For years I have examined the reasons behind why many young people have chosen to harm themselves. Yet, during this journey I have learned that it is not about understanding why they would want to harm themselves so much, but rather what they may be trying to escape, avoid, or cope with through their acts of self-harm. Contrary to suicide, self-harm is not an attempt to take one’s life. Instead, acts of self harm serve as a way to release the buildup of emotions plaguing its young captives. Non-suicidal self-injury (NSSI), is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as the “deliberate, self-inflicted destruction of body tissue without suicidal intent and for the purposes not socially sanctioned”. NSSI includes behaviors such as cutting, biting, rubbing, and burning of skin. Its actions may also include the purposeful breaking of bones, development of eating disorders, and the addictive behaviors of alcohol, drugs, and sex.
A common misconception held about NSSI behaviors is that they are a cry for help or attention by the particular individual. Although there are a fair number of cases in which young individuals are seeking attention, NSSI is really more of a private behavior. In fact, unless the individuals reveal their scars, you will not be aware of what they are doing to their own bodies. Typically, a child who engages in NSSI behaviors will do so in a private bathroom or bedroom with no one around to observe her. Then, once she has successfully engaged in self-harm, she leaves the safety of these locations and will most likely cover the areas of harm carefully so as to not draw attention to her wounds. This is why efforts to identify adolescents who are in need of help is difficult for parents, educators, and health care professionals.
As an expert in NSSI, I am often asked by my peers how self-harm may possibly begin for many young adolescents. My answers continually evolve and vary as new research emerges, but there really is not a set answer to this question. Self-harm may begin with a simple, small cut from the razor used in the shower. Or, perhaps it began with the continual rubbing of an eraser on a student’s arm during class. Out of curiosity, the youth will initiate self-harm a second and third time to investigate the stimulus of their actions to their body. For those individuals, a trial-and-error period then occurs shortly following the initial act of self-harm. Once a preferred method of self-harm is chosen, the individual will actively seek out this form of negative behavior to alleviate her mental and emotional pain. Since she is lacking any positive coping strategies, she will continually turn to self-harm to assuage her emotional and mental pain.
The question still remains – Why? Why would someone want to continually harm themselves? In all of my research, I still have not been able to provide an easy answer in any form. Those who self harm do not typically fit into a neat little classification. In years past, I am sure that many public health officials considered this behavior to belong to the gothic community or the Kurt Cobain grunge population who seemed completely disinterested in the common way of life. However, with updated research and a sense of urgency placed upon this medical concern, it has been revealed that NSSI affects all walks of life, socioeconomic classes, races, ethnicities, and religions. There is not a specific example of an adolescent who engages in NSSI. It can affect the high school athletic and academic over-achiever as much as the forgotten girl-next-door. It haunts the transgender adolescent as much as the straight champion hockey player with a full ride to Boston College. That’s what makes NSSI so widespread and yet, hidden in the shadows of school and home hallways.
Adolescents struggle with life’s occurrences daily, yet many of them have very little positive, heathy coping strategies. Their emotional and mental pain calls to them night and day. For these adolescents, there is no silencing of the mind. It can be likened to a subway train that operates 24 hours a day. This emotional and mental “train” has little to no stopping, is inclusive of flashes of life’s pressure continually felt on your mind, heart, and chest, and is accompanied by continual thoughts that race through your brain with only seconds in between “stops”. Many of these adolescents endure this “train ride” daily as part of their norm. Each day they force themselves to wake up, struggle to put on a brave face, appear “normal”, well-adjusted, and functional, and yet they feel like a train with no stops. To these adolescents, NSSI allows them to “get off the train” by engaging in acts of cutting or burning of their skin, starvation or engorgement, drugs, alcohol, and unprotected sex.
Another image that often accompanies NSSI is that of a balloon. Many adolescents describe a buildup of daily feelings- unpleasant looks and statements from classmates and teachers alike, disgruntled friends, family members, personal trauma, and the everyday anxiety to be perfect.- to be comparative to that of filling up of a balloon. Once the balloon is so large, there is no where for the air to go, so it just explodes. To the adolescents who engage in NSSI, the actual physical action of cutting ones flesh open, even if a tiny line, is like releasing the air in the balloon. That rush of release is how they feel once they engage in an act of self-harm. For them, the balloon they have felt being blown up each day, filled with anxiety, tension, self-loathing, and further emotional pain, releases its air, deflates, ready to begin the week again, once the physical injury occurs.
So then what? Honestly, it begins all over again. Without the knowledge of how to process emotions in a socially-acceptable, healthy way, the adolescent will continue to self-harm, possibly even increasing the range of self-harm to a more severe state. Imagine, again, the balloon. Once the emotional release occurred, the balloon went back to its resting state, deflated and empty. However, the following week, more of the same negative interactions with those around the adolescents occurred, self-loathing thoughts were established, and more social disapproval was demonstrated, thereby re-inflating the balloon. The feeling of being overwhelmed will occur, and the child will engage in self-harm again. Such behavior becomes cyclical. It may only be interrupted by discovery by a friend, teacher, or family member or when the self-harming individual seeks help herself.
Acts of NSSI can remain at the level of small destructions of skin or may escalate to greater acts of self-harm, some requiring intensive medical care. Again, it is important to remember that since NSSI occurs in private, many do not see the evolution and escalation of self-harming behaviors in their home, classroom, or community. In fact, detection of self-harm is often through the word of a sibling or a classmate, but usually is discovered after quite a bit of time and several acts of self-harm have occurred.
