QUESTION: I have just discovered that my 16-year-old daughter has been harming herself by cutting her arms. I had noticed some marks, which she tried to explain away before finally admitting it. She says she does not know why she does it but that she just gets so frustrated about things. My husband and I are very upset about it as we did not know anything was wrong. She has always been a responsible girl who studies hard in school. Though she can be quite shy and doesn’t have a big circle of friends, we didn’t think she was so unhappy.
Since the new year, she has become more withdrawn and down in the dumps and now it seems she had a falling out with her main friend in school. We have taken her to our GP and he has referred us to an adolescent mental health service and we are waiting for this. What is the best way to manage in the meantime? My husband and I are very concerned and feel we are walking on eggshells as we are worried she might self-harm again or do something more serious.
There are lots of different reasons as to why teenagers engage in self-harming behaviour such as cutting their arms. Usually, it is a sign of distress or a call out for attention because some part of their life is not going well.
Frequently, it can be a way of managing stress and relieving frustration – instead of getting angry or hitting out, young people can take their negative feelings out on themselves by self-harming.
For some young people, self-harm can be in the context of being isolated or feeling low or having poor self-esteem and for many self-harming behaviour can become a habitual way of coping with difficult stresses.
Does the self-harming behaviour mean my child is suicidal?
When researchers survey young people after an episode of self-harm, only a small group report being suicidal or having a wish to die. Not all children who harm themselves are suicidal but children who self-harm are at a higher risk of going on to be suicidal if their distress escalates.
As a result, it is important to take your daughter’s behaviour seriously and to try to tune into what might be going on for her. Be aware of the danger signs of her becoming more distressed or suicidal such as her mood deteriorating, or if she becomes more isolated or if she expresses an intention to harm herself. Be prepared to seek emergency support from services as needed.
Encourage her to express her feelings rather than self-harm
Often self-harm is a symptom of negative feelings turned inward rather than expressed. It can help a great deal if young people who are self-harming can talk about their feelings and what is going on in their minds.
Though it must have been very distressing for you to discover that your daughter was self-harming, at least it means that her unhappiness is now out in the open and it can open a new level of communication between you.
It can be very hard for young people who harm themselves, so encourage her to talk more about her feelings and what is on her mind. Sometimes asking her to write things down and even to email you how she is feeling can help.
Address underlying issues where possible
When possible empower your daughter to address the issues in her life that make her unhappy. If she is open, set time aside to problem solve with her as to how she might repair her lost friendship or make new friends.
What hobbies, activities or interests could you encourage her to take up now that might boost her self-esteem and confidence? Even taking small active steps to change things in her life will make her feel a lot better. Have a look at the other articles on self-esteem and friendships on this website.
Explore other strategies for coping
Encourage her to have strategies other than self-harm that can help her cope when she experiences distress or frustration such as noticing “trigger situations” and telling someone when she feels down or doing something active like taking a walk or learning relaxation techniques.
Encourage her to take up a relaxation or yoga class or anything else that might help her learn good coping skills. If she is open, you could even do a class together so you could be there to support her.
Be vigilant and supervise
As well as being supportive and encouraging, it is important to keep your eyes open and to take steps to supervise her and to be vigilant about when she might be getting low or experiencing a trigger for self-harm.
Recognise that she might need some extra support and attention at the moment. It can be helpful to try to get an agreement from her that she will tell you when she feels at risk, so that you can talk to her about her options.
Seek professional support
You are on a list for professional support and it is important to pursue this. As well as HSE mental health services, there are lots of voluntary sector services for young people who might be suicidal and their families, such as those provided by Pieta house – www.pieta.ie.
Lots of different types of support could help such as individual counselling for your daughter to help her express her feelings and learn alternative coping strategies as well as therapy for the whole family to help you increase positive communication and support.
You also may find it beneficial to attend a parenting group such as the Space programme which is specifically for parents of children who have self-harmed and is run by Temple Street children’s hospital in Dublin (email firstname.lastname@example.org). There is also a great Irish book for parents – A Short Introduction to Understanding and Supporting Children and Young People Who Self-Harm – by Prof Carol Fitzpatrick.