Professionals can look for the following signs that a young person may be engaging in self-harm, or experiencing emotional distress that needs intervention:
• Superficial or clustered cuts, burns, scars or similar marks on the forearms, arms, fists, side or stomach
• Wearing long sleeves, jackets or pants in warm weather
• Constantly wearing bandages, wristbands or other coverings
• Avoiding activities where more of the body is shown (e.g., swimming or gym class)
• Having odd possessions, such as razor blades
• Appearing tearful, depressed or withdrawn, lacking energy, or overly anxious
• Developing sudden attendance problems
• Giving explanations for the symptoms above which seem unlikely or incomplete
Sources: Dr. John Peterson, senior instructor in the department of psychiatry at the University of Colorado School of Medicine and the Cornell Research Program on Self-Injury and Recovery
Working with parents of self-injuring youth
Getting parents involved can be essential to helping young people, said Dr. John Peterson, because parental consent is often required to access mental health treatment. He added that a teen feeling like she cannot talk to her parents can be an additional stressor that needs to be addressed in counseling. Family therapy is often a major component of treatment.
When talking to parents or caregivers about self-harm, Peterson suggested emphasizing that this is a fairly common behavior, but one which requires help from a mental health provider as well as treatment for the physical injuries.
When to involve the parents may vary depending on the underlying reasons for self-harm, said Boys & Girls Clubs of America’s Director of Child and Club Safety Mitru Ciarlante. “Since cutting and other self-harm is sometimes linked to a way of coping with abuse, it is usually safer for the child to have a mental health professional assess the situation, serve as an advocate for the youth, and help to communicate with parents and caregivers,” she explained.
What the research says — and doesn’t say
Good research on self-harm, especially in younger children, teens and young adults, is limited, said Dr. Jill Harkavy-Friedman, senior director of research at the American Foundation for Suicide Prevention. In the research that currently exists, “who you ask and how you measure it has a major impact on what you find,” according to Harkavy-Friedman.
The number of articles studying self-harm has tripled in the past 10 years, said Peterson, who also noted that there’s a wide variation in what the research shows. He noted that the recently released DSM-5 proposed that non-suicidal self-injury (NSSI) or self-harm without suicidal intent, be studied for possible inclusion as a mental-health diagnosis (currently it’s only a symptom), which could help standardize research.
Current data available on self-harm, such as reports from emergency room visits, do not always indicate whether individuals had suicidal intent. Peterson did note one significant finding from recent research: A large study of adolescents with depression published in 2011 in the American Journal of Psychiatry found that NSSI was almost as strong a predictor of suicide attempts as past suicide attempts. Past NSSI was also the strongest predictor of future NSSI.
When self-harm stems from abuse
Ciarlante pointed out that when talking with young people about the reasons behind their self-harming behavior, youth workers may uncover information that requires a mandatory report such as for child abuse.
A 2012 review by the Child Welfare Information Gateway found that 11 states required staff of youth-serving programs to report suspected abuse or neglect. And all states have reporting guidelines. See childwelfare.gov/responding/reporting.cfm for resources, state-by-state mandates and tips regarding reporting abuse or neglect.
Youth workers who have established rapport with kids and relationships with child protective services or mentalhealth agencies can demystify these systems for the young people they serve.