Please be advised: Some of the pieces in this entry contain references to self-harm and suicide, which some individuals may find distressing. 

“Why did you cut your arm?” I asked.
“It’s nothing,” she said and tugged her sleeve over her arm, indifferently.
“I saw you do it.”
“Not your business.” She did not look at me. She grabbed her pen and suddenly became very interested in her workbook.
“Are you doing okay?”
“I am fine!” A few seconds later, she started sobbing.

She was Liang, a charming girl with excellent grades, an impeccable reputation as a middle school student, and a nothing-goes-wrong family. She was not my patient. She was the girl who sat by me in school. We were both thirteen years old.

If you are reading this and you used to be the thirteen-year-old Liang, you are not alone. 10-20% of adolescents have reported self-harm behavior, according to global surveys.4 People hurt themselves for various reasons, including using self-harm as a distraction to avoid emotional pain or bad memories, self-stimulating as a grounding method to “feel something,” punishing oneself, avoiding suicide, and more.2 From a psychodynamic point of view, they might be attempting to achieve control, re-enact past trauma, or express aggression. Minors with self-harm behavior often have underlying anxiety or depression disorders.3 They are at more than 20 times higher risk of suicide than their general counterparts.4 Unfortunately, most of them have never received mental health care.

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Whether it’s cutting, scratching, burning, or punching walls with their fists, self-harm behavior in children and adolescents should always be taken seriously. Despite the challenging communication for parents or teachers, avoiding talking about self-harm often makes things worse. Pretending not to see it or making excuses for the child to “save face” are not good ideas, either. Adults can gently express care and support, approaching children with a non-judgmental stance.

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All children and adolescents deserve a life free from depression, anxiety, and other conditions related to self-harming behavior.

Timely intervention is the key to recovery. The only wrong thing to do is to do nothing. Referring minors to a mental health care provider can help them live better and even potentially save their lives.

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Available resources:

References

  1. Campisi, S.C., Carducci, B., Akseer, N., Zasowski, C., Szatmari, P., Bhutta, Z.A. (2020) Suicidal behaviours among adolescents from 90 countries: a pooled analysis of the global school-based student health survey. BMC Public Health. 20(1):1102.
  2. Edmondson, A.J., Brennan, C.A., House, A.O. (2016) Non-suicidal reasons for self-harm: A systematic review of self-reported accounts. Journal of affective disorders, 191:109-117.
  3. Hawton, K., Saunders, K.E., O'Connor, R.C. (2012). Self-harm and suicide in adolescents. The Lancet, 379(9834):2373-2382.
  4. Olfson, M., Wall, M., Wang, S., Crystal, S., Bridge, J.A., Liu, S.M. (2018) Suicide after deliberate self-harm in adolescents and young adults. Pediatrics,141(4): e20173517.