Self-injury in children and teens

What does self-injury in children and teens mean?

Non-suicidal self-injury, also known as self-injury, is the intentional harming of one’s own body tissue (e.g., skin), most often done to cope with uncomfortable emotions and always done without intending suicide.

Most children injure themselves as a way to cope and regulate their emotions. Some see it as a way to decrease emotional pain and tension because physical pain may seem more tolerable.

What are the different types of self-injury in children and teens?

Children and teenagers who injure themselves may:

• Cut their skin

• Excessively scratch themselves

• Intentionally hit or punch themselves, or intentionally hit their head or body on objects

• Cause an abrasion by intentionally rubbing their skin excessively

• Burn themselves

What are the signs and symptoms of a child engaging in self-injury?

Common signs and symptoms of self-injury in children and teens include:

• Having frequent or unexplained bruises, scars, cuts or burns

• Wearing clothing designed to conceal wounds, like multiple bracelets or wristbands, or wearing hoodies and sweaters in warm weather

• Refusing to participate in gym class or physical activity that might reveal their skin

• Creating art projects, poems or stories that focus on blood, razors or depictions of cuts and wounds

• Signs of depression like sadness, mood changes and withdrawal from friends and family

• Spending unusual amounts of time in the bathroom or in isolated areas

• Having objects such as lighters, razors, thumbtacks, shards of glass or blades from the plastic pencil sharpener

What causes children and teens to self-harm?

Scientists don’t know exactly what causes non-suicidal self-injury in children. Most children injure themselves to cope with emotional distress. Some may hurt themselves at first by accident and find that it decreased the intensity of their emotions in that moment, and then later purposely self-injure when feeling emotionally overwhelmed again.

Others may have learned about the behavior from others, like the media or friends, as a way to cope, and try it for themselves. The condition often appears with depression, anxiety or eating disorders, but even children and adolescents who do not struggle with a mental health disorder may self-injure.

How is self-injury in children and teens treated?

Your child probably understands that you don’t want them to injure themselves, so telling them to “just stop it” isn’t going to work. Instead, we’ll talk to them about their reasons for engaging in this behavior. Then we’ll create a treatment plan, tailored to their response.

Coping strategies

The best way to treat self-injury is by helping children regulate their emotions and adding healthy coping strategies that serve the same or similar function to replace the self-injury. The focus on this type of treatment is not changing the emotions themselves but changing how children and teens respond to their emotions.

• Cognitive behavioral therapy - Helping children recognize how their thoughts, behaviors and emotions affect each other, and then teaching them how to change unhelpful thoughts and behaviors.

• Dialectical behavior therapy - Helping children learn skills to regulate intense emotions, tolerate distress, improve their relationships and become more mindful of emotions by neither avoiding them nor over-identifying with them.

• Emotion regulation therapy - Teaching children how to identify and accept their emotions and become more willing to experience them even when the emotions are uncomfortable. We teach them how to identify their values for the present and differentiate them from goals for the future. We also help them identify activities that they find meaningful and how to orient their lives so that they live according to their values.

One of the guiding principles behind this therapy is to learn how to willingly experience uncomfortable emotions in order to pursue meaningful activities in life.