By Katie Langer, MSW

Katie Langer is a training specialist at FamiliesFirst Network. Katie spent 10 years helping children in foster care to find permanent adoptive families prior to transitioning to her current role as a trainer for child welfare staff. She has a passion to help families and children heal and grow after suffering from trauma and abuse. After watching numerous children in care silently struggle with self-harm, Katie sought to educate staff and caregivers about the risks and path to recovery.

In college, a close friend of mine battled with self-harm. At the time, I struggled to understand it. How could someone purposefully hurt their own body? But as I began to understand self-harm, I realized that we almost all have unhealthy coping mechanisms. People drive too fast, text while driving, work long hours, smoke, drink, eat too much—you get the idea. These are all potentially self-destructive behaviors that we may use to distract ourselves from our anxieties, and although self-harm has potentially harsh ramifications, it is also just a coping mechanism.

For many, self-harm is a way to deal with current or past problems, strong feelings or lack of feeling, a desire for calm, or a desire for pain.  People engage in self-injury for a reason, and in order for them to be able to replace self-injury with alternative and helpful behaviors, we must understand the specific context in which the self-injury has developed and is maintained.

The Big Picture

Self-harm is defined as “an act of violence inflicted by and against the self” (Clark & Henslin, 2007), and it can take many forms such as cutting, burning, branding, bone-breaking, hitting, pinching, hair pulling, swallowing harmful substances, or restricting air. Self-harm is an attempt to relieve emotional pain by turning it into something more tangible: physical pain.

In other words, the physical wounds resulting from self-harm represent much deeper emotional injuries caused by trauma, abuse, neglect, and other adverse experiences. While many who self-harm might not be able to immediately connect their actions to a past event or trauma, studies show that complex trauma— repeated exposure to multiple traumatic events by someone entrusted with the child’s care—affects how individuals express and regulate emotions, putting them at an increased risk for maladaptive coping strategies like self-harm.

In fact, 79 percent of individuals who self-injure report experiencing maltreatment or neglect in childhood. Other risk factors for self-harm include:

  • Lack of supportive caregivers
  • Low self-esteem, depression, and anxiety
  • Strained family or peer relationships
  • Poor social connections
  • Self-harm or suicide of a close family member or friend

Of course, not everyone who experiences complex trauma will self-injure. Likewise, not all individuals who self-injure have a history of childhood maltreatment. However, we cannot ignore that children and youth who have experienced adoption and foster care have many of the risk factors associated with self-harm.

The Cycle

It is hard to define when the cycle of self-harm begins, because the root causes of that negative emotional pain can be predictable—as mentioned—but can also vary widely. Usually, self-harm begins with feeling alienated, frustrated, rejected, angry, or depressed. Without proper outlets to release or control these overwhelming negative emotions, the feelings build to tension, anxiety, and panic.

We aren’t designed to always be operating under stress. So, when a person is under such high levels of stress or anxiety, the mind begins to look for an outlet to find relief. Many people use exercise, running, art, or writing as a release. Others turn to the coping mechanisms outlined at the beginning of this article. For some, self-harm becomes a way to release that pain and anxiety.

Like driving too fast or going for a run, the immediate physical pain caused by self-harm releases adrenaline and endorphins, natural opiates that simulate a sense of euphoria. For youth who struggle to regulate and identify emotions, this will feel like relief — a reminder that they are alive, a shock to the system, or, as my college friend said, a way to simply “feel” again.

In the moments after the incident, the mind will focus only on the pain as it prepares to fight, flee, or shut down against the perceived threat. This provides the mind and body with a distraction or relief from the emotional pain.

But the relief is typically replaced by guilt, shame, or remorse. The negative emotions build, often leading to further injurious behaviors. And so, the cycle continues. The more often the person self-injures, the more accustomed they become to the pain they inflict on themselves, requiring a more severe level of injury to get the same level of relief.

The Stigma

The shame and guilt that come after someone has self-harmed—the same shame and guilt that push them to self-harm again—are rooted in the stigma that surrounds the act. Understanding and putting a stop to this dangerous cycle means understanding facts around the behavior.

  • People who self-harm are not typically suicidal. Self-harm has a low lethality rate, and the behavior is about feeling pain in order to release emotions, become calm, punish oneself, or deal with the stressors of life. But usually the person still plans to be alive when it’s over. Only a small minority of self-harmers will intentionally attempt suicide and, on occasion, some acts of self-harm will lead to death whether intended or not.
  • People can’t just “stop” self-harming. Like all addictions, self-harm releases pleasure chemicals called endorphins that contribute to a cycle of dependency, tolerance, and withdrawal. Research suggests that by about the 30th cut, an individual may already be addicted to self-harm, meaning it’s not easy to quit. Like addiction, too, the more often someone engages in this behavior, the more tolerant they become to the pain. This means that they must inflict a more severe level of injury to get the same level of relief.
  • Self-harm isn’t a mental illness; it is a coping strategy. Still, the DSM-V does acknowledge that self-harm can be the focus of certain treatments or therapies and can be the result of mental illness (like anxiety and depression).
  • Self-harm is a very secretive addiction, and many people suffer without ever telling anyone. However, because self-harm turns invisible emotional injuries into physical scars, it can be a way for others to recognize emotional distress and should be regarded as a cry for help. Common warning signs of self-harm include secretive behavior, covering the body, changes in mood or behavior, negative self-talk, and injuries in various stages of healing.
  • Ignoring a dangerous behavior because you think it will go away on its own can result in more frequent and severe incidents of self-harm. All self-harm deserves care and attention. When ignored, the behavior tends to increase in frequency and severity.  

