Self-Harm Behavior among Children and Adolescents

​​​Self-harm occurs when an individual hurts oneself on purpose. Self-harm may first occur at the transition between childhood to adolescence. Around this time, adolescents begin to think more about their feelings, pay more attention to peers’ behaviors and place more of an emphasis on fitting in. Boys Town Center for Behavioral Health shares information to help prevent and respond to self-harm.

• Transcript

  Self-Harm Behaviors

  Self-harm behaviors are not as common as some of the other concerns we see, like depression, anxiety, kind of acting out behaviors, but I would say that pretty much all the clinicians have a few adolescents on their caseload whom they are treating for self-harm.

  At what age do you start seeing self-harm behavior?

  ​We usually see them start coming up around ages ten or eleven, that's when you're going to think of most kids are transitioning into adolescence and they are able to think a little bit more about their feelings.  They are more concerned about what their friends are thinking about them, and just a little bit more aware of how they may or may not be fitting in.  That becomes pretty important.

  What are the warning signs?

  If you notice your teen is really isolating themselves a lot, so if they are spending more and more time alone in their bedroom.  They are wearing long sleeves or they are really working hard to cover up different limbs or different parts of their body.  For females and for males you might see a large amount of bracelets being worn so they can cover up areas like their wrists.​

  Why do kids self-harm?

  For some kids it's a way for them to communicate how pain they are going through.  It may be really difficult for them to put into words what they are experiencing but they might be able to inflict pain or other wounds to kind of show people that this is what I'm going though. 

  Sometimes kids self-harm because they want to feel like they are part of a group.  They might self-harm so that they can talk to other friends who are self-harming about it. 

  Then the third reason it's a way to manage emotional pain.  So a lot of research has found that when teens inflict physical pain on themselves it can provide relief from emotional pain.

  What can parents do to help their child?

  My advice to them is always to try to be as matter of fact as possible, and keep it short and simple when you're talking to your teen about self-harm.  So your goal should be to communicate to them  I want to support you and I want help you find new ways of coping with what's going on.

  I tend to think of self-harm as more of a symptom of other things going on and it's not necessarily the main thing you want to focus on.  We really work on helping them build new skills so that they feel like they have better ways of managing their emotions helping them develop positive relationships with their peers or with their family and helping them become more involved in things that are important to them in their life.​​​​

How is self-harm prevented?

The first step in addressing self-harm is educating parents. Upon discovering that their adolescent is self-harming, parents may become deeply concerned and wonder if their child is thinking of suicide. It is important to know that self-harm and suicide are two distinct concerns and one does not always imply the other will happen. Understandably, many parents want to understand why their son or daughter is self-harming. Children and adolescents may self-harm for a number of reasons. Below are three common reasons why some self-harm:

• Communication. An adolescent may try to communicate to others that she is experiencing emotional p​ain. In this case, the cuts may be on wrists or other visible areas and the individual may not try to conceal them.
• Belonging. Engaging in self-harm may give individuals a sense of belonging if they spend time with peers who also self-harm. For example, individuals who are seeking a sense of belonging through self-harm may talk about cutting or may take pictures of their cuts and share them through social media. This shared interest may give adolescents a sense of belonging and acceptance that can be appealing.
• Emotional pain. Some may self-harm to manage emotional pain. Research has found that adolescents who self-harm to manage emotional pain report that they feel better after cutting. Those who self-harm for this reason may hide it for months before it is discovered and often do not want others to know.

The examples above suggest that self-harm is often maintained by the responses from others or by skill deficits in managing emotions. Therefore, self-harm can be treated by modifying the responses and by teaching skills to better manage emotions.

What are the signs of self-harm?

Signs of self-harm may include isolation, staying up much later than the rest of the family, taking long showers, frequent disappearance of sharp or other objects, wearing long sleeves all year long, wearing several bracelets at once, other behaviors that indicate resistance to showing skin, telling others about self-harming, or sharing pictures of cuts or wounds through social media.

• Direct self-harm. Direct self-harm behaviors include cutting with sharp objects, razors, knives, scissors, burning with a lighter or hair straightener, hitting, scratching, etc.
• Indirect self-harm. Indirect behaviors may include risky sexual behavior, eating disorders, alcohol and drug use, etc.

How to talk to your child about self-harm:

• Open discussions. Self-harm can be difficult to discuss. Parents should try to limit lectures or questions and maintain a neutral tone of voice. While parents may be experiencing strong emotions, expressing these emotions to adolescents can be overwhelming and may limit how willing they are to continue the conversation.
• Keep Routines Consistent. It may be tempting to minimize expectations, demands or instructions after you discover your adolescent is self-harming. It is important to maintain typical routines, rules and expectations. Allowing your child special concessions may inadvertently teach her that self-harming is an effective strategy for accessing wants or avoiding rules and expectations. Keeping routines and expectations consistent helps minimize the likelihood of this happening and demonstrates that you believe your adolescent can fulfill expectations and manage disappointment.
• Avoid Talk of Suicide. While talking with your child, it is important to avoid suicide terminology or to assume that they are having suicidal thoughts. Focusing on suicide may interfere with problem solving. That being said, you want to ensure your adolescent is safe. If you have any concerns that she may seriously harm herself, you should take her to the emergency room.

How to manage behavior and begin to move forward:

• Balance. It is important to maintain a balance. All adolescents need privacy and benefit from opportunities to earn trust. Requiring body checks, removing the door from his room and other strategies may be perceived as invasive and may further complicate your relationship with him.
• Monitor access to sharp objects. Have your adolescent check out and turn in sharp objects such as razors after use.
• Reward good behavior. Reward the use of effective coping strategies. Encourage improvement and involvement in daily life activities.

Self-harm often occurs within the context of other concerns such as depression, anxiety, risk-taking, eating disorders or oppositional behavior. If these concerns are interfering with your child’s relationships, interest in activities, and academic performance, talk with your primary care physician about a referral for behavioral health services.