“What do I do now?” whispers the mom through her tears as the reality of what I have just disclosed begins to sink in. Her daughter is cutting, and has been secretly doing so for months. A combination of disbelief, panic, anger and despair ripple across her face.
As a counselor, I find myself walking alongside the parents of youth who self-injure all too often. I have learned that when the most important adults in a teen’s life embrace a few key principles, outcomes vastly improve. Here are five important things to know about self-injury:
Self-injury is a coping strategy.
It is the outward manifestation of underlying causes. For many, those causes may be uncomfortable emotions as a result of current or past life difficulties. Self-injury plays a similar role to the abuse of drugs and alcohol, in that the endorphin release can rapidly shift one’s internal state. Anxiety about an upcoming exam, sadness as a result of rejection from peers, fear due to flashbacks of abuse, anger regarding family conflict; all are almost magically lifted.
This is what can make it so difficult to move past self-injury. In spite of all the costs (scars, stigma and its addictive nature, to name a few) self-injury works. At least in the short-term. As helpers we need to appreciate this fact and strive for a balanced focus between the behaviour and what lies beneath.
Suicidal behaviour and self-injury are not the same.
The intent with a suicide attempt is to end all feelings. The intent with self-injury is to shift feelings. Yet often there is an assumption that self-injury is suicidal in nature.
The two are connected however. Self-injury and suicidal ideation often co-occur. Some youth turn to self-injury as a type of suicide prevention. As one individual put it, “I don’t want to kill myself….I know cutting will take the edge off.” Research has shown that the greater the frequency of self-injury and number of means utilized, the greater the risk of a suicide attempt.
As helpers, we need to find a balance between jumping to the conclusion that self-injury is a suicide attempt and separating the two so completely that an important warning sign for suicide is overlooked. It’s important to ask on a regular basis if suicide is part of the picture for those who self-injure, and also to appreciate that the self-injury may be keeping suicidal ideation at bay.
Self-injury should not be ignored or punished.
Sometimes self-injury is viewed as attention seeking or a means for manipulation and the decision is made to ignore the behaviour. Though self-injury is often kept hidden, in some cases, when an individual is intentionally displaying recent wounds, it may very much be about getting attention. We need to keep in mind that it is a basic human need to communicate and receive attention. In other words, to connect with people. A more helpful response might be to consider why the individual is seeking connection in such a drastic manner. What message are they trying to send?
Just as ignoring the behaviour is not helpful, neither are responses of judgement, hysterics, anger or punishment. These reactions often shut down communication and result in the individual going further underground with their self-injury. Maintain a demeanor that is calm, unassuming and compassionate.
Moving past self-injury involves learning to tolerate difficult emotions.
Most people who self-injure have great difficulty understanding and tolerating the full range of their emotions. They just know when they feel bad and are in a rush to change that feeling, self-injury does this. The goal is to help these individuals be able to sit with and express their emotions in a multitude of healthy ways rather than pushing those feelings down with the action of self-injury.
As Jon Kabat-Zinn, the founder of mindfulness-based stress reduction, so aptly describes it, “You can’t stop the waves, but you can learn to surf.” Emotion regulation skills include things like breathing and relaxation techniques, physical movement, connection with others and creative expression. The fact is, healthy coping strategies won’t work as quickly as self-injury in the short-term. But in the long-term, they increase one’s capacity to manage difficult situations and emotions in ways that youth can feel good about as they move forward in their lives.
The support of others is paramount.
Individuals who self-injure need adults in their lives who get it. Who won’t judge or get angry, but will be there to support and validate them. When youth sense that they no longer have to keep their self-injury a secret and have guidance for their journey, positive change is more likely to occur.
I ended my conversation with the devastated mom by telling her, “give your daughter a hug, tell her you love her and that you’re going to help her through this.”
How would you advise the parent of a teen who self-injures? Many have been in these shoes or know someone who has. What do you think are the most important things to know about self-injury?