Why Children Intentionally Hurt Themselves

By Drs. Jason Sabo and Errin Price of Lee Health’s Pediatric Behavioral Health Practice

Self-Injury Awareness Day March 1 was created more than 20 years ago to help raise awareness about self-injury with the hope that fewer people feel alone and suffer in silence.

Sadly, non-suicidal self-injurious behaviors and suicide attempts continue to rise in Lee County among youth ages 5 to 17. Golisano Children’s Hospital experienced a 494% increase of admission rates for non-suicidal self-injury and suicides attempts between January and August 2021, with admission rates the highest in May 2021.

Statistics on self-harm are often underreported due to stigma and shame, but Mental Health America estimates about 15% of teens report some form of non-suicidal self-injury and the American Academy of Child Adolescent Psychiatry notes the average age of first self-harm is 13.

These behaviors are on the rise because children and adolescents are dealing with large systemic stressors today. Many of these children are victims of situations that are out of their control like child abuse, sexual abuse, lower socio-economic opportunities, lack of access to quality health care, bullying, social media, academic stressors and the pandemic, to name a few.

When children are stressed or overwhelmed, it is important for them to express emotions in a healthy manner. Unfortunately, a growing number of children use non suicidal self-injury or suicidal behaviors to provide temporary escape from emotional pain.

This self-injury is defined as any intentional injury to one’s body that often leaves a mark or causes tissue damage and can include cutting, burning, picking of skin or re-opening wounds, self-biting, scratching, head-banging, hair pulling, hitting self, piercing skin or breaking bones.

The behavior frequently occurs among adolescent females, children with a history of abuse (physical or sexual), children with neurodevelopmental delays, mental health disorders (substance abuse, OCD and eating disorders), individuals with poor support network, conflicted interpersonal relationships, prior history of non-suicidal self-injury, and depressive triad (helplessness, hopelessness, worthlessness).

Although the act involves pain, many who self-harm say that they feel no pain at the time, due in part to the role of endorphins, neurotransmitters that provide an adrenaline rush. However, the behavior is often followed by feelings of guilt or shame.

Understanding self-injurious behaviors is critical. Because they are used to regulate intense negative emotions, engaging in self-harm can sometimes increase the risk of engaging in suicidal behaviors.

Often, an adolescent self-harms in discrete places on the body where they can be easily hidden, but signs of non-suicidal self-injury can also be indiscrete. Any changes in behavior that can be a warning sign that a child needs help.

Additional warning signs involve scars that appear unnatural (i.e., lined patterns on the arm or wrist), frequent reports of accidental injury, increase in conflicts with friends or family members, prior history of non-suicidal self-injury, feelings of helplessness, hopelessness, and worthlessness, becoming more withdrawn, increase in impulsivity, and wearing long sleeve shirts or pants in hot environments.

Here are some techniques to support an adolescents who may be engaging in self-harm:

  1. They may choose to withdraw from friends and family. Approach them in a non-judgmental way and attentively listen to them about the triggers for self-injury.
  2. It is okay to explain the reasons that you may not understand the behavior, but that you are there to learn and help them anyway. Acknowledging and validating their feelings is a good starting point.
  3. Refrain from telling them to stop. Expressing concern may be a more supportive way to encourage them to seek help from a professional.
  4. Not talking about the behavior may cause the individual to feel further guilty or ashamed.
  5. Be sensitive, remain sincere and avoid making jokes, which is a common coping mechanism when uncomfortable.
  6. Continue to demonstrate ongoing concern and support. Attempt to avoid drawing attention to scars in public, only discussing the topic in private.
  7. Remove access to sharp objects or medications, even over-the-counter medications.
  8. Have the child or adolescent be evaluated by their pediatrician, who can refer them to a trained mental health professional in the community.

When a clinician is able to identify the purpose of the unhealthy coping strategy, the team and the family can help the youth develop more positive coping mechanisms or challenge negative emotions or thoughts. Recovery requires parent and family participation so they can also learn beneficial coping strategies to help build the child or adolescent’s self-esteem and emotional regulation skills.

One of our patients who received psychotherapy at Lee Community Health’s behavioral health outpatient clinic affiliated with Golisano Children’s Hospital started non suicidal self-injury at age 12, triggered by multiple traumatic events in her life. She said she engaged in these behaviors to “deal with her sadness and worry.” She described being numb to the world. “Cutting is the only time I feel alive.” “I’m afraid of myself, but I am also afraid of what will happen if I tell anyone how I feel.”

Within therapy, she was able to identify triggers to her emotions and learned to identify and manage feelings of sadness and angst. She was able to learn to redirect negative thoughts. Most importantly, she continues to use healthy coping strategies and has not experienced a suicide attempt or non-suicidal self-injury for nearly two years.

You can help us enhance and expand programs in our community to reach children who are struggling by becoming an advocate today!