According to a recent study in the British Medical Journal (BMJ)1, a 68% increase in self-harm incidence was found amongst girls aged 13-16 between 2011 and 2014 in the UK, with an annual incidence of 77 per 10,000 (or 0.77%) in that specific group of age. The study also highlights that self-harm is the strongest risk factor for subsequent suicide, with suicide being the second most common cause of death before age 25 worldwide. According to the authors, these revealing results indicate an “urgent need to develop and implement effective interventions for girls in their early-mid teens”.
The Children and Young Person’s Service at Re:Cognition Health was established to help diagnose and treat a wide range of mental health conditions affecting children and adolescents, a big concern which, according to Public Health England 2016, up to 1 in 10 or 11 young people between the ages of 5 to 16 years suffer from a diagnosable mental health illness.
Dr Maite Ferrin, Consultant Psychiatrist at Re:Cognition Health has vast experience in treating children and adolescents with all types of mild and more severe psychiatric conditions including depression and self-harm. Below she shares her insight on the growing concern with advice on dealing with the issue:
Self-harm is described as “any intentional act causing physical injuries to oneself without a clear intention to die”. It can include superficial cutting (with a knife or razor), scratching or hitting oneself, and intentional drug overdose. Many young people who self-harm use more than one method of self-injury, and some of them do it on a regular basis, while others do it more sporadically.
Self-harm is an adaptive coping mechanism to deal with any stressor in life including school difficulties or bullying, however it might also reflect a more impairing psychological condition including anxiety, depression or PTSD. Different reasons have been described, including affect regulation (e.g., an attempt to alleviate emotional pain that cannot be expressed verbally), self-punishment (e.g., an attempt to relieve feelings of shame or guilt) or anti-dissociation (e.g. an attempt to stop feeling numb), just to name a few.
Although self-harm is done without suicidal ideation, it can eventually lead to fatality. In fact, according to the BMJ study, young people who self-harmed were almost nine times more likely to die due to suicide or accidentally fatal acute alcohol/drug poisoning.
Further, the behaviour is positively reinforced through feelings of relief, satisfaction and reduction of anxiety levels, and might therefore predispose to vicious cycles and increasingly more risky behaviours, while it will impede young people to develop more effective and adaptive coping skills to regulate emotions and tolerate distress.
If you suspect an adolescent patient is engaging in deliberate self-harm:
Bear in mind that a majority of young people with self-harm feel ashamed of the act and that they often worry about the negative judgement of others, including their family members. An initial empathetic approach is usually recommended.
Empathic listening consists of listening so that the other person is encouraged to talk; this is especially important for young people with self-harm, who often feel unheard and misunderstood. We should create a safe space for them to freely discuss their problems without interruption so that they are more able to disclose their own problems.
Simple empathic responses, such as “sounds like things have been quite tough for you” that withhold negative judgements of their self-harm so they can validate their emotional experiences.
Offer the young person some hope and support “thank you for sharing this with me. Let’s think about how we can make you feel better”
Basic tips for parents of young people with self-harm tendencies:
• Remain calm and validate their emotions and struggles
• Do not push the young person to talk if they do not feel comfortable to
• Do not punish or minimise their feelings or the self-harm act as this may deepen guilt or shame
• Focus on the underlying struggles rather than the act of self-harm
• Encourage healthy ways of coping with stress
• Reinforce the young person’s strengths
• Do not expect or seek a quick fix for the self-harm behaviour
• Allow them time to learn alternative healthier coping mechanisms to replace the self-harm behaviours
• Seek assistance and support from school counsellors, child and adolescent psychiatrists or psychologists, social workers or counselling centres
• Finally, when an underlying psychiatric condition is suspected (e.g. anxiety, depression, PTSD, etc), or for those who have poor responses to initial approaches earlier described, a referral to a specialist might need to be considered.