So how can educators, families, and friends help break the cycle? At the societal level, we must first start by shining a light on this ever-growing epidemic. We must open our doors to welcome in the discussions of mental and behavioral health within everyday educational settings. As a society, we must acknowledge that we serve as caretakers, parents, and guardians of all of our young people. We must educate ourselves to recognize children who are in need of social-emotional, behavioral, and mental health help. Then dive deeper – learn the signs of NSSI and the triggers that encourage self-harm, simultaneously promoting open dialogue centered around mental health with our youth. Learn to model healthy coping strategies that will allow our children to positively deal with negative emotions while enduring life’s hardships. Current research pinpoints a lack of positive and healthy coping strategies among our youth as a catalyst for the increasing number of self-harm in adolescents. In an age of increasing social media and a decline in meaningful face-to face discussions, our children lack the essential know-how to communicate their feelings in positive, effective, and meaningful ways. More so, children do not feel free to be themselves and express their genuine emotions. To the contrary, our children hide their feelings inside themselves or anonymously put them online into chatrooms for all to see. Yet, everyday their internal tension builds until they are ready to burst. This is when children look towards negative methods like cutting to seek an emotional release. Still, the question remains: how does one make the leap from negative feelings to taking an eternal object and hurting herself? Where does she gain that, so to speak, courage, to alleviate her emotional and mental pain through physical pain? Again, unless you are a self-harmer, the answer alludes you.
Nonetheless, there are steps that we, as a society, can take to combat NSSI and it’s co-occurring coping strategies. First, we must learn the signs to identify a child who may be engaging in self-harm (see chart below). Become educated on the ways NSSI can occur, how NSSI can be hidden, when and where self-harm can occur, how it can begin, the reasons why children may self-harm, and finally how children may try to deny engaging in NSSI. Do some investigation work. Identify the most common triggers that cause adolescents to harm themselves. Determine if the student has any of these triggers in her life. Then, continue investigating. Check to see if the particular student may have a pre-existing or undiagnosed condition such as ADHD, anxiety, depression, or another that may increase her risk of self-harm. Take a day or two to fully examine the adolescent’s daily routines – does she have friends, does she socialize frequently with others during the day, does she tend to rush out of school as soon as she can? Talk to her teachers and coaches. Ask if the student in question exhibits a frequency of perfectionism with her work, has suddenly become passive in the classroom, or has begun to demonstrate obsessive behavior when completing academic tasks? Does she have a tendency to take risks, is she impulsive in class or on sports teams, or does she have frequent conflicts with friends and teammates? The answers may reveal a child in need of help.
Second, really educate yourself about the various positive coping strategies for adolescents. Knowing these strategies and modeling such strategies will help you to talk with children about working through their emotions in healthy ways. By providing solid, concrete ways to process human emotions, adolescents will be armed with the know-how to help them cope positively with their emotions while effectively communicating their social and emotional needs to the adults and peers around them.
Third, highlight who in the school, in the community, and at home could serve as a soundboard for children in need. Create a positive group name for the fellow staff members- something that encourages open dialogue between the adults in the building and the student population. By identifying these staff members, students may be more willing to seek help, especially from adults who are not typically in the traditional role of guidance counselor or school psychologist. However, it must be noted that it is essential for schools to provide fundamental training to those staff members before any such action can take place. Once training is complete, and the identification to the school is given, staff will be able to provide social-emotional, behavioral, and mental health help, de-escalation skills, as well as the critical connections to professionals both in the school and within the community who may be able to help them further. With a team in place, children will be comforted to know they have people around them willing and able to support them.
Most important, DO NOT AVOID the conversations around self-harm, self-esteem, and self-loathing. These three conversations of “self”s are real, and they are hitting our youth particularly hard – especially with the overuse of social media. As educators, community caretakers, and parents, we must not avoid difficult conversations. Fooling ourselves to think it does not occur with “my child” or “within our school” will not help to break the cycle of self-harm. Again, self-harm, self-loathing, and self-esteem concerns are not isolated to a particular region, school, or person. All children, whether young or old, are susceptible. If we don’t think we have the have the answers or know of possible solutions, tell those children that you will need time to discover the answers and get back to them. Then, do your research. Be vigilant to find answers, models, anecdotes, videos, everything and anything that can help a child with her social emotional, behavioral and mental health needs. Then, share what you discovered with those children who are asking life-sculpting questions.
Through identification, conversation, and continual support, trained or self-educated adults can and will be able to help our struggling youth. Make sure you learn the signs of non-suicidal self-injury and its co-occurring negative coping strategies today.
Signs of Possible Self-Injury:
|* Unexplained cuts, bruises, burns, or breaks (often on wrists, upper & lower arms, inner thighs, and chest area)|
|* Refusal to change clothing in front of others, including peers and family members|
|* Prefer to wear concealing clothing, despite hot weather and/or uniform requirements.|
|*Loss of hair (resulting from having been pulled out by the child)|
|*Avoidance of situations where less clothing may be expected (parties, swim events, other sport activities)|
|*Change in eating habits (Over-eating or under-eating, skipping meals, dieting)|
|*Sudden increase or decrease in exercise. (at times excessive)|
|*Change in relationships with friends, romantic relationships|
|*Unpredictable, impulsive behaviors and outbursts, moodswings|
|*Decrease in the desire to socialize with peers or family members|
|*Sudden increase / decrease in sleeping|
|*Increase in anxiety|
|*Keeping sharp objects on hand or hidden in bedroom|