Understanding self-harm amongst young people and how to prevent it!

Having your child or adolescent deliberately self-harm is the psychological issue which many parents or carers fear most. The term deliberate self-harm describes any non-fatal physically injurious act in which a young person deliberately engages, and includes a medication overdose, cutting and scalding. Sometimes a young person’s self-harm may be a consequence of a primary psychological condition. For example, young people on the autistic spectrum may engage in self-harming behaviours such as head banging and pica (eating of non-food items) as an aspect of their condition. However, deliberate self-harm more often represents a young person’s way of coping with emotional and social issues in their lives which they experience as overwhelming.

Parents and professionals supporting young people need to understand the risk factors which make self-harm more likely.   Deliberate self-harm is more common amongst secondary school aged young people than younger children. Self-harm also occurs more frequently among young people who experience a psychological difficulty such as anxiety, depression or conduct disorder than among young people who do not experience behavioural and emotional problems.

For example, a 2005 national representative survey of 10,000 young people in the UK found that 18.8% of adolescents diagnosed with a depressive disorder engaged in self-harm. There are also gender differences, with self-harm being four times more common among female adolescents than males.

Self-harm is more common amongst young people who experience significant family difficulties and maltreatment. This can include people who have spent some or most of their childhoods cared for by relatives other than their parents, or who have been placed in adoptive, foster and residential care because of family difficulties. Sometimes this alternative care has not fully met young people’s emotional needs.

These young people and adults have often experienced physical, sexual, emotional abuse or neglect and may have been exposed to difficulties within their families such as parental mental health problems, substance abuse and domestic violence with which they were developmentally and emotionally unable to cope with as young people.    

Young people in social services and those placed within secure institutions are at particularly high risk of developing a pattern of deliberate self-harming behaviour as a strategy for coping with emotional and social difficulties within their lives particularly when emotional support is unavailable from adults to assist them with the family issues which have damaged their lives.

Young people are also more likely to self-harm when they and their families experience economic difficulties which damage their physical and emotional health. Sometimes parents believe that issues such as unemployment, debt and poverty primarily affect adults but the impact upon young people can be devastating.

The 2014 Birmingham Child Poverty Review found that there has been a 40% rise in deliberate self-harm amongst young people because of economic austerity. Those young people growing up in families who have experienced significant welfare cuts were most likely to self-harm. Adults working with such young people need to be committed to offering outreach practical and emotional support to these young people to reduce the likelihood of them becoming involved in a destructive cycle of self-harm.  

Young people who experience difficulties which cause them to feel isolated from their peers or alienated from the family unit in which they live are also at heightened risk of deliberate self-harm.  Examples of such issues include bullying, concerns about sexuality, and experiencing fractious relationships with parents or stepparents. 

Parents or caregivers experiencing an acrimonious divorce or separation from a partner who is the parent or served as a parent figure to their child need to understand what a stressful life event personal relationship breakdown can be for young people in the family. Engaging in deliberate self-harm is sometimes the coping strategy which young people choose to communicate their distress about family relationships which are not meeting their emotional needs.   

Parents experiencing personal relationship breakdown should be open to attending services such as mediation and family counselling which are able to help both young people and adults to cope with the emotional trauma of relationship breakdown. It can also help parents to move forward after separation in establishing positive co-parenting relationships which place the needs of their young people as the central focus within the family. 

Parents, carers and professionals supporting young people who deliberately self-harm should understand that acts such as cutting and overdosing are often very impulsive without any conscious intention on the part of the young person to end their life. Young people often describe such acts as a cry for help. This is very different to similar acts of self-harm amongst adults when there is more often a plan on the part of individuals to end their lives. 

Young people who self-harm are often communicating their emotional distress about their lives to those around them rather than attempting to end their lives. Interestingly, a significant minority of young people who deliberately self-harm do not regard their behaviour as in any way problematic because they perceive their behaviour as a form of personal anxiety relief which does not harm anyone else. It is not suggested however that deliberate self-harm amongst young people should not be viewed seriously as there is less often an intention on the part of the child or adolescent to end their life.

Unfortunately because many young people do engage in self-harm on the spur of the moment with little or no thought for the consequences, some young people place themselves at critical risk. Male young people, while engaging in self-harm less often than females, are known as a group to use more lethal means such as hanging - placing them at greater risk of actually committing suicide. 

Sadly many young people who self-harm do not enjoy a confiding relationship with an adult and often discuss their problems with a same aged friend who may feel over-whelmed by their difficulties. It is this emotional distance between young people and adults which needs to be bridged to reduce the incidence of self-harm.

Innovative new approaches such as the Social and Emotional Aspects of Learning (SEAL) group counselling project are helping young people to talk about their feelings from an early age within schools. If we prioritise providing space to allow young people to talk about their feelings within schools, home and elsewhere in the community so that both they and we have a greater understanding of their feelings and are more confident in our ability to support young people with emotional difficulties (including seeking psychological counselling or therapy when appropriate) at an earlier stage before a young person self-harms, then over the long term we will be able to reduce the frequency of self-harm amongst young people.