Self-injury, self-harm and physically hurting oneself

Self-injury or self-harm is an action or activity intended to turn unbearable emotional feelings into a physical pain that can express them and temporarily relieve them.

“Self-injury” is not the most usual term you hear people mention – “self-harm” has become the most common. But both refer to the deliberate act of hurting oneself physically for a reason.

Since these concepts are not quite the same as suicide intention, I’m grouping them here, and keeping them separate from the idea of a child intentionally setting out to end their life.

This is because most children who self-injure are not doing it to end their life. They’re in emotional torment and don’t have the means to deal with it more healthily. If we help them in good time, there is the opportunity to stop it getting as far as an intention to commit suicide.

Suicide intention happens when the young person sees no other way out of the mess.
Self-injury happens when they don’t have good coping skills to ease the emotional pain they’re in.

Whatever term we use, self-injury is moving down the age groups worryingly fast. It used to be mainly teens. Now it’s as young as junior school children.

But with children, self-injury is the beginning of a long road in their life if they can’t stop it as soon as possible.

What do children do when they self-injure?

We adults probably don’t sit down and contemplate how much we, too, are "doing self-injury" when we drink too much alcohol, have poor eating habits, and go without sleep etc. Perhaps we should consciously consider it! But we do it openly, alongside a kind of wry acknowledgement that we really shouldn’t.

Children, on the other hand, self-injure in secret, covering their arms, legs and tummy very carefully afterwards (these seem to be their preferred areas of attack).

You might not become aware of it for a long time.

Your child may have been doing self-injury by any of the following methods (and more):

Cutting or piercing their skin with anything handy (pencil sharpener blades are common tools)
Pulling their hair out
Banging their head with their fist or on the wall
Punching themselves or the wall
Burning themselves – with anything to hand - or rubbing hard to create a burn mark
Swallowing substances that make them sick
Scratching their skin till it’s raw
Bruising or biting themselves
Carving symbols into their body
Inserting small objects under the skin

They, too, of course, like us, lose hours of sleep checking social media with their smartphones. They, too, drink alcohol in secret. And they, too, binge on snack food after school at the local shop.

But, somehow, the ones I listed seem more serious.

How will you be able to recognise that your child is self-injuring?

Well, they may accidentally allow the damaged skin to show in a moment of inattention. They may even tell you, if they have a good relationship with you and finally realise they need help.

Other than that, you might notice these things and become curious:

They’re not happy, they're over-anxious and a bit unstable emotionally (that’s why I’ve filed self-injury under “symptoms of anxiety”
They have fresh scars or bruises
They keep themselves covered up, even on a fine day – maybe a reluctance to go swimming
They seem to be claiming a lot of “accidental” injury lately
They’re very negative about everything.

You’ve come here because you believe your child is anxious – keep your eye open for signs of self-injury and be ready to start a conversation in the best way for the age of your child.

What are the main causes of self-injury in a child?

The short answer is "dealing with their emotions unhealthily". This includes, but is not limited to, anxiety.

Your child may not have developed enough useful coping skills to deal with how anxious, stressed or upset they are.
Or perhaps your child just happens to find it hard to understand exactly what their emotions are saying.

The thing is: emotions are not wrong or right in themselves.

I like to think of them as messengers. They tell you something – and help you decide what your next behaviour should be. If your child gets good at recognising emotions as messengers, they will not need to resort to self-injury to deal with the feelings.

And since dealing with emotions unhealthily is the main cause of children starting to self-injure, I’ll give some strategies for ensuring your child grows up knowing how to deal with strong, overwhelming emotions as well as good ones. Then they’ll not have to resort to cutting and burning when they can’t cope well enough.

I know schools do try to deal with this kind of learning, but it needs to start as early as possible.

But if it’s now “later” for your child, don’t worry – there’s always time to catch up. Children’s brains are very malleable.

If your child has already started hurting themselves, you’ll need to listen to them and talk with them quite a lot before they’re ready to try new tactics. There’s lots about listening and talking on my strategy pages.

Importantly, it's good to remember that the need to self-injure decreases as coping skills increase. It can seem a long road but it's not impossible.

There's a good video for parents, carers and teachers by Nip in the Bud about understanding self-harm. The average start age is older but the problems start from earlier, so have a watch and see if it's helpful.

I give some practical, fun ideas for dealing with emotions in the moment below, so have a read and try them out?

The family balloon messenger game

You can play a family game with the following idea from an early-ish age – at least, when children don’t mind balloons popping! Or you could use envelopes instead of balloons (see instructions) but that isn’t quite so much fun!

You need (say) 5 balloons, 5 small slips of paper (big enough to write a sentence on in writing your child can read, if they're readers), a pin or needle, and a felt marker.

1 Think of 5 emotions, eg happy, sad, angry, pleased and another. Any are fine, but stay pretty basic to start with.

2 For each one, write a sentence that would be a reason for that particular emotion. Example: For happy, you might write on the slip of paper “You got a birthday present”. For angry, you might write “Your friend didn’t come to play”. Keep to “you” and adjust ideas for the age of your child.

3 Write the emotions you thought of, each one on its own balloon, neatly in marker pen (it will get bigger when you blow it up!).

4 Roll up the corresponding slip of paper and insert it in the neck of the correct balloon while it's still deflated.

5 Blow the balloon up and tie it off.

You throw/bat a balloon out into the room. Anyone can try to catch it. Adults should join in too, in the spirit of the game.

