Teenager Self Harm - Immediate Strategies for Parents

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Any parent who has a teenage son or a daughter has either heard or witnessed 'self-harm' first hand. For parents not only is self harm very concerning but it also leads to significant conflict. They question if they are 'good enough' parents. Are they doing the 'best' for their children. 

So what is self-harm? Self harm is when a teenager hurts herself physically. Clinically, the most common forms of self harm I see are cutting, scratching, picking skin, pulling out one's hair, burning one's own skin and ingesting pills. 

Why would my son or daughter want to self harm? Many reasons. But the most common I see is anxiety and stress either from school or home. At school stress could happen due to being bullied, not fitting socially, not achieving academic excellence, poor self esteem, relationship issues & gender identity issues. At home, stress could happen due to parental conflicts, conflicts with siblings, financial problems, coming out for kids who identify themselves as gay, lesbian or transgender, abuse and not meeting parental expectations. 

Teenagers often report to me that self harm takes away the emotional pain they are suffering and replace it with physical pain which is more tolerable. Some teenagers are venting our anger and frustration towards themselves or others by hurting themselves. For some self harm is ritualistic and for some self harming can make them feel a sense of heightened emotion or experience. 

As a parent what should I do or not do? Most importantly, Do Not consider Self harm as merely an 'attention seeking behavior'. It is a genuine problem and a very strong predictor for future suicide. It is often difficult for parents to comprehend the problem. It is better to be concerned, confused and conflicted than ignoring the problem. Do not ignore it. Take Action. 

I just saw my child who has self harmed. What do I do? 

  • If injuries are serious, call your child's pediatrician. If it is after hours or doctor's office is not responding, call 911 or take your child to the the nearest emergency room.
  • If the wounds are fresh, provide appropriate first aid like dressing fresh wound. 
  • Do not over react. It can make matters worse. 
  • While waiting for the ambulance or on your way to the hospital, ask questions like
  1. How did it happen?
  2. Go through the events step by step.
  3. How did they harm themselves?
  4. Where did they do it?
  5. Their feelings at the time of harming themselves
  6. Is it their first time harming themselves or have they hurt them selves before?
  7. Have they ingested anything as well like alcohol, pills, drugs?
  • At the ER, your child will be evaluated physically and then by a mental health clinician as well. 
  • Upon discharge from the hospital, they will put into place a plan like having to see a therapist and a psychiatrist.
  • Follow the discharge plan as recommended
  • At home, implement a safety plan like removing dangerous objects, Ensuring the child is not left alone and Check in with them regularly.
  • Inform the school about the recent ER visit or hospitalization and develop a safety plan with the school guidance counselor or psychologist.

Anxiety in Infants, Toddlers & Preadolescents

Anxiety is common in Children. Much of it is normal developmentally, meaning age appropriate. For example, Infants can be anxious about strangers or startled by sudden and loud sounds. Toddlers can be fearful of darkness, imaginary creatures and fear separation from parents or significant care providers. Elementary school children are often fearful of injury, storms or death. As kids move to middle school, school performance and social status becomes increasingly important which can lead to anxiety around these issues. 

When does anxiety become problematic?

If developmentally appropriate anxiety does not subside with time or starts impairing a child's everyday functioning like missing school days or not able to keep friends, then intervention is required. 

What causes anxiety in my children?

No single cause. Anxiety is multi-factorial and results from interaction between biological and environmental risk factor. Biological factors include genetics, family history of anxiety or presence of any other psychiatric condition increases the risk of having anxiety. Environmental risk factors include bullying, parenting styles and trauma.

Treatment Options

I don't want my child to be on medications. That is the first comment I hear from numerous parents even before my first evaluation is complete. Well, as per American Association of Child & Adolescent Psychiatry (AACAP), the first line of treatment for anxiety disorders, especially if it is mild, is Psychotherapy.

So how does psychotherapy help? Psychotherapy lets children talk about underlying feelings and problems. They receive emotional support, learn to resolve conflicts with peers and family members, perceiving comments as they are and not 'overthinking' them. 

How long? Some forms of therapy are time bound like CBT (Cognitive Behavioral Therapy). CBT can last 12-16 weeks. Some centers offer time bound group therapy sessions. Individual therapy which is readily available in the community could last many months to many years depending on the complexity of the child's condition and progress.

What about medications? If the anxiety is severe or psychotherapy has failed completely or has shown partial response,  adding medication to treatment may be helpful. In my recommendation, the child should not be taken off therapy when on medication. It should go hand in hand. 

How long would my child be on medications? If the child is being prescribed for the first time,  I try to taper the medications off after 6 months to 1 year. The child should be in remission on medications for significant period before this decision is made. During the course of taper, I recommend that child should continue to be on therapy.  Some children do very well after the taper and might not require medications again. But for many children, especially with significant genetic load, they might need medications again. The length of treatment will then depend on individual case.