Self-Injury

Is your child:

• Scratching, picking, pinching, cutting, hitting, biting, and/or burning himself or herself?
• Head banging when agitated?
• Wearing long-sleeved clothing to cover up injuries?
• Expressing self-loathing or excessive self-criticism?
• Feeling ashamed or embarrassed often?
• Pulling away from you during times of high stress?
• Becoming more withdrawn and less involved with family activities?
• Hiding sharp objects (razors, knives, pins or needles) in bedroom or backpack?
• Spending long periods in the bathroom or bedroom?

Sometimes children intentionally hurt themselves. Childhood self-injury can present at very young ages. The most common forms of self-injury are scratching, cutting, and hitting (particularly in younger children). Parents often feel frightened, shocked, angry, sad, or guilty when they discover or observe their child to self-injure. Certain acts of self-injury, such as cutting, are particularly upsetting to parents. If your child’s attire changes, particularly toward longer sleeves or more layers, this change may be evidence of cutting.

Unexplained scratches that frequently appear may be suspect. If you observe small, linear cuts, know that this style of injury is the most common presentation of cutting behavior.

In our clinical work, we have seen some adolescents cut words into themselves.

If your child has generally struggled with stress, he or she may be vulnerable to self-injury. If you have not observed your child to self-injure or have not witnessed signs of injury, it is important to verify your concerns.

If your child has recently experienced a new, negative emotional event (e.g., a social rejection, a breakup, teasing/bullying, parental divorce, death/loss, or academic failure) and has become more withdrawn, the risk for self-injury increases.

For children with developmental delays or impairments, self-injury may occur during the toddler years. The most common behaviors observed in this young population are hairpulling, headbanging, eye gouging, and slapping around the head or arms.

These behaviors are outwardly evident and often coincide with a negative emotion aroused by a denial of something desired, change in plans, or anxiety.

Clinically, self-injury is associated with many psychological conditions. However, self-injury is separate from suicidal behaviors. Self-injury does not mean your child wants to die. Rather, self-injury is tied to a relief of emotional pain, intense feelings, emotional numbness, or anxiety. Sometimes, the behavior is short-lived, but, particularly with cutting and scratching behaviors, the behavior can escalate if left untreated.

The most common reasons for self-injury are as follows [6]:

• Relief from feelings: an expression of feelings like depression, isolation, frustration, and alienation
• Stopping, inducing, or preventing dissociation: a defense mechanism for intense or overwhelming emotions that may stem from feeling separated from oneself
• Physically expressing pain: a physical experience of emotional pain
• Communication: a way to tell loved ones about pain or emotional distress
• Self-nurturing: a method of taking care of oneself; wound care
• Self-punishment: a reaction to shame or self-criticism over past ‘wrongs’

Self-injury is a behavior that can be initiated by any number of factors. Self-injury can arise when your child has not found an adequate means of expressing their emotional pain or when your child experiences low self-esteem or physical discomfort.

It may come about as a result of emotional, sexual, or physical abuse. However, children from healthy homes may also self-injure. Research shows that cutting behaviors have an element of contagion, so peer pressure may be a factor [6]. Most often, self-injury serves as a vessel for emotional relief.

The act of harming one’s self provides a feeling of control and can release endorphins, much in the same way drugs can. Thus, the cutting behavior creates an experience that releases the pressure of negative emotions and provides the reward of relief. This experience of relief may feel like a warm wave of calm that washes over the individual, and it can become addictive.

Because self-injury can be an addiction, some of the treatment strategies are similar to those used for other addictions. For example, psychologists help children identify triggers, understand the emotions related to those triggers, provide distraction during the ‘tension’ phase, and develop positive coping strategies to manage strong emotions [6]. Often, if the child finds a way to distract herself during the ‘tension’ phase (the part where the body is gearing up to self-injure), the urge can be averted, and a positive coping strategy can take place instead.

