Self-injury (also known as self-harm), is when people harm themselves on purpose to help them deal with difficult thoughts or feelings. They are not trying to end their life but think that self injury may be the one way, at that moment, to cope with or communicate their distress. Some may have suicidal thoughts but not always. At those moments, self-injury may be a less harmful way to deal with their thoughts and feelings.

Common types of self injury are:

• scratching or cutting the skin
• burning the skin
• biting or severely pinching the skin
• self hitting

A person can have one reason or many reasons for self-injuring. These reasons may develop over time and may change. 

Common reasons include:

• to cope with grief, loss, violence, chronic illness or major stressors
• to deal with unwanted feelings like anxiety or depression
• to punish themselves
• to express feelings of failure, anger or self hate
• to make their emotional distress feel like physical pain
• to  feel something, instead of feeling nothing or feeling numb
• to feel in control of something when other things feel out of control
• to feel better at that moment or feel a release of tension
• to avoid dealing with a stressful situation
• to communicate distress or a need for help or the feeling that they can’t be helped

Some young people may become “addicted to” self-injury behaviour.

Self-injury is more common in youth than in the general population. Most of those who self-injure do so only once or twice and are not likely to continue. Those who self-injure more often and for longer periods are more likely to continue. 

Teens are more at risk for self-injuring if they:

• feel extreme emotions and tend to react quickly and intensely
• take more risks
• have not developed coping skills to deal with the stress they experience
• don’t feel accepted, validated or supported by people important to them
• have an unhealthy lifestyle such as:
  • overuse or dependence on social media
  • poor sleep
  • lack of physical activity
  • poor nutrition

Those more at risk for continuing to self-injure may be those:

• with depression or anxiety that is untreated or undertreated
• with gender identity or sexual identity issues
• unhappy with their body image

Those who stop self-injuring say they:

• are working on addressing the underlying issues that lead to the self-injury
• are more able to handle their emotions
• have become more self-aware
• have important relationships with others

Self-injury can be a symptom related to mental health challenges such as:

• eating disorders
• depression and depressive disorders
• bipolar disorders
• anxiety disorders
• substance use challenges
• attention-deficit/hyperactivity disorder
• personality disorders (usually diagnosed after adolescence and when behaviours persist over time)

It is important to note that these mental health challenges can be treated.

First think about where to start. This journey will take time and you will need to be patient and persist. You will also have to manage your own emotions and expectations. Self-injury may occur along with thinking about suicide and the risk of a suicide attempt. There is also a risk for suicidal thinking and attempts in the future.

If your child or youth is willing and able to share, start by listening. Show respect and curiosity without judgment. Be careful not to offer or imply your own values or ideas about self-injury. Communicate in a way that recognizes and accepts your child’s experience and feelings. Show support and concern, but set limits such as “I am not a professional, but I know how we could go about finding one”. If you are concerned about suicidal thoughts and risk of suicide, you could say, “I don’t feel that I am a good judge of your safety but I can take you to the emergency department where we can talk to professionals. “

What can be done about self-injury behaviours?

Any treatment must include an assessment of why and when someone is self-injuring and if they are motivated to change the behaviour. The following treatments may be helpful.

To improve mood and anxiety related self-injury:

• Cognitive Behavioural Therapy (CBT) - teaches people how thoughts and behaviours affect their mood. It may help reduce the feelings that trigger self-injury and may also improve anxiety, depression, self-esteem, problem-solving skills and coping skills.

To improve emotional regulation and management of suicidal related behaviours in a crisis:

• Dialectical Behaviour Therapy (DBT) - teaches how to replace extreme and rigid ways of thinking with more flexible ways of thinking. It also teaches skills like acceptance and problem-solving, and can teach people how to cope with uncomfortable or difficult thoughts, feelings and situations.

To manage interpersonal and relational issues and depressed mood:

• Interpersonal Therapy (IPT) - focuses on the personal relationships that are at the center of the emotional distress.

To help those not fully motivated to change:

• Motivational Interviewing (MI) - Helps people deal with mixed feelings and fears around change by supporting the process of finding internal motivation to do so.

Managing the risk of self-injury at home

Encourage your child or youth to explore new, healthy ways to cope with their feelings. For example, help your child to:

• understand what triggers the self-injuring, and why this is a trigger. Be aware of steps or stages that lead to the triggering to help manage.
• understand what the main reasons for self-injury have been.
• find ways to avoid triggers and to manage triggers when they arise. For example, help your child improve their own awareness (write in a journal, reach out and talk with a trusted friend or adult, draw, paint, etc.).
• deal with low mood or anxiety by practicing mood enhancing or anti-anxiety techniques that match their interests (relaxation, distraction, physical activity, creative or social activities).
• expect and understand that it will take time and motivation to learn new ways of managing.

How can I help my child or youth?

It’s natural to feel shocked, confused, guilty or even frustrated and angry when you find out that someone you love self-injures. While you try to deal with your own emotions, you may decide to seek help and support. It can be helpful for your child to see you do that. Here are some ways to help yourself and someone who is self injuring:

• learn more about self-injury
• avoid judgment, keep a balanced point of view
• focus on your child or youth’s concerns or issues and less on the act of self-injury
• support and create opportunities for positive, healthy ways of coping
• don’t expect the self injuring to stop immediately or your child or youth may feel that they have disappointed you further
• let your child or youth know that you’re willing to listen, but don’t force them to talk
• encourage your child or youth to seek professional help and assist them in getting those supports

Tips for caregivers:

It’s important to take care of yourself, too. Do things that help you to relax. Talk with a friend about your own feelings. It may help if you get support from a mental health professional or support group. Be realistic and set boundaries on your role as a parent and those of the professionals available to you.

If wounds from self injury look serious:

• in an emergency, call 911 or go to the nearest emergency care facility
• if not an immediate emergency call 811 to speak with a registered nurse
• make sure you care for any injuries properly, keep basic first aid supplies on hand
• see your doctor if you’re not sure what to do next

If wounds from self-injury do not look serious:

Talk to your doctor and get help from a mental health professional by:

• Getting a mental health assessment and support through your local Child and Youth Mental Health team (through a walk-in intake clinic in your community). 
• Contacting your Employee Assistance Plan (EAP), if you have this option.
• Contacting a private psychologist or counsellor.

For information on how to manage acute risk and possible suicidal behaviour, check out mental health first aid guidelines from Australia. This resource has information on self injury and how to help if you know someone who self injures.

Looking for more information on this topic? Connect with a family peer support worker at the Kelty Centre to discover additional resources, learn more about support and treatment options, or just to find a listening ear.