Self-Injury: Steps to support adolescents who self-injure

On average, the prevalence rate for self-injury is 15-20% of adolescents (Heath et al., 2009).

#1 Know what self-injury looks like

• ·      Self-injury is intentional, self-inflicting, and is performed to reduce and/or communicate psychological distress.  Self-injury typically has low lethality.
• ·      The average onset on self-injury is 12-14 years old.
• ·      Types of self-injury include cutting, scratching, carving, excoriation of wounds, self-hitting, self-burning, banging head, self-inflicted tattoos and hair pulling. Self-harming behaviors often accompany self-injury such as eating disorders, substance abuse, and risk taking.
• ·      Be aware of contagion behaviors – On occasion, adolescents begin self-harming after learning about this behavior from a peer. 

#2 Stay Calm

• ·      It is important for all parties involved to stay calm.  This includes parents, teachers, coaches, counselors, and extended family.
• ·      When discussing self-injurious behavior, it is important to remain “low-key” with neutral responses.  It is important to avoid having reactive responses when discussing or learning about self-injury.
• ·      Create a safe place by displaying a nonjudgmental attitude regarding the behavior. This does not mean you accept the behavior. Rather you are providing a safe place for the adolescent to discuss the behavior openly, which is the first step to making changes.
• ·      Display respectful curiosity.  This suggests you want to learn more about the problem rather than have the problem go away quickly.
• ·      Remember: Self-Injury is not necessarily suicidal behavior.  When someone is suicidal, they would like to terminate consciousness.  When someone is self-injuring, they would like to modify consciousness (i.e. self-soothe).
• ·      When approached regarding self-injurious behavior, you should not minimize or dismiss the behavior.  

#3 Know what effective treatment approaches are available

• ·      It is important to refer an adolescent who is engaging in self-injury to a clinician who has experience in working with adolescents who self-injure. 
• ·      Treatment providers should also present as low-key and non-judgmental.
• ·      Agencies and providers should offer both individual and family treatment to assist self-injuring adolescents.
• ·      Thorough assessment of self-injurious behaviors should be conducted upon initiating treatment.  Assessment should include many dimensions such as environment, family and adolescent personal history, biological, cognitive, affective, and behavioral.
• ·      Treatment approaches should include strengthening the adolescent’s ability to manage distress, regulate emotions, and develop self-soothing coping skills.