Terms that are synonymous with self-injury are ‘self-harm,’ ‘self-mutilation,’ or ‘cutting.’ Self-injury occurs more often among females. Many individuals who self-injure report histories of abuse, coexisting disorders (e.g. eating disorders, substance abuse), and home environments that punished negative emotional expression (e.g. anger).

Mental health professionals are the most qualified to evaluate your child’s self-injury. An evaluation can offer important information about the cause and course of treatment. Self-injury may indicate that your child struggles with a psychological issue, such as depression, posttraumatic stress disorder (PTSD), borderline personality disorder, or bipolar disorder, and that the self-injury may be a method of coping with intense emotions.

If you have suspicions or have confirmed that your child is self-injuring, it is best to address the behavior immediately. While some children and adolescents self-injure because they want to fit into a peer group, self-injury should not be treated as a ‘phase’ or as something that can be ignored.

A misconception among many adults is that self-injury is a ‘cry for attention,’ which is generally not the case. Most likely, your child is experiencing difficult emotions, and the act of self-injury provides a legitimate relief.

The most effective way for you to help your child is to validate their feelings and understand their self-injury. To achieve both, you will need to be present and available to your child.

Even if you do not feel it, provide a calm and comforting environment. The very fact that your child is intentionally hurting herself is an indication that she is not coping well with stressful situations. Try not to make interactions more stressful. Offer your love and support, and reassure your child that you want to help.

Do not assume you know what your child is feeling; this assumption can create distance and misunderstanding. Ask your child to describe his experience. You have your own emotions in this experience, so it is important to use them productively.

Rather than saying something like, “How can you do something so crazy,” a better way to express the fear and shock you feel would be, “Seeing you hurt yourself is hard for me. I want to get you help, but I also want to understand how self-injury makes you feel better.”

Power struggles, ultimatums and your own emotional outbursts will be unproductive. If your child does not want to engage in a discussion, let him or her know that you will be there when the time is right.

Children who self-injure typically lack coping mechanisms and skills for discussing their inner experiences, so they may need time to figure out how to talk to you about their emotions.

One powerful strategy for self-injuring adolescents is the idea of a Sensory Box or a Comfort Kit [6]. You and your child can seek to discover a set of objects and thoughts that bring a feeling of comfort and relaxation.

In this box, you and your child would collect positive sights (post cards, greeting cards, pictures), sounds (music, ocean sounds, meditation sounds), smells (essential oils, aromatherapy), and tactile objects (blankets, towels, stuffed animals).

The Comfort Kit [6] might include a set of index cards that lists specific strategies and positive phrases the child will use instead of resorting to self-injury.

Your child’s improvement may take a while. Remember your child is working hard to change a behavior that has been effective in the past. You can help by making time for relaxation. It can be helpful to remove some pressure or responsibilities from your child as he or she works to end self-injurious behaviors.

As your child learns self-care skills and improves self-esteem, self-image, and emotional coping, you can expect the self-injury to diminish. While your child is working to be mentally healthy and stable, it can be helpful to seek your own therapy in an attempt to ensure that your home is a safe haven and a refuge for your child.

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• Compulsions: some children who self-injure may have other compulsions, such as constantly ‘checking’ lights and switches, lining up toys, hoarding food or objects
• Perseverating: some children who self-injure may get stuck on things and may have trouble ‘letting it go’
• Cognitive distortions: some children who self-injure may be struggling with the thinking patterns associated with anxiety and depression
• Emotional regulation: some children who have difficulties managing strong feelings of anger, sadness, or anxiety may also self-injure
• Family problems: some children who have recent difficulties in their families such as a recent death, divorce, substance abuse problem, or other family discord may also self-injure

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this does not serve as a diagnosis in any way. See ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Borderline Personality Disorder (BPD) or related traits in teens: a psychological disorder that is characterized by intense and frequent mood swings, impulsive behaviors, self-harm, or difficulties with relationships.
• Depression: a pervasive sad mood, or, in children, irritability that is pervasive; decreased interest or pleasure in activities that used to be enjoyable.
• Generalized Anxiety Disorder: a pattern of persistent worries that get in the way of everyday functioning.
• Obsessive Compulsive Disorder: a pattern of thoughts/fears (obsessions) that lead to repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.
• Disorders of trauma and attachment & Posttraumatic Stress Disorder (PTSD): PTSD occurs after someone experiences or witnesses something harmful, frightening, or extremely stressful. Symptoms that arise are feelings of jitteriness, trouble concentrating, flashbacks, and difficulty with sleep.

