Most contemporary parents are at least familiar with the notion of self-harm, and increasing numbers of families are dealing with it firsthand. Non-suicidal self-injury, or NSSI, refers to a person hurting themself on purpose without the intent to die. While frightening to consider or address, some basic knowledge of these behaviors can only help if it affects your child or one of their friends.

The most common form of self-harm is cutting, but self-injury can take other forms including hitting oneself, head banging, hair pulling, burns, excessive scratching to the point of drawing blood, and ingesting harmful substances. Cutting can manifest as single deep cuts, numerous smaller ones, or some combination. The American Academy of Pediatrics states that NSSI is most prevalent among teens, and females are more likely to self-harm through cutting and males through hitting. However, adolescents of any age ranging from pre-puberty through early 20s and gender–including non-binary or transgender individuals–are equally capable of self-harming behaviors. 

Parents or caregivers who have identified NSSI often struggle to understand why their loved one feels the need to self-harm. This confusion, combined with sadness, fear, and perhaps some anger, can lead to unhelpful (if well-intentioned) reactions. While each case is unique, a few principles can help parent and child navigate this challenge:

KNOW WHAT TO LOOK FOR

Active kids are naturally more prone to small wounds, but those engaging in self-harm will almost always hide their marks. Long clothing (even in warm weather), bandages repeatedly placed in the same area(s), frequent bruises, or other recurring marks may be cause for concern. Symptoms of depression, such as overwhelming feelings of hopelessness or worthlessness, sleep disturbances, and persistent fatigue, should also be noted. Young people suffering from depression are more likely to engage in NSSI. 

APPROACH A DIFFICULT CONVERSATION WITH LOVE

Your internal thoughts may be screaming, “How could you do this?!” or “What could you possibly be so miserable about?!” It’s important to foster a safe space for the adolescent to discuss what is real to them. While there is no clear explanation for self-harming habits, many teens report a need to escape feelings of agony or feel better for even a moment. The AAP explains that when human bodies are injured, the brain releases endorphins and other natural painkillers to cope. This may suggest a connection between self-harm and temporarily “feeling better” when other solutions are unclear.

Regardless of the reason, remind your loved one that you’re concerned for their well-being and want them to feel safe. While it’s ok to acknowledge your sadness, do so in a way that does not impose more shame on the sufferer. Explain your concerns gently, and be open to hearing what they have to say even if it doesn’t make sense to you right away. 

TALK TO THEIR DOCTOR

Since people who engage in NSSI are likely to hide it, they might have a strong or negative reaction when you address it. Let them know that you plan to talk to their doctor and hope they will participate in the conversation. 

“Remember that incidents of threatened or confirmed self-harm do not make you a bad parent,” says Dr. Eleanor Braun at South Louisville Pediatrics. “This is a challenging, murky topic that pediatricians are addressing in a wide spectrum of patients and families. Neither you nor your child need feel stigmatized. Help is available.” 

Follow through on your doctor’s recommendations, including any follow-up appointments, specialist referral, and/or safety plan. If you need help, ask! Behavioral healthcare is in high demand and not always straightforward in the billing department. Your pediatrician’s office will strive to help.  

NURTURE A HEALTHY HOME ENVIRONMENT

If your child is confirmed to self-harm, you can make your home safer by limiting access to dangerous implements. Beyond stashing sharp objects–and just as important–you can:

• Maintain open communication and regularly check in on their emotional state
• Prioritize mental health for the whole family through self-care and downtime
• Set a healthy example of limiting social media exposure
• Never overshare about a person’s private struggles, or write them off as a ploy for attention

24/7 Crisis Support Options:

https://www.crisistextline.org/ | Text HOME to 741741 to connect with a volunteer Crisis Counselor

The National Suicide Prevention Lifeline: DIAL 988. When people call, text, or chat 988, they will be connected to trained counselors that are part of the existing Lifeline network. These trained counselors will listen, understand how their problems are affecting them, provide support, and connect them to resources if necessary. The previous Lifeline phone number (1-800-273-8255) will always remain available to people in emotional distress or suicidal crisis.