What It Means, Why It Happens, and How We Can Help
Working with children and young people, the prevalence of self-harm is sadly higher than any clinician, teacher, or parent would hope to encounter. Globally, studies estimate that between 17% and 30% of adolescents have engaged in self-harming behaviours at least once [1][2]. Rates have significantly increased in the past decade, particularly among teenage girls, and many cases still go unreported. This growing trend makes it essential and urgent to understand what self-harm really is and how we can respond, whether we’re professionals, parents, or loved ones. We can first start with some definitions and common misconceptions to better understand ‘self-harm’. At the end, we’ll explore supportive and practical ways on how to support someone who is struggling.
Self-harm & Non-Suicidal Self-Injury (NSSI): Same or different?
The two terms are often used interchangeably, especially in everyday language. However, they do carry important distinctions in clinical and research contexts:
Self-harm[3]: Used as a broad term that refers to behaviours intended to cause harm to self, regardless of the motive. In this context, the key distinction lies in the intent: regardless of the behaviour being linked to a desire to end one’s life.
Non-Suicidal Self-Injury[4]: Used to define the deliberate damage to the body-tissue with cutting, burning, scratching, hitting oneself, etc. without the intent to die.
Myths and the Need for More Conversation
Talking about suicide with my child will increase the chance of it happening: This is understandably a very difficult conversation to have with anyone, let alone your child or a loved one. However, having an open conversation, without judgement and in a sensitive way can create room for communication and could increase the possibility of seeking help for the person that could reduce the suicidal ideation[5]. Don’t be afraid of starting the conversation and don’t be afraid to seek help as a parent or a loved one supporting someone through suicidality. It certainly is not an easy topic to navigate, and you shouldn’t be going through it alone.
My child is self-harming/ talking about suicide just to get attention: The idea of self-harming to seek attention is a harmful myth that misrepresents the reality of what is actually happening. It is most commonly reported that self-harm is a way to cope with overwhelming emotions and a maladaptive strategy to feel relief[6]. In a similar theme, suicide is analysed as a drastic measure to escape from self and the intolerable misery the person is in[7]. Taking these into consideration, even if attention is a factor, using such methods as a way to communicate pain and emotional distress should always be taken seriously and should never be dismissed.
Shame & Guilt and Breaking the Cycle
Shame and guilt are quite heavy emotions we feel when we reflect on ourselves and our actions. Both shame and guilt may be experienced before, during and after self-harm which reinforces the self-harming behaviours and makes the cycle difficult to break[8]. These feelings feed a painful cycle: the person feels emotionally overwhelmed, self-harms to relieve distress, then feels shame or guilt afterwards which in turn, can trigger the urge for more self-harm. As this cycle continues, it can become a learned unhealthy coping mechanism, not because it is effective long-term, but because in that moment, it offers a sense of control, relief, or even self-punishment.
So how can we break this cycle? The most effective way of dealing with self-harm is a non-judgemental, validating and compassionate approach, not only from others but also within the self[9]. This means creating a space where the individual feels safe to express their emotions without fear of punishment or dismissal. Though it may seem like a small step, this approach is incredibly powerful and more incredibly, it’s something each of us is capable of offering.
What can I do?
As a Parent or Loved One:
- Asking instead of assuming: We all have similar but different ways on how we would like to be helped. This also holds true for your own child: even when we know our children well, we might not always know exactly what they need in moments of distress. A simple question of: ‘how can I help?’ or ‘what can I do to support you?’ goes a very long way with respecting their journey in a way that respects their pace and their needs.
- Listening instead of fixing: Seeing someone we love and care for in pain, the first instinct is to offer solutions and solve problems. Being truly present, actively listening and acknowledging the pain can be more healing than any solution that could be offered.
- Seeking help for yourself: It’s quite overwhelming and heavy to support anyone going through suicidal thoughts and self-harm. Make sure to take care of your own wellbeing during this time and reach out to someone whether this a trusted friend, support group or a professional.
As a Young Person Self-Harming:
- Power of talking: Opening up to someone you trust to talk about what you’re going through can be incredibly relieving, whether this is a close friend, a family member or a counsellor. It can lighten up the emotional load that you got used to carrying by yourself, which can be the first step in feeling less alone in this journey.
- Understanding your triggers: It might be that you don’t fully understand how these feelings build up or how overwhelming these emotions can be for you. Taking note of what tends to lead up to those urges can help you understand your patterns. By recognising these patterns, it may become easier to find alternative coping strategies.
- Talking to a professional: Having a judgement-free space to talk about what you are going through can help you hear your own thought process and explore new ways of managing these difficult feelings. Asking for help is a sign of courage. You don’t ever need to do it alone and you certainly don’t have to be in crisis to reach out for help.
Final food for thought:
If someone you love opened up to you about self-harming, how would you want them to feel in that moment? Start there.
References
Klonsky, E. D. (2009). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226–239. https://www2.psych.ubc.ca/~klonsky/publications/functions2009.pdf
Gillies, D., Christou, M. A., Dixon, A. C., Featherston, O. J., Rapti, I., Garcia-Anguita, A., … & Fazel, M. (2018). Prevalence and characteristics of self-harm in adolescents: Meta-analysis of community-based studies. Journal of the American Academy of Child & Adolescent Psychiatry, 57(10), 733–741.e10. https://doi.org/10.1016/j.jaac.2018.06.018
World Health Organization. (2022). Adolescent mental health. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
Hawton, K., Bergen, H., Casey, D., Simkin, S., Palmer, B., Cooper, J., … & Kapur, N. (2007). Self-harm in England: A tale of three cities. Multicentre study of self-harm. Social Psychiatry and Psychiatric Epidemiology, 42(7), 513–521. https://doi.org/10.1007/s00127-007-0199-7
Nock, M. K., & Favazza, A. R. (2009). Nonsuicidal self-injury: Definition and classification. In M. K. Nock (Ed.), Understanding nonsuicidal self-injury: Origins, assessment, and treatment (pp. 9–18). American Psychological Association. https://doi.org/10.1037/11875-001
Dazzi, T., Gribble, R., Wessely, S., & Fear, N. T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361–3363. https://doi.org/10.1017/S0033291714001299
