By Kristy Champignon, L.P.C., L.M.H.C., A.C.S.
The tween and early teen years are a time of change, growth and discovery, often filled with intense emotions.
To cope with these emotions, an increasing number of children in this age group are turning to non-suicidal self-injury, deliberately hurting themselves to provide relief or express themselves.
In fact, a recent study found that emergency room visits for nonfatal, self-inflicted injury among boys ages 10-14 increased by 93% between 2001-2015. For girls, this rate increased by 261%.
Additionally, substantial increases were seen in teens ages 15-19, especially girls.
Penn Medicine Princeton House Behavioral Health, through its child and adolescent programs, provides treatment for children and teens who self-harm as a mechanism for dealing with intense emotions. Treatment is focused on improving the management of emotions, decreasing impulsive behaviors and learning healthier ways to communicate needs.
What is self-injury?
Non-suicidal self-injury is the deliberate destruction of one’s own body tissue without suicidal intent. Common forms of non-suicidal self-injury include:
- Cutting
- Burning
- Scratching
- Blunt injury (e.g. punching)
- Friction or rubbing
- Interfering with healing
The most common places for self-injury include:
- Arms and wrists
- Upper leg
- Torso
Why do children and teens self-injure?
Some instances of self-injury are communicative in nature: a way to ask for support or express the intensity of how they feel. In other cases, self-injury can serve the purpose to generate a feeling when tweens and teens feel numb or feel as though they need to punish themselves. Additionally, young people may be using self-injury to replacing or distract from intense emotional pain, which is sometimes difficult or confusing to understand and manage, with a physical pain they can control.
There is also a biological component to self-injurious behavior.
The brain registers both emotional and physical pain in the same two areas: the anterior insula and the anterior cingulate cortex. The onset of physical pain brings discomfort, but the removal of the pain stimulus provides the more pleasant experience of relief.
Because of some degree of neural overlap, this relief is sensed for both physical and emotional pain. Through self-injury, a child may inflict pain to find relief from an array of confusing, self-questioning emotions or from coexisting conditions like depression and anxiety.
Further, tweens and teens are more frequently seeing self-injury as a viable option via their peers, social media, television and music. It can quickly become a vicious cycle if they experiment with self-injury and then begin to rely on it for relief.
Who is at risk?
A 2008 research study showed that between 1/3 and 1/2 of adolescents in the United States have engaged in some form of self-injury, starting on average between ages 12-14.
While both boys and girls are at risk, girls are more likely to engage in self-injury than boys, with 9th grade girls three times more likely to self-injure than their male counterparts. There is also a higher risk for self-injury in the LGBTQ community.
In addition, young people who exhibit the following characteristics may be at greater risk for self-injury:
- Intense emotion without regulation
- Challenges with communicating thoughts, feelings and needs effectively
- Lack of skills for tolerating stressful situations
Moreover, common threads among young people who self-injure are the absence of feeling validated at home as well as high parental criticism.
Self-injury may also coincide among mental health conditions such as depression, anxiety, trauma, eating disorders and substance abuse.
What should parents look for?
Typically, there are clear physical signs of self-injury, though often they can be easily covered up or dismissed. Signs include:
- Unexplained bruises, cuts or scratches
- Body shyness
- No longer taking care of one’s self, not showering or brushing one’s hair
- Wearing long pants or long sleeves in warm weather
- Avoiding activities that would require showing areas that were injured, such as swimming
Additionally, parents should also look for emotional signs of self-injury risks such as mood dysregulation, high levels of stress and lack of communication regarding their child’s thoughts and feelings.
What else can parents do?
If you are concerned that your child may be self-injuring, talk to them. Parents can support their children by validating their feelings and demonstrating a respectful curiosity.
Rather than trying to “fix” how the child is feeling, parents can actively listen to their child and offer support in a non-threatening and non-judgmental manner. Parents can avoid the urge to problem-solve and instead suggest healthy ways to cope with emotions like going for a run, taking a bath or listening to music.
In some cases, professional treatment is necessary to help stop the behavior and equip children with the necessary tools they need to manage their emotions in a healthy way.
What is dialectical behavior therapy?
Dialectical behavior therapy (DBT) is a proven treatment approach for children and adolescents engaging in self-injury. DBT focuses on four areas:
- Mindfulness to build an awareness of thoughts and feeling that may influence self-injury.
- Distress tolerance to increase resilience and effective coping during times of stress or anticipated stress.
- Emotion regulation to increase understanding of emotions, decrease emotional suffering, reduce emotional vulnerability, and stop debilitating or ineffective emotions from starting.
- Interpersonal effectiveness to improve expression and communication of needs while respecting one’s own and others’ boundaries.
At Princeton House Behavioral Health, therapists teach DBT skills ranging from cope-ahead plans and effective communication techniques to building a toolbox of options that young people can use in moments of distress.
Through the use of DBT, young people learn that no matter how difficult things may seem, there are safe, healthy ways to address emotional pain and find relief.
Princeton House offers partial hospital programs from 9:30 a.m. to 3:30 p.m. five days per week and intensive outpatient half day programming three days per week. Depending on the site and track of treatment, some programming is offered after school.
Lunch is provided for full-day programs, and free transportation may be available within defined areas.
For more information about child and adolescent programs at Penn Medicine Princeton House Behavioral Health, call 1-888-437-1610 or visit princetonhouse.org.
Kristy Champignon, L.P.C., L.M.H.C., A.C.S., is a licensed mental health counselor and approved clinical supervisor. She is the adolescent and child clinical manager at Penn Medicine Princeton House Behavioral Health’s Hamilton site.