Colman Noctor: Worrying rise in self-harm among young people 

In my practice, I have also observed an increase in self-harm in children and adolescents. And discussions around using self-harm as a coping strategy have become more commonplace in my interactions with young people.

Worryingly, like most other mental health presentations, self-harm is featured much earlier in childhood than before.

The reason for this rising trajectory is largely unknown. We can assume that access to social media and the evolution of technological communication have a role to play. The increasing pressure on children to excel in everything they do — like academics and sports — also contributes to the mental health crisis. And we cannot underestimate the impact of pandemic disruption on their social and emotional development.

Self-harm is an indicator of deep distress, and some parents will respond by immediately taking their child to the GP or A&E department. It is likely they assume self-harm is a gateway behaviour to suicidal attempts and want to address the behaviour urgently. While the association between self-harm and suicidal behaviour is well-known and accurate in some cases, this is not always the case.

For many children and young people, self-harm serves a different purpose — it is a coping strategy. Perhaps a young person is a victim of social exclusion in their peer group and they feel powerless to do anything about it without making things worse. Or maybe a young person is struggling to keep up with their parent’s expectations and they feel overwhelmed and stuck. These stressful experiences can lead a child to resort to self-harm to cope.

Other parents may worry that attending the GP or A&E would stigmatise the child or ‘feed into’ the behaviour and minimise their reaction to the self-harm. They may believe the source of the behaviour is part of a fashionable fad doing the rounds among the child’s peer group and decide the less attention paid to it, the better the outcome. While this may be true in some instances, it is not valid in all cases, so this approach may not be optimal.

It is essential to allow your child to discuss the origins of their distress as a first step, so an open and measured approach is recommended. This discussion will better inform you about the reason for the self-harm behaviour and help guide your response.

Signpost to the problem

To understand self-harm, we need to see it as a signpost to the problem, not the problem itself. In my experience, there are multiple reasons why young people engage in self-harming. For some, it is a means of making emotional pain visible and tangible; for others, it is an emotional release that offers some relief from their emotional and psychological distress and can become addictive.

Many young people have told me over the years how they had experimented with self-harm, but they gained no relief from doing it, so they stopped. However, others described using it as a way to release pent-up
emotions. In many cases, it developed into a pattern of behaviour that became their unhealthy ‘go-to’ strategy for coping with life’s stressors.

Self-harm remains recognised as one of the strongest predictors of suicide and we should never treat it lightly. It is also essential to understand that self-harm can have other functions and this is reflected in research — the numbers of young people who engage in self-harm are vastly greater than those who take their own lives.

Research carried out by Sedegewick, Epstein, and Ougrin as part of the UK’s Association of Child and Adolescent Mental Health suggests we need to recognise the complex nature of these behaviours and refer to constructs like ‘non-suicidal self-injury (NSSI)’ and suicide attempts.

Whether an act of self-harm was used as an attempt to end one’s life or a means of trying to cope, control, or communicate is an important distinction.

Some young people will experience gratification from acts of self-harm which are used, not unlike substances, to cope with stressful life events. Other young people use self-harm as a form of control. When they feel overwhelmed and have no influence over what is happening to them, exerting control over something gives them a sense of autonomy over their lives. And sometimes young people engage in self-harm to communicate to those around them that ‘this is how bad I feel’. Often in the absence of an emotional vocabulary, self-harm is a literal form of writing the pain on their bodies.

While much self-harm is done in secret and in places on the body where it can go undetected, like the upper thighs, other forms of self-harm are not, and many young people describe a sense of relief when a friend or family member notices their injuries.

Open up the conversation

So what should you do if your child tells you they have been engaging in self-harm or if you come across marks or scratches on their body? Keep your emotions in check. When a young person is experiencing psychological turmoil, the priority is to open up the conversation and give them the freedom to talk about their feelings. Hysteria can only serve the purpose of shutting down the discussion. However, minimising the seriousness of the behaviour is not advisable.

The key is to not focus solely on the self-harm but the origin of their distress. There is little value in paying attention to the signpost and not looking where it is pointing. Encourage your child to discuss the emotions that led to self-harm. Explore ways in which you can support them to find alternative ways of coping with this distress. Self-harm occurs in response to adverse experiences in the child’s life and if we can address the source of that distress, the destructive behaviour is likely to stop.

Be open in your discussions and listen closely to what the child says. You can validate their distress without condoning their behaviour. Striking this balance will encourage your child to discuss their emotional pain with you and hopefully seek support when things get difficult, instead of trying to manage it alone.

Once parents have explored the meaning of the behaviour with their child, the next step is to seek professional support. Regardless of intention, a child engaging in self-harm indicates high stress levels and needs help to develop better coping mechanisms. Studies show the risk of suicide after adolescent self-harm is very low in those younger than 15 years (Hawton, Saunders, and O’Connor).

While the discovery that your child has engaged in self-harm is terrifying, if we offer prompt and skilled support, many young people will develop coping strategies to support them long after the crisis has passed.

• If you are affected by any of the issues raised in this article, please visit irishexaminer.com/helplines/list
• SpunOut, a youth mental health service and member of Mental Health Reform provides a free support messaging service on 50808, text50808.ie
• Dr Colman Noctor is a child psychotherapist