Caring for Children with Nonsuicidal, Self-Injurious Behaviorby Jeanne Preisler
Someone close to me used to intentionally cut himself when he was younger. He wasn’t trying to kill himself. He wasn’t trying to harm himself at all. On the contrary, he cut himself because it helped him cope in really difficult situations.
This is often referred to with terms such as “nonsuicidal self-injury” or “self-harm” or “self-mutilation.” Youth who use self-injury can be suicidal, so this can be a complicated behavior to address.
But for the purposes of this article, let’s assume we’ve asked the young person directly if they are thinking of killing themselves and they have told us no. Therefore, we are faced with a youth engaged in a nonsuicidal self-injurious behavior.
There are many forms of self-injurious behaviors, including cutting, burning, scratching, self-bruising, ripping/tearing skin, interfering with the healing of wounds, banging objects, pulling out hair, and many more.
These behaviors are common. Walsh (2010) found self-injurious behavior occurred in 10-20% of middle and high school students in the U.S.
Given how common they are, as foster and adoptive parents, we need to educate ourselves about these behaviors, know how to identify the signs of self-injury (youth can be skilled at hiding their injuries), and know how to support a young person with these behaviors.
Why Does It Happen?
It is vitally important that we understand that self-injury is a coping mechanism; therefore we must strive to understand what is driving the behavior. According to Klonsky and Muehlenkamp (2007) young people may engage in these behaviors to:
- Manage painful feelings of current or past trauma
- Punish themselves
- Exert influence over others
- End feelings of unreality or being detached from themselves
- Avoid or combat suicidal thoughts
- Feel pain or relief
- Show control of their body
Some examples might look like:
A young man cannot concentrate in class because he keeps remembering the violence he witnessed over the summer. He uses a paperclip to carve in his skin, which forces the intrusive memories out and allows him to focus on what his teacher is saying.
A young lady who experienced years of sexual abuse uses matches to make burn marks on her body so she feels unattractive. She believes this will thwart additional sexual advances from anyone.
Another young person whose mind is racing all the time with worry about being bullied picks at scabs. This allows their mind to focus on something specific and to forget, even for a little while, what bullies and others think of them.
None of these are healthy coping mechanisms (and there are many other strategies we want to teach these young people) but right now, the strategies these young people are using are “working” for them.
What to Do
As resource parents, if we discover a child or youth is engaged in a nonsuicidal self-injurious behavior, our job is to be supportive and non-judgmental and to ask what we can do to help.
Our primary message should not be “stop cutting, it is bad for you!” Rather, our focus should be on learning what happened to make them want to cut, understanding how the cutting helps them, and exploring alternatives. Ultimately, we will help connect the young person to professionals who can teach them safer coping skills.
As mentioned earlier, some youth are skilled at hiding their injuries. If a young person is consistently wearing long sleeves or long pants, even when it’s hot outside, this may be a sign they are using self-injurious behavior to cope. (Then again, they may simply have fair skin–always keep an open mind.) If your home is consistently running out of first aid supplies or you find blood on the clothing of a youth, it may be a sign to investigate further. If you notice a young person frequently has an injury of some kind (a bruise here, a burn there, scabs that won’t heal, etc.), it may be time to say that you have noticed these things, are concerned for their well-being, and begin a dialogue about it.
And finally, there may be times when self-harm turns into a medical emergency. If a burn gets infected, if a cut will not stop bleeding, if punching something caused a broken bone, if banging against a wall causes unconsciousness, use your First Aid/CPR skills and seek professional medical attention as needed.
If a young person threatens to hurt or kill themselves, keep them safe and get professional help as soon as possible. For youth ages 10-14, suicide is the third leading cause of death; for ages 15-24 it is the second (CDC, 2015). One thing you can do right now is program your cell phone with the national suicide hotline (800-273-8255). You never know when you will be near someone who needs help.
Youth Mental Health First Aid
It is exactly because we never know when we will be near someone who will need our help that the North Carolina Department of Health and Human Services (NC DHHS) wants to increase the skills of every North Carolinian to address mental health concerns. NC DHHS, along with other public and private partners, wants to give you the skills to recognize symptoms, intervene appropriately, and help teens who are struggling. For this reason they have invested in a training called Youth Mental Health First Aid. Nonsuicidal self-injurious behavior is just one of many common behaviors discussed throughout this training.
Youth Mental Health First Aid USA is an 8-hour course designed to give you skills to offer help to a young person experiencing a mental health challenge, mental disorder, or a mental health crisis. Mental Health First Aid (MHFA) is given until appropriate help is received or until the crisis resolves.
To locate a MHFA course near you, go to www.mentalhealthfirstaid.org. I encourage you to take this course with other foster or adoptive parents (check with your supervising agency, but it should count toward your relicensure hours), or your church group, or friends and neighbors. It is a powerful course and something we can use to strengthen our communities, support young people and ultimately, try to avert crises before they happen.
Jeanne is a Program Consultant with the NC Division of Social Services and is leading an effort to help our child serving system become more trauma-informed. She is also a Certified Youth Mental Health First Aid Instructor. While developing this article she used, with permission, the Youth Mental Health First Aid for Adults Assisting Young People manual developed by the Maryland Department of Health and Mental Hygiene, Missouri Department of Mental Health, and National Council for Community Behavioral Healthcare (2012).