In clinical psychology or mental health realms, when a young person deliberately causes harm to him or herself as a way of managing or communicating distress to others, we refer to this as self harm.  Self harm in times of distress most commonly includes cutting, burning, re-opening old wounds or head banging and the results can be superficial or very extreme and requiring hospitalisation. Self harm can also co-occur with other distressing conditions such as depression, anxiety, substance use and eating disorders. Whilst not all young people who self harm are suicidal, there is definitely an overlap and when someone is self harming, especially when they are causing extreme damage to themselves, there is an increased chance of accidental death.  So, it is incredibly important that any sort of self harm by a young person is given the appropriate response.

Whilst any self harm is concerning, the latest figures on mental health and young people in Australia tell us that rates of self harm are dramatically increasing.

If we look at people who have injured themselves and needed hospitalisation, the figures show that between 1996−97 and 2005−06, the hospitalisation rate for intentional self-harm among young people increased by 43{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de}, from 138 per 100,000 young people to 197. In 2010-2011, that number had increased to well over 600 per 100,000 young people.

Recently, the results of ‘Second Australian Child and Adolescent survey of Mental Health and Well-Being’ that surveyed over 6300 families and youths aged 4-17 were released.

As many as one in 10 teenagers – or about 186,000 – had engaged in some form of self-harm in their life, including a staggering quarter of teenage girls aged 16-17

….and those are the figures that those surveyed were willing to speak up about – Self harm is a very private behaviour that people may be reluctant to report.

Self harm can cause significant, long lasting body issues and it can also be really hard on friends, family and those who are aware of the self harm, but may feel powerless to stop a young person from hurting themself in that way.

When we look to the research to help us understand the problem of self harm the research includes mostly small studies. It also tells us that young people who self harm are a really diverse group and difficult to clump together. This heterogeneity means that what works for one young person who self harms may not work for another.  That means, we really need to carefully assess and understand each person who is self harming and find out what purpose it serves for them and then, how best to help them.

Self harm can serve many purposes for a young person.

It can be the way they:

• regulate strong unpleasant feeling
• control feelings of numbness or bring themselves back when they feel disengaged from their lives (dissociation)
• test to see if they could suicide or kill themselves
• try to feel in control over something
• deal with internal conflict
• re-directed aggression – if they are not comfortable being angry with others, sometimes they can turn that onto themselves
• communicate and try to control of others
• express and try to get rid of shame or guilt
• seek out strong sensations or risk
• deal with an underlying mental health or physical health condition

From my experience, I would say that it’s most likely that self harm in young people is the way they deal with negative or distressing feelings, especially when they themselves feel like nobody cares about them.

When you think about it, just about anyone is capable of self harm.  So – what stops us?

Most of us would have lots of barriers in place or lots of reason why we would not want to harm themselves – it hurts, it’s messy, it can scar, it would upset others or we might be concerned about what other people might think.

For a young person to harm and hurt themselves, one of the first things they need to do is push those internal barriers away.

The normal barriers that prevent us from hurting ourselves, can be overcome by a range of things and some in combination:

• Alcohol and drugs can lower lots of barriers for lots of people. If a young person is drunk or under the influence of a substance that alters their thinking, they can push past the rational and logical reasons that would normally stop them form doing something.
• Religion or cult involvement may sometimes encourage a young person to push themselves past lots of different barriers in order to reach some higher level of status or to be closer to a deity.
• Impulsivity can mean that people can act without thinking. They can rush in and do things that they later regret because their ability to control and urge or an impulse is compromised
• Grief can mean overwhelming emotions or a blunting of emotions. If they are overwhelming enough or sufficiently numbing, a young person may be able to push past the reasons not to self harm in an attempt to (in the case or overwhelming emotion) seek relief or (in the case of numbing) “feel” things again.
• Social influences are especially strong for young people. If they want to fit into a group that are also hurting themselves, they may push past the rational reasons to seek a sense of belonging.  Sadly, there are numerous social media sites that encourage self harm or depict self harm as fashionable or darkly mysterious.
• Practice can push away barriers to self harm. If a young person has previously experienced lots of piercing, tattoos or other experiences that involve discomfort in order for a specific outcome, it can be easier for them to push past the pain involved in self harm.
• Being able to switch off from feelings can make it easier to decide to harm yourself. Switching off from feelings or dissociation can be something that young people learn to do if they have been in abusive or traumatic circumstances before.  It’s not always a conscious choice to switch off, but if they have dissociated before, then they can switch off again at other times.  That means they can switch off the reasons for not harming themselves.

When we are trying to help and support a young person who is self harming, we need to understand the purpose self harm has for them and how they push themselves past the internal barriers that would normally prevent them from self harm.

Self harm is often very private and very hard for young people to talk about.  Help is best left to qualified professionals, but – if you are a first responder – need to look at the safety needs first and avoid a million probing questions….those are best left til later, calmer and more professional circumstances.  I love this advice from Cornell about “respectful curiosity” and I’d encourage you to read it.

Professional treatment will consider the underlying concerns and the functions and put in place a safety plan for the young person.  Good treatment should assess dangerousness, suicidality and then go about trying to assist the person to be safer, to deal with problems that can be dealt with (problem solve), learn to communicate with others, learn to understand and sit with big emotions, and find other ways of dealing with distress.

Clearly, self harm in young people is not something to muck about with or to ignore.

For 24 hour support or crisis help:

• Lifeline 13 11 14
• Beyond Blue 1300 224636
• Your local emergency services and hospital

For treatment, contact your GP or a registered Psychologist

For resources on how to help a friend… try this from Cornell.  If self harm is an issue at your school, or amongst the young people you care for, I’d love to come and talk with you some more to help you to help.