Understanding Self-Harm in Young People


Self-harm is when an individual hurts themselves as a way of dealing with very difficult feelings, painful memories, or overwhelming situations and experiences [1]. It is of course an issue of great concern, particularly for young people in recent years. The average age of the first incident of self-harm is around 12 to 13 years old, but the rate of self-harm among younger children (age 9 to 12) has increased in the last 10 years [1]. The issue of self-harm is very complex, often developing from a difficulty with regulating and managing intense emotions. Many individuals turn to self-harming behaviours when they feel they have no other option of regulating or redirecting their emotions. There are many reasons an individual may come to feel this way, including issues with mental health, adverse life circumstances, and interpersonal difficulties.


Since the start of the Covid-19 pandemic, feelings of loneliness have increased, as many individuals struggled with social restrictions and limited interaction with friends and family. Cases of mental health issues such as anxiety and depression have risen significantly, with 1 in 6 children aged between 6 and 16 experiencing a ‘common mental disorder’ in 2021 [2]. Such a decline in mental health and wellbeing is easily understood by looking at the many consequences of the pandemic, such as increased rates of domestic abuse, financial stress and unemployment, fear and anxiety about self-isolation and social distancing, as well as a reduction in overall life satisfaction and happiness [3].


Lack of social interaction makes it difficult to seek and reach out for help, creating an environment of secrecy, with which comes a level of shame and stigma [4]. Many individuals who intentionally harm themselves will attempt to keep their behaviour a secret to protect themselves from judgement, but also to allow themselves to continue to use this behaviour as a coping mechanism, despite how destructive it may be. Young people in particular, can hesitate to seek help from family or friends due to feelings of guilt and shame or a belief that their family or friends will not understand why they are harming themselves. It is crucial for those close to the young person to try to be understanding and compassionate because if they react with anger or disappointment, it is more likely to make the young person feel worse, more isolated and lead them to be more secretive.


There are still a lot of misconceptions about self-harm, including the idea that it is a measure of the severity of mental illness. Many young people struggling with mental health issues feel that attempts to harm oneself are the only way in which they will be warranted further treatment [5]. This may come from the stigma of mental health compared to physical health, where the latter is more easily measurable and so unquestionable; there is no need to prove oneself as ‘ill enough’ to receive a certain level of treatment. Whereas there is no tangible measure of the severity of mental health, leading many to believe that self-harming as a physical representation of mental health struggles is the only way they will be heard. However, it may come from the fact that mental health services are seriously under resourced, and therefore the cases with highest risk or potential danger are prioritised.Either way, it is “important to not become desensitised to suffering that isn’t physical.” [5]. No one, especially not young people seeking help, should have to harm themselves in order to prove they are having problems with their mental health, or that they are worthy of help. It is important for those responsible for providing support to young people with mental health issues to acknowledge, understand, and try to resolve reasons for self-harm without using the level of physical injury to measure the level of mental struggle. It is also important to continue to invest in resources to deal with and intervene mental health issues in young people as early as possible.


In light of world suicide prevention day this Saturday 10th September, it is relevant to discuss the relationship between self-harm and suicide. It is important to note that although there are cases of Non-Suicidal Self Injury (NSSI), and not every individual who displays self-harming behaviours has suicidal intentions, self-harm is still one of the strongest risk factors for completed suicide [6]. It has been found that in 2020, the leading cause of death for people aged 5-34 was ‘intentional self-harm’ [7]. For this reason, prevention strategies are in place, such as public health interventions and education in schools and neighbourhoods to ensure a level of understanding and proactivity, as well as media guidance on reporting of suicide in a non-sensationalist and respectful manner.


Interventions and treatments for individuals struggling with self-harm include psychological interventions such as DBT, MBT and CBT. Furthermore, when self-harm occurs in the context of a mental disorder, the disorder itself should be treated, alongside management of the self-harm. Many interventions for young people will incorporate some family involvement in managing the risk and treatment of self-harm, which has been shown to be effective in preventing suicide attempts [8]. Here at Surrey Therapy Practice, we have a team of experienced professionals who are qualified to work with young people experiencing problems with mental health and self-harm. Many of our team members use an integrative approach to tailor their treatment plans to specific individual needs, incorporating different types of therapy including CBT. If you or someone you know is having problems with self-harming, get in touch and make an enquiry here.


References:

1. https://www.acamh.org/freeview/understanding-self-harm/

2. https://www.nuffieldtrust.org.uk/news-item/mental-health-indicator-update?gclid=Cj0KCQjw39uYBhCLARIsAD_SzMTfsPqajIhiGCzthScE5vIZvtlhzZCaiWI6y2LirICPehJ19MMMfbgaAsdyEALw_wcB

3. https://www.gov.uk/government/publications/covid-19-mental-health-and-wellbeing-surveillance-report/2-important-findings-so-far

4. https://www.acamh.org/blog/isolation-and-secrecy/

5. https://www.acamh.org/young-insights/conflating-risk-and-mental-illness/

6. Hawton K, Zahl D, Weatherall R. Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry. 2003;182(6):537-42.

7. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregistrationsummarytables/2020

8. Asarnow JR, Hughes JL, Babeva KN, Sugar CA. Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry. 2017;56(6):506-14.