The Healing

Self-harm is cyclical, addictive, and the result of a deeper emotional wound, but there is hope! For a child in care who is self-injuring, it is always best to call a professional for assistance. Strong trust is the key to helping people who self-harm develop new, healthier coping mechanisms. This means that by being supportive and addressing self-harm, you can play a significant role in the healing process of others.

This can be an uncomfortable process, but it is important that you address these behaviors early, before they become more severe or frequent. Note first that as caregivers or child welfare professionals, we are equipped to help walk alongside a youth on their journey to recovery, but we’re not always uniquely trained to treat the challenging underlying causes. Seek outside assistance to help both of you better understand this issue, and then work with them to create a safe, non-judgmental, compassionate place for a person to heal. In addition to reaching out for outside help, remember to:

  1. Listen calmly and empathetically. While you might feel worried, overwhelmed, or upset, addressing someone’s self-harm by demanding that they stop or asking “How could you do this?” only perpetuates a harmful cycle of shame and guilt, and jumping to find instant solutions won’t diminish the deep emotional pain they’re experiencing. Instead, try to remain calm and open dialogue with them. Ask open-ended questions about how they’re feeling and what they think contributes to the behavior and consider having this conversation while engaging in an activity, like driving to dinner or playing a game of basketball, so that they don’t feel pressured to answer right away. Make time to connect with them one on one, so if they’re not ready to talk now, they know you’ll be there when they are.
  2. Avoid blaming or guilt trips. Trying to figure out “who” incited this behavior will also exacerbate the guilt and shame the child is experiencing and can invalidate their very real pain. Instead, ask them if there’s anything you can do to help them feel better now.
  3. Validate feelings. In any healing journey, validation is essential. Acknowledge their emotions by paraphrasing what they say back to them: “I understand why you might be feeling this way. It’s natural that after [this experience], you would feel [this emotion]! That must be hard.”
  4. Educate yourself on self-harm. There are many helpful sites about self-injury, including To Write Love on Her Arms at twloha.com, Self-Injury Outreach and Support (www.sioutreach.org) or SAFE Alternatives  (www.self injury.com).
  5. Identify triggers and find new coping mechanisms or distractions. Work with the person to determine what contributes to this behavior—talk through the day before their most recent self-harm incident, for example. If the trigger can be predicted in the future (i.e. an anniversary of a traumatic experience), come up with ways to distract like going to a funny movie or having a spa day. If the trigger is less predictable, create a list of alternative coping mechanisms like drawing or painting in red ink, writing down the negative feelings and tearing up the paper, taking a hot or cold shower, or calling a friend.
  6. Avoid ultimatums and punishments. Remember: self-harm is not an act of rebellion, it is a sign of pain. Punishing someone for trying to work through the pain might encourage them to keep their self-harm a secret in the future, which could prove to be dangerous.
  7. Offer to provide first-aid care or make sure the person is using safe first aid practices. By providing or asking about bandages, antibiotic ointment, and other types of first aid, going over the signs of an infection, and telling them who to call in the case of an emergency, you can start a dialogue that communicates to the person that you are ready to support them calmly and without judgement— it’s also an important safety precaution.
  8. Develop a self-injury safety plan together. Healing from self-harm takes time and patience, but while you begin the journey, it’s important to make sure the person is safe. Remove dangerous objects, make sure they aren’t left alone with the door closed, check in with them regularly to see how they are going. You can also work with them to create a list of people they can call before or after self-harming. By including them in the creation of a safety plan, you allow them to feel more in control and empowered to heal.

Take Care of Yourself

Whether you are a caregiver, parent, caseworker, or friend, know that helping someone overcome self-harm also means caring for your own emotions. Caring for someone who self-harms can be exhausting, confusing, and overwhelming. I remember at first I felt directly responsible for keeping my friend alive, and there were times that made me feel angry, helpless, powerless, and scared. All of those feelings were normal.

But the more I learned about self-injury, the better equipped I felt to support her in the journey toward healing.  Walking alongside someone who is trying to be free from self-harm is a long, complicated journey, but it is important that that person knows they don’t have to walk alone. Through it all, I learned the most powerful weapon against self-harm is hope. When you give someone hope, you give them the courage to overcome anything. B   

References

Alderman, T. (1997). The Scarred Soul: Understanding and Ending Self-Inflicted Violence. California: New Harbinger Publications.

Clark, J. & Henslin, E. (2007). Inside A Cutter’s Mind. Colorado: NavPress.

Flemming, M., & Aronson, L. (2016). The relationship between non-suicidal self-injury and child maltreatment. Information Brief Series, Cornell Research Program on Self-Injury and Recovery. Cornell University, Ithaca, NY.

Levenkron, S. (2006). Cutting: Understanding and Overcoming Self-Mutilation. New York/London: W.W. Norton & Company, Ltd.

McEvery-Noble, M.E., Khemlani-Patel, S., & F. Neziroglu. (2006). When Your Child is Cutting: A Parent’s Guide to Helping Children Overcome Self Injury. New York: New Harbinger Publications.

National Child Traumatic Stress Network. (2014). Complex Trauma: Facts for Caregivers. Los Angeles, CA, & Durham, NC: National Center for Child Traumatic Stress

Richardson, C. (n.d.). “The Truth About Self-Harm”. Mental Health Foundation and The Camelot Foundation.

Sutton, J. (2007). Healing the hurt within: Understand Self-Injury and Self-Harm, and Heal the Emotional Wounds (3rd ed.). How to Books.

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking.

Categories: Disabilities & Challenges, Grief & Loss, Parenting, Trauma

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