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07 Aug, Sunday
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Montreal Families

Self-injury: a fixation for some

Will D. posts a note that is among one of the most heartbreaking things a parent can come across on the Internet: “I relapsed about a week ago” he writes to members of an online group called Cutting and Self-Harm. “I had gone two months without cutting. And now I’m sitting here typing with new cuts on my wrist from five minutes ago. F#@% this. I don’t want to do this anymore – but I can’t f#@% stop.”

His post, one of many that can be found on the Internet, offers a harrowing glimpse into the intense emotional turmoil of teens who use self-injury to cope with overwhelming emotions. Health professionals call this behaviour Non-Suicidal Self-Injury (NSSI). It can involve cutting, burning, scraping, biting or hitting oneself, but without the wish to die from the injuries.

These are frightening behaviours, but as Dr. Nancy Heath, associate professor in McGill University’s Department of Educational and Counselling Psychology says, “Hurting themselves is the only coping mechanism these young people have right now that works for them, however maladaptive it may be.”

A new epidemic?

Researchers estimate that 13 to 15 per cent of teens intentionally injure themselves, but no one knows if this rate is on the increase or not. Some experts believe more young people are resorting to self-harm while others suggest that there is now more attention given to the issue, so more people are receiving a diagnosis.

Whatever the case, as more attention has been paid to the problem, a better picture of those involved has begun to emerge. Young people who self harm are more likely to be women (60 per cent), to have suffered some kind of abuse or trauma and to have an eating disorder or substance abuse problem. But even teens who appear to have a very privileged life may harm themselves as do people from all races, education levels and socio-economic groups.

It is important to remember that self-harm is actually not a suicide attempt, but rather a coping mechanism (admittedly an unhealthy one) allowing individuals to express and manage emotional pain. Those who intentionally hurt themselves do so to get relief from their feelings or to feel something other than numbness in the face of overwhelming emotions.

Paradoxically, teens often describe a temporary feeling of calm or relief after hurting themselves, but another stressful event can trigger the desire to do it again. Injuring oneself can induce an endorphin rush, so people often describe becoming addicted to the behaviour and being unable to control the impulse to hurt themselves.

Cutting, biting or burning oneself is likely to be regarded with great alarm by others, so teens who hurt themselves are reluctant to talk about their behaviours. Disclosure can lead to disgust, confusion and avoidance in others, perpetuating a cycle of secrecy and shame. Many of the posts on Internet sites about self-harm revolve around hiding wounds and scars with long shirts, long pants and makeup.

Seek professional help

So what should parents do, if they are concerned their kids may be hurting themselves?

“It is important to address it openly and calmly,” advises Dr. Heath. Parents, despite their fears and worries, should not say something like “Oh my God, why did you do this?!” Instead, Dr. Heath suggests starting a discussion with a general comment, like “I’ve heard some kids cut themselves to feel better. What do you think of this?”

Teens who already hurt themselves should not be pushed to stop the behaviour immediately, adds Dr. Heath. “Until you teach them other coping mechanisms, you can’t ask them to stop the one thing that they feel helps,” she says.

And not every teen who self-injures needs to be rushed to the emergency psychiatric ward. Instead, parents need to ask some questions. “Ask them to tell you about it and you can get a sense of what the self-harm is for. If they say, ‘I do this because I don’t want to live anymore’ then you need to take them right away to the emergency room. If they say, ‘It makes me feel better,’ then you can proceed more calmly,” says Heath.

An important step is an assessment by a professional, preferably someone who understands the issue (see “Resources” below). Teens who self-injure will need to learn healthy ways of dealing with their emotional pain, which takes time and support. Reaching out to others and talking about this issue are crucial, so no teen feels that the only way to cope with life’s difficulties is through injury.

Signs of self-injury:

  • Scars, such as from burns or cuts
  • Cuts, scratches or other wounds
  • Bruises
  • Broken bones
  • Keeping sharp objects on hand
  • Spending a great deal of time alone
  • Wearing long sleeves or long pants even in hot weather
  • Claiming to have frequent accidents or mishaps

– Courtesy of the Mayo Clinic

Resources
 

For immediate assistance, and to speak to professional counsellors free of charge, teens can call Kids Help Phone (800) 668-6868 or visit www.kidshelpphone.ca

Websites

Canadian Mental Health Association www.cmha.ca (“Understanding Mental Illness”)
S.A.F.E.: Self Abuse Finally Ends www.selfinjury.com
Self-Injury: You are NOT the only one www.palace.net/~llama/psych/injury.html

Books

Self-Injury in Youth: The Essential Guide to Assessment and Treatment by M.K. Nixon and Nancy L. Heath (Routledge Press. Publication date June 2008)

Treating Self-Injury: A Practical Guide by Barnet Walsh (The Guilford Press, 2006)

When Your Child is Cutting: A Parent’s Guide to Helping Children Overcome Self-Injury by Merry E. McVey-Noble, Sony Khemlani-Patel, Fugen Neziroglu (Raincoast Books, 2006)

See My Pain! Creative Strategies and Activities for Helping Young People Who Self-Injure by Susan Bowman and Kaye Randall (Youthlight Inc., 2004)

How parents can help
 

Listening to kids talk about how they feel is probably the most important thing you can do for them. Just knowing that someone is listening and that they are finally being heard can really help. Avoid being judgemental or critical, even if you are shocked by what you hear.

Encourage them to get professional help: a guidance counsellor, pediatrician or psychologist will know how to get them the help they need. Offer to go with them or to find help for them if they are reluctant.

Do research work for them — there are plenty of resources online and in print for those who self-harm. Be sure that Internet resources are from a trusted professional or non-profit source.

Give yourself a break: It is normal to be shocked or upset by this behaviour, though it is best not to pass those feelings on to the person you are trying to help. Find someone you can talk to openly so that you have support as well.

Remember that you are not responsible for the fact that they hurt themselves.

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