Tiffany’s mom tiptoed into her room to check on her daughter who had recently had the flu. The girl was sound asleep. It was then, she noticed the cut marks on her daughter’s arms. Tiffany had seemed withdrawn lately. It had been a difficult time since her dad walked out on them. Her mom was working two jobs and cried a lot lately. Her dad had partial custody of her brother. And money was tight. She couldn’t do things with her friends and was too ashamed to tell anyone why.
In her talk at the recent 2014 Intercourt Conference, Kaye Randall, MSW, LISW-CP of Turning Point Counseling gave a workshop titled, ‘See My Pain! Helping Children and Adolescents Who Self-Injure’. She said there are several reasons teens self-injure. There might be neglect or abandonment by a parent, or loss through death or divorce, or a tense relationship- even abusive relationship between parents. There could be alcoholism or drug abuse by a caregiver; physical, emotional or sexual abuse either long ago, previously or currently. Looking at the issue of self-harm developmentally, a teen may not have learned how to handle strong emotion or express him/herself to others. There is often a self-image issue, self-loathing, perfectionism and/or mood swings.
While some professionals see self-injury on a continuum with suicidality, others see deliberate self-harm through cutting, burning, bruising, scratching or worse, as an attempt to manage painful feelings that cannot be expressed verbally. The pain behind self-harm might be expressing a sense of loss, desertion, isolation, helplessness, rage, rejection, grief, anxiousness, guilt, shame or feelings of failure. Families don’t often connect-and teens feel a sense of isolation. Randall says in her workshop guide that, “American youth today are often considered to be in a state of crisis. Approximately half of all adolescents are at moderate to high risk of engaging in one or more self-destructive behaviors, including eating disorders, self-injury, unsafe sex, drug and alcohol abuse; under-achievement, failure, or dropping out of school; and delinquent or criminal behaviors.”
Pomegranate Certified Nurse Practitioner, Philip Wang, says ‘Frequently self-harm and cutting occurs with other DSM IV diagnoses, such as bi-polar disorder, personality disorder, an eating disorder, or depression.” Why do they self-harm? Randall explained that “Many of these problem behaviors are interrelated. Some of these behaviors are related to the multitude of physical, social, and emotional changes adolescents are experiencing. Some are related to dysfunction in families; violence in the streets and at home; and media which portrays alcohol and drug use, extramarital sex, and violence as often-occurring, normal behaviors.”
Teens who self-harm may be trying to use self-harm to avoid overwhelming emotional pain by releasing it physically/symbolically, attempting to control it, or punishing themselves. For Andrew who lost two family members in an accident, “I let the grief out a little at a time, and then ‘put the cap back on the bottle’, because it would be overwhelming- too much- to pour out all at once,” he explained in a husky voice.
Intervening by having a teen explain (to a professional) what it was that they were trying to express is often helpful: what led up to it; what they were feeling; how they felt afterwards. The emotion behind the self-injury should be validated, not dismissed, disparaged, or ignored. Pain in life cannot be avoided, but children and adolescents DO need to learn healthy coping skills. Individual and group discussion may be helpful, identifying emotional triggers, and learning healthy diversionary practices can help. Art therapy is often very useful in expressing emotions too deep to handle. Pomegranate’s acute hospital employs a registered art therapist to facilitate the discovery and healing process.
[photo credit: sad teen boy at firstname.lastname@example.org #1286156]
Read more at:
YouTube videos: (Note: there are lots of videos on the topic, many self-produced by teens. Our disclaimer is to see a professional; not to believe everything you see/hear. Not all ‘professional’ videos provide the same caliber of information.)
http://www.youtube.com/watch?v=iclExy_qJ-4 (news story Heartland News)
http://www.youtube.com/watch?v=y5JMoeTGLQQ (Dr. Drew)
http://www.youtube.com/watch?v=zv9KORPxMxg (RN- Powerpoint presentation)