Deliberate self harm can be a scary & confronting issue for many parents, & it can be difficult to know how to respond if you have discovered, or suspect, your teen is self harming.
Firstly, it’s important to understand what deliberate self harm (DSH) is (& what it isn’t). DSH is
sometimes called non-suicidal self injury. It is important to understand that DSH & suicidal
behaviours are different & have different reasons for arising. That being said, it is important to note that DSH behaviours in an individual increase their risk of suicide, particularly if the DSH has been going on for some time.
Examples of DSH are behaviours such as cutting, scratching (breaking the skin), burning, hair
pulling, head banging, punching self & any other intentional behaviour designed to cause
intentional injury. The intention behind DSH is not to end one’s life- that is where it differs from suicidal behaviours.
Some young people may experiment with DSH & do not continue because they find it does not give them a desired emotional effect. However, for some people, they find DSH serves a useful purpose of either giving them a sense of emotional relief or, providing distraction with physical pain- which feels like relief from emotional pain.
It can be hard for those who have never engaged in DSH to understand why others would do it- but think about things you might use to distract yourself from emotional distress. For example, how many of us indulge in a drink after a stressful day at work? DSH serves the same purpose, but the underlying distress is usually much higher.
One of the biggest barriers to treating DSH is the broad misunderstanding of the behaviours. There can be a lot of shame & stigma associated with these behaviours. Often DSH is treated by focusing just on the behaviours, for example devising ‘safety plans’ which do nothing to address the underlying emotional pain. We need to understand DSH is the symptom- the real problem is very high distress in a person who feels they have no other options for how to deal with it.
What tends to happen over time with DSH is that it escalates. The behaviours will usually become more frequent & severe. This escalation occurs due to reduced tolerance to emotional distress.
When a young person first starts to engage in DSH, they have usually been experiencing high distress for quite some time. Given their practical resources & level of development, they may struggle to identify ways to manage their distress, & find DSH provides quick, effective relief.
The young person’s brain learns that DSH is an effective way of avoiding distress, so they start to use it more frequently. What happens over time is that their tolerance to distress goes down. Less severe triggers will result in DSH, & for some young people they will end up feeling they need to engage in DSH just to get through a normal day.
This reduction in distress tolerance is a big problem- because distress is an inevitable part
of life!
We need to teach young people how to increase their tolerance to distress, particularly those facing stressors in their lives which may increase the levels of distress they experience (eg. Trauma, mental or physical health issues, family dysfunction, bullying etc).
The Do’s & Don’ts if you suspect DSH:
Don’t:
Completely freak out! This is completely understandable if you discover your child has been
engaging in DSH. However, it’s important to not get distracted by the behaviours, & instead
understand & address the underlying problem (high emotional distress).
Do:
Try to understand why they have been self harming. What does it do for them? Ask lots of open & non-judgemental questions.
Don’t:
Be afraid to ask questions about suicidal thoughts. Ask them directly if they have been having any thoughts of wanting to end their life. If the answer is yes, that’s the time to immediately get in contact with crisis services who can do a thorough risk assessment.
Do:
Contact a crisis service or mental health service immediately if you suspect or have evidence of suicidal thoughts in your child. Do not delay or wait to see if it passes. Call the Mental Health Access Line, Lifeline or attend your local emergency department right away.
Don’t:
Just remove a teen’s access to means in which to harm themselves (eg. Removing blades), but not take any further actions to address the underlying distress. Removing a person’s access to means is rarely successful in preventing future DSH if done without other action steps. Remember, DSH is often an indication of very high distress & not knowing other ways to manage. We need to teach them other ways to manage their distress.
Do:
Ensure immediate safety by making the environment safe & stay with your child. Make a plan with your teen of where to get help & make appointments to do so ASAP.
Don’t:
Punish DSH behaviours. Punishment shows a lack of understanding of the real problem a young person is experiencing. It is likely to damage trust & drive the young person to be more secretive about their DSH.
Do:
Say that you are worried & that you will find help for your young person so they can feel better. DSH is a sign of very high emotional distress (even if your young person says it’s not!).
Don’t:
Assume DSH is done for ‘attention- seeking’ purposes. Most people who engage in DSH will want to keep it hidden, as it’s a source of shame for them. Those that do openly disclose DSH are often feeling so desperate in their distress that it is a way of physically showing how much emotional distress they are in.
Do: Respond with compassion & without judgement. Try to understand why your young person is engaging in DSH.
Don’t:
Assume young people will grow out of DSH or it’s ‘just a phase. DSH usually escalates with time & can evolve into chronic suicidal behaviours.
Do:
Act quickly. Early intervention is key. If your teen does not ‘click’ with the first therapist they see, shop around until you find someone who they feel comfortable with.
Don’t:
Just book them into any mental health service assuming they know how to treat DSH. Treatment for DSH is specialised & the wrong treatment can make the problem worse.
Do:
Seek specialist advice & treatment. Ask your GP or look for services who specialise in the treatment of DSH. Specifically, dialectical behavioural therapy (DBT) has been shown to be an effective form of treatment for DSH. Investing in your child’s mental health treatment now can prevent further deterioration & risks for them later in life.
Want more detailed guidance & support? Check out our Self Harm in Teens: A Parent's Guide self-paced learning program
Contacts:
Mental Health Access Line (Central Coast): 1800 011 511
Lifeline: 13 14 24
Mindful Recovery Services: www.mindfulrecovery.com.au or (02) 4660 0100
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