Whoever catches it announces the feeling that is written on the balloon.

You ask, “OK. The messenger is telling someone they’re (eg happy). What might have caused that feeling?

Take any and all answers as suggestions. The one inside the balloon is NOT the only answer!

Invite someone to be brave and stick the pin in the balloon. Be absolutely sure their eyes are closed or shielded.

Someone must now find the roll of paper that has flown out!

Invite that person to read it out. Remember, this is just another possible cause of the feeling.

Then ask what the person might do next, granted they’re feeling happy/angry/sad/ whatever the balloon said. Remember, the emotion is a messenger – and you have to understand the message to decide how to act!

You might get suggestions like this:

For happy, it might be: say thank you so you get more presents in future!
For angry, it might be: ask if the other child is okay, or forgot to come etc. (Not “refuse to play with them in future”!)
For pleased, it might be: do more of whatever you were doing that made you feel that way.

Basically, you're opening up a necessary discussion in a family-friendly way – with some fun attached.

I’ve seen time and time again that where adults join in with games, the children are happy to play along and benefit.

Seeing their parents join in validates the whole activity. Whereas offering an activity and leaving them to get on with it gives the message that “we’re just being palmed off”.

When a child feels involved and having fun, they're really receptive to learning.

The mad distraction activity – 10,9,8,7,6…

When someone is overwhelmed with anxiety and has started to resort to harming themselves, even in a light way, they need a distraction activity while the feeling wears off.

Feelings of overwhelm do come and go. The trick is to ride out the wave. Get through the other side.

That doesn’t get rid of the problem, obviously, but when feelings are aroused, the thinking brain cuts out. Habits then click in (like running from a woolly mammoth in olden times) and you need a metaphorical windbreak as a temporary shelter from the storm.

So, this activity can be used in families regularly for a bit of fun and laughter. And then it’s also available in time of need.

When things get fraught in a family or in a child’s life, you need to change the ingredients of what they’re doing/thinking/feeling. This activity changes those things with a bang!

So – try this in your family. Adults too – as I keep saying!

Everyone stands and counts backwards from 10 to 1. Reasonably fast. But – you have to do this while waving your right arm and hand around!

Repeat the count until you’ve done it next with your left hand, and then your right leg and then your left leg (yes, try not to fall over!) That’s 4 repeats on end. Yes, it's breathless and funny.

Immediately go back to the start but only count from 9 downwards. Four times again, to cover waving with each arm and leg in turn.

Then – you guessed! – start again at 8. Repeat with each limb.

Then 7 downwards…

It gets more and more riotous, because a) you have less time to think what the next starting number is, and b) you have to change limbs more quickly as there are fewer numbers being recited! By the time you’re doing 1..1..1..1.. the feeling that led to distress will have altered.

Then you can talk.

How to calm your breathing

Self-injury happens in an aroused moment. An attempt to feel something, and maybe not feel something else. If your child can calm themselves, the situation can be improved.

So your child needs to learn early on how to breathe slowly to calm their body systems back to normal.

The whole family can learn together and it can become the household routine as a means of de-stressing.

One way of doing this is to sit quietly and comfortably, shut your eyes, and mentally count to 10 while breathing in at 1 and out at 2, in at 3 and out at 4 etc, slowly and calmly. No rush, no specified speed.

If you forget what you were counting, simply start that count again! Sometimes your mind roves, but if you can manage to just listen to your in-and-out breaths, it's a beneficial activity for changing thoughts and feelings that are getting out of hand.

When you’ve done this (ie counted breaths from 1-10) 4 times, you’re done. If you can keep your muscles relaxed that’s a plus.

It takes a few goes to learn to do this – and then it becomes a habit.

There are other suggestions about breathing on my strategy pages.

Remember…

Teaching your child how to understand, interpret and regulate their emotions will give them a head start on the road to not going the way of self-injury, self-harm or hurting themselves.

But if things have gone too far by the time you discover the problem with self-injury, please seek the help of your GP initially, or a counsellor if you prefer. My Help page shows you how to do that safely. The GP or counsellor will help your child to deal with the issues they’re not managing to resolve themselves.

Self-injury is not a healthy way out – however careful the child is with using clean implements and dressing the wound afterwards. An anxious younger child needs help way before they even start on that route.

A book to help children of 7+ and their parents

Can I Tell You about Self-Harm is written by Pooky Knightsmith and published by Jessica Kingsley. It's suitable for reading with your child if you find they're self-injuring. But do read it yourself first to see if it's suitable for your child if they're in the lower age range.

A course for young people who self-injure

Alumina is a free, online 7-week course for young people who struggle with self-harming/self-injury. It's for older children 14–19, but I name it here in case you have an older child still struggling to overcome this habit. Have a read of all the details on that link, and see what you think. But it's UK-run – by trained youth workers and counsellors, and has stringent safeguarding policies. You can also download a detailed factsheet for parents or email the project manager, Jenny Flannagan, at helloalumina [AT] youthscape [DOT] co [DOT] uk.

You might also find these pages helpful

Should you Worry about Perfectionism in Your Child?
Ideas, strategies and games to deal with the sort of perfectionism that is not helping a child's wellbeing
Stomach Pain: Why Does My Child Have It?
Stomach pain, headaches and feeling sick can all be symptoms of a child's anxiety and can be helped
Sleep Disturbances: the Vicious Circle
Sleep disturbances like nightmares, bedwetting or changed sleep patterns can make a child tired and therefore more anxious during the day