Intervention Advice for Self-Harm

Nearly a quarter of teenage girls in the UK are self-harming according to new study

British Medical Journal 2018 Study reveals:

• 68% increase in self-harm amongst 13-16 girls between 2011 and 2014 in the UK.
• Self-harm is the strongest risk factor for subsequent suicide
• Suicide is the second most common cause of death before age 25 worldwide.
• Young people who self-harmed were almost nine times more likely to die due to suicide or accidentally fatal acute alcohol/drug poisoning
• Results indicate an: “urgent need to develop and implement effective interventions for girls in their early-mid teens”

1 in 10 young people have a diagnosable mental health condition: Dr Maite Ferrin discusses the symptoms behind the statistics

Dr Maite Ferrin, Consultant Psychiatrist at Re:Cognition Health, has vast experience in treating children and adolescents with all types of mild and more severe psychiatric conditions.

What is self-harm?

Self-harm is described as “any intentional act causing physical injuries to oneself without a clear intention to die”. It can include superficial cutting (with a knife or razor), scratching or hitting oneself, and intentional drug overdose. Many young people who self-harm use more than one method of self-injury, and some of them do it on a regular basis, while others do it more sporadically.

Self-harm is an adaptive coping mechanism to deal with any stressor in life including school difficulties or bullying, however, it might also reflect a more impairing psychological condition including anxiety, depression or PTSD.

Causes of self-harm

People self-harm for different reasons. For example, affect regulation (e.g., an attempt to alleviate emotional pain that cannot be expressed verbally), self-punishment (e.g., an attempt to relieve feelings of shame or guilt) or anti-dissociation (e.g. an attempt to stop feeling numb), just to name a few.

Self-harm can eventually lead to fatality. In fact, according to the BMJ study, young people who self-harmed were almost nine times more likely to die due to suicide or accidentally fatal acute alcohol/drug poisoning.

Self-harm behaviour is positively reinforced through feelings of relief, satisfaction and reduction of anxiety levels, and might therefore predispose to vicious cycles and increasingly more risky behaviours. It could impede young people’s ability to develop more effective and adaptive coping skills. These skills are important to regulate emotions and tolerate distress.

Advice on how to respond if you think your child is self-harming

It is always advisable to seek advice from a medical professional. We recommend adopting an empathetic approach. This is because the majority of young people with self-harm feel ashamed of the act. They often worry about the negative judgement of others, including their family members.

• Empathic listening encourages the other person to talk. It is especially important for young people with self-harm, who often feel unheard and misunderstood. We should create a safe space for them to freely discuss their problems without interruption so that they are more able to disclose their own problems.
• Simple empathic responses, such as “sounds like things have been quite tough for you” that withhold negative judgements of their self-harm so they can validate their emotional experiences.
• Offer the young person some hope and support “thank you for sharing this with me. Let’s think about how we can make you feel better”

Basic tips for parents of young people with self-harm tendencies:

• Remain calm and validate their emotions and struggles
• Do not push the young person to talk if they do not feel comfortable to
• Do not punish or minimise their feelings or the self-harm act as this may deepen guilt or shame
• Focus on the underlying struggles rather than the act of self-harm
• Encourage healthy ways of coping with stress
• Reinforce the young person’s strengths
• Do not expect or seek a quick fix for the self-harm behaviour
• Allow them time to learn alternative healthier coping mechanisms to replace the self-harm behaviours
• Seek assistance and support from school counsellors, child and adolescent psychiatrists or psychologists, social workers or counselling centres
• Finally, when an underlying psychiatric condition is suspected (e.g. anxiety, depression, PTSD, etc), or for those who have poor responses to initial approaches earlier described, a referral to a specialist might need to be considered.

¹ Morgan C et al. Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care BMJ 2017; 359 doi https://doi.org/10.1136/bmj.j4351