Understanding Self-Harm

What is self-harm?

Who self-harms?

Why do teens self-harm?

Is a teen who self-harms also suicidal?

What can be done about a teen who is self-harming?

Are there suggestions for working with a therapist?

What is self-harm?
Non-fatal intentional behavior that results in actual tissue damage, illness or risk of death.

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Who self-harms?
Self-harm is correlated with the following behavior/symptoms, but is NOT caused by these:

depression loneliness/isolation hopelessness perfectionism impulsivity impaired family communication

anxiety self-blaming low self-esteem hypercritical parents awareness of self-harm by peers

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Why do teens self-harm?
Reasons vary, but tend to fall into one of these categories:

• to stop bad feelings
• to feel something
• to avoid doing something unpleasant
• to get a reaction

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Is a teen who self-harms also suicidal?
Typically teens who self-harm are trying to feel better, while a teen who attempts suicide is trying to end all feelings, BUT...
The intent of the behavior can vary and needs to be assessed. Self-harm can be a risk factor for suicide; the higher the frequency of self-harm, the greater the risk for suicide.

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What can be done about a teen who is self-harming?

• Don't react with criticism or horror
• Remain non-judgmental; let the teen know that you care
• Understand that the behavior is a coping mechanism
• Validate the emotion that triggered the behavior, not the behavior
• Get professional help that will provide the teen greater insight into their emotional states and replace the self-harming behavior with effective coping skills (see below, questions for interviewing and selecting a therapist)

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Suggested Interview Questions for Therapist

1. Have you previously treated children and/or adolescents who were cutting or intentionally hurting themselves?
2. If so, what is your theoretical orientation to treating this behavior?
3. How do you involve parents/guardian in the treatment?
4. How do you balance confidentiality between the patient and the parent?
5. Do you tend to recommend medication for the teens that you are treating for self-harm?

Whatever their theoretical approach, the therapist should be able to explain it to you in a specific, understandable fashion. Preferably their approach is focused less on understanding why your child is engaged in self-harming behavior and more on teaching and reinforcing coping skills.

If the therapy is not making sense to you or if you feel that your child is not making adequate progress, talk with the therapist. Be an advocate for your child and consider interviewing and selecting another therapist. The first therapist may not be a “match” with your child.

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