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• CLEAR Child Psychology: to obtain a customized profile of concerns for your child, or to consult ‘live’ with a psychologist
• Dialectical Behavior Individual/Group Therapy (DBT) (Psychotherapist): a program that helps people gain control over self-destructive impulses (such as self-injury). The individual and group format supports the individual in learning how to tolerate emotional distress and how to learn and sustain new coping skills.
• Family therapy (Psychotherapist): this mode of therapy addresses what may be occurring in the family system that relates to the self-injury behaviors. A family therapist will help the family learn to communicate more directly with each other and to confront family stress.
• Group therapy (Psychotherapist): a group setting offers the unique opportunity to discuss your experiences with other people who have similar experiences and struggles. Groups help reduce any shame associated with self-injury, and group members often learn coping strategies from other members.
• Psychologist: a psychologist can consider symptoms in mental health context and can provide one-to-one support in ending self-injury behaviors.
• Psychiatrist: a psychologist can determine if a pharmacologic approach can aid in ending self-injury. Antidepressants may help with mood symptoms, and anti-anxiety medication may help with the impulsive nature of self-injury.

These professionals may recommend or administer the following tests for this symptom:

• Roberts, BASC-3, Clinical Interview, RCMAS, CDI-2, Human Figure Drawing, Brief Projective Measures: projective assessment and emotional assessment through drawing tasks, open ended questions, interviews, rating scales, and sometimes storytelling (Neuropsychological or psychological evaluation)
• WISC-V: establish a baseline of intellectual abilities that can help us understand emotional knowledge and symptoms and determine what interventions may work best. (Psychological or School Psychological evaluation)
• TOL-2, CTMT, WCST, TOVA: Assessing areas of executive function may help to determine the skills and resources a child has, like ability to plan, organize, and attend. (Neuropsychological evaluation)

[1] Dialectical Behavioral Therapy: What is DBT?

[2] The Cornell University Research resource on self-injury, a comprehensive website for parent, caregivers, and mental health care providers. https://www.amazon.com/Kitchen-Table-Wisdom-Stories-Anniversary/dp/1594482098/ref=asap_bc?ie=UTF8

[3] If you think your child needs intensive support, SAFE Alternatives is a nationally, research-supported, program with resources for those who injure and their networks. https://selfinjury.com/

[4] A touching reflection of a mother whose daughter was self-injuring. https://mobile.nytimes.com/2015/03/01/style/bringing-a-daughter-back-from-the-brink-with-poems.html

[5] Bowman, Susan & Randall, Kaye (2012). See my pain: Creative strategies for helping people who self-injure. Amazon: https://www.amazon.com/See-Pain-Strategies-Activities-Self-Injure/dp/1598501259/

[6] Randall, Kaye (2017). Critical Mental Health: A conference on suicide and self-injury. Accutrain: Developmental Resources. www.dev-resources.com

This article was contributed by guest author and subject matter expert:

Author Credit:

Chesleigh Keene, MA

Chesleigh is a doctoral candidate in Counseling Psychology at the University of Denver. She is a predoctoral intern at the University of Utah Neuropsychiatric Institute. She has clinical and research training in traumatic brain injury, developmental disorders, child/family therapy, serious mental illness in adults, and topics of diversity.

Image Credit:
Description: A bunch of colorful bandages on child’s leg
Stock Photo ID: #133959743 (Big Stock)
By: DV Studio
Cutters self injury
Previously Licensed on: May 21, 2017
Stylized by Katie Harwood exclusively for Clear Child Psychology

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