns. Dr. Hoffman explains that some self-injurious behaviors result in no significant physical harm for the child and do not need medical follow-up, but if there are open wounds or other injuries, it is important to tend to these wounds and see a physician if injuries are more significant. Once a child is determined to be stable medically, you can begin to focus on the behavior.
Children who self-harm aren’t bad children, so resist the urge to punish your child for hurting themself. Taking away their phone or grounding your child won’t address the behavior and may shut down your lines of communication.
The first goal in parenting a child who self-harms is to provide a buffer between the thought of your child harming themself and the action of doing it. That time may allow them to stop and think, to use healthy coping skills to address their feelings of pain. You may not be able to stop all instances of self-harm, but there are things you can do to reduce access to items that they may use, and provide that extra time to make a healthier decision.
Begin with an open, honest conversation with your child about next steps. If they are calm and mature enough to understand your reasoning, you may reinforce open communication and allow your child to feel more in control. Calmly explain that it is your job as a parent to help keep them safe, so you must search their bedroom for items they might use to hurt themself. If you can, include your child in the search — they may lead you to items you hadn’t considered. Sharp tools such as shards of glass, safety pins, nail scissors, knives, even the metal nose strips in masks can be used for cutting. Those should be removed and locked in a combination safe or a locked room or closet. For under $100, you can buy a safe with a code at big box stores including Walmart, and have peace of mind knowing that these items are not easily accessible.
Then begin the process of finding a mental health professional who can support your child to build their self esteem and learn healthy coping mechanisms to let go of their need to self-harm. In the meantime, it could be helpful to provide your child with alternatives. It is important to note that safer alternatives are a controversial idea, as these things are merely substitutes and aren’t actually dealing with the issue at hand. Therefore, doctors recommend that these alternatives be used in conjunction with seeing a therapist so the child isn’t merely trading one coping mechanism for another.
With that said, these alternatives can be helpful for kids and parents who are concerned with increasingly compulsive behavior that may cause more significant wounds or scarring.
Some kids find it helpful to wear rubber bands on their wrists, and the action of snapping the bands against their skin is a safer way to feel a small sting without being truly injurious. It often helps kids “snap back in to the moment, and out of the negative thoughts,” as one child explained. Kids who self-harm may write on their skin as a way of marking their bodies, so they have a visual reminder of their internal pain. Additionally, creative outlets are often used in therapy, so providing your child with body markers and pens may be helpful in both regards. BIC makes a BodyMark temporary tattoo pen set available on Amazon, and the colors wash off in about a week.
Finally, Dr. Hoffman recommends rubbing frozen fruit on the skin. The cold of the frozen fruit provides the sensory experience your child is seeking with self-harm, and the smell of the fruit can be helpful in grounding an anxious child. Grounding exercises often use smell as a way of being in the present, and this provides not only the experience the child is seeking, but also the therapeutic effect of a positive sensory experience.
One final note: Self-harming doesn’t have an overnight fix. Parents must be prepared to stay on top of things for many months or years to come. Therapy, love, and empathy are all necessary ingredients to helping your child overcome this behavior, build their self esteem, and find positive coping mechanisms to deal with stress and emotional pain. With your help and understanding, your child can lead a healthy, happy life.