What is it?

There are many reasons why youth may self-harm and those reasons can change over time. Some people harm themselves to gain relief from distress caused by difficult thoughts or feelings. They are not trying to end their life but think that self-harm may be the one way, in that moment, to cope with or communicate their distress. Some may have suicidal thoughts but not always. In these moments, self-harm may be a way to deal with their thoughts and feelings and could reduce risks of suicidal behaviours.  

Common types of self-harm are:

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

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

Self-harm can sometimes become a habit that is hard to stop.

Youth may find it difficult to explain the self-harming behaviour. Some reasons may be that: 

• They may not be aware of a reason for their self-harm
• They may feel shame or other big emotions when they try to share their experience  
• They may wish to protect others from their distress

How do I know?

Self-harm is more common in youth than adults. Like other behaviours, self-harm can be something that young people experiment with. Youth may self-harm a few times and then stop. For others, it can become something that they do again and again over time. Those who self-harm more often and for longer periods are more likely to continue.

Signs your child may be self-harming: 

• Scars, often in patterns
• Keeping sharp objects nearby that can be used to hurt yourself
• Wearing long sleeves or long pants to hide self-harm, even in hot weather
• Often saying they got hurt by accident
• Behaviors and emotions that change quickly and are impulsive, intense and unexpected
• Talk of helplessness, hopelessness or worthlessness
• Talking about self-harm
• Wounds that don’t heal or get worse
• Cuts on the same place
• Increased isolation
• Avoiding social activities
• Refusing to go into the locker room or change clothes in school

Self-Harm Factors

Youth are more at risk for self-harm if they:

• Feel and react more intensely to emotions
• Take more risks or are more impulsive
• Feel overwhelmed by demands and challenges in life
• Have underdeveloped coping skills to deal with the stress they experience
• Don’t feel accepted, validated or supported by people important to them

Those more at risk for continuing to self-harm may include 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-harming say they:

• Are more able to handle their emotions
• Have become more self-aware
• Have meaningful relationships with others
• Have a healthier balance in life

Getting better at the skills above can help youth stop or reduce self-harm behaviours. 

Self-harm can be a symptom of, or connected to, mental health challenges such as:

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

Self-harm may occur along with thinking about suicide and the risk of a suicide attempt. There is also an increased risk for suicidal thinking and a higher chance for suicidal behaviour to occur in the future.

It is important to note that these mental health challenges can be treated. Improvements to a young person’s mental health will generally lead to a decrease in self-harm.

What can be done?

This journey may take time and will need patience and persistence from parents and caregivers. It's important to manage your own emotions and expectations as best you can, which can be very challenging if your child is self-harming. This is a highly challenging skill for a parent or caregiver to develop in relation to their child’s self-harm. While everyone’s pathway is different, most parents and caregivers might benefit from extra support or professional support to be able to do this.

Some tips on how to support your child: 

• If your child is willing and able to share, start by listening.
• Pay attention to any fear or worries that come up for you.
• Try to understand what feelings or stress may have led to the behaviour.
• Show respect and curiosity without judgment.
• Do your best to avoid offering your own values or ideas about self-harm.
• Validate their feelings and help them feel safe.
• Talk to your child in a way that shows you understand and accept how they feel.
• Show that you care and want to help, within your own boundaries.  
• If you are concerned about suicidal thoughts and risk of suicide you could say “I am not a professional, but I know how we could go about finding one. You are not alone. I’m here for you and we will get through this together.”.

Harm Reduction

It’s normal to want your child to stop self-harming. However, taking away how they cope without helping them find new ways can make them more upset and lead to more self-harm.

Being too forceful in stopping your child’s self-harm can make them feel powerless, stressed, and less in control. It can hurt their self-esteem and make them depend more on others. If prevention limits their freedom, it can cause fights and more stress. This makes it harder to help them in the long run.

Work towards finding a balance that helps the young person as a whole and works to reduce self-harming. It’s important to understand why they self-harm and help them build skills to deal with those reasons.

What can be done about self-harm behaviours?

A harm reduction approach can help with reducing risk related to self-harm behaviour. This approach includes reducing the risk and making it as safe as possible when self-harming does happen. This could include help to reduce the frequency or severity of injury or even prevent the self-harm.

A good way to feel better is to have a healthy balance in life. This can include:

• good sleep quality
• healthy physical activity
• good nutrition
• managed screen time use
• engaging in relaxation and healthy activities to manage stress
• enjoyment from social activities

Any treatment must include an assessment of a person’s reasons and situations when someone self-harms, along with their level of motivation to change the behaviour. The following treatments may be helpful.

To improve mood and anxiety related self-harm: 

• Cognitive-Behavioural Therapy (CBT) teaches people how thoughts and behaviours affect their mood. It may help reduce the feelings that trigger self-harm 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-harm at home

Managing the risk of self-harm at home is individual to the youth and their home environment. It’s about finding a balance that helps with the short-term goal of reducing acts of self-harm and the longer-term goal of recovering and overall mental health improvement. Overall open communication between a youth and parents or caregivers improves both short-term and longer-term outcomes.

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

• Understand what triggers self-harm and why this is a trigger. Sometimes there may be steps or stages that lead to the trigger.  Identifying these can be helpful with managing your child’s response.
• Understand what the main reasons for self-harm may have been.
• Find ways to avoid triggers and to manage triggers when they arise. Help your child improve their own awareness (for example: 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 (for example: relaxation, distraction, physical activity, creative or social activities).
• Expect and understand that it will take time and motivation to learn new ways of coping.

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-harms. 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-harming:

• Learn more about self-harm
• Avoid judgment, keep a balanced point of view
• Focus on your child’s concerns or issues and less on the act of self-harm
• Support and create opportunities for positive, healthy ways of coping
• Don’t expect the self-harming to stop immediately as your child may feel that they have disappointed you further
• Let your child know that you’re willing to listen, but don’t force them to talk
• Encourage your child to seek professional help and assist them in getting those supports

Tips for caregivers:

It’s important to take care of yourself, too. Do activities that help you to relax. 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.

Where to go from here?

If wounds from self-harm 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.

Talk to your doctor and look for help from a mental health professional. 

• Self-refer or get a referral to the local Child and Youth Mental Health team
• Contact your Employee Assistance Plan (EAP), if you have this option
• Contact a private psychologist or counsellor:
  • Visit the BC Psychological Association website or call 1-800-730-0522
  • Visit the BC Association of Clinical Counsellors website or call 1-800-909-6303

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-harm and how to help if you know someone who self-harms.

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.