Adolescence is a phase of confusion, questioning, change and discovery. Now, that’s a loaded and heavy attempt at describing the teenage years that we live through. It feels that way, because we have made it seem heavy, through the stereotypes in which we think about young people and their behaviour. Add self-injury to the equation and we often feel lost, scared, angry and helpless as adults and parents. This is normal. However, we could attempt to unpack self-injury, to understand it for what it is, to see it’s different dimensions and to cope with it ourselves, while we help young people in our lives ride the waves of their emotions and weather the storms in their hearts and minds.
Non-Suicidal Self Injury (NSSI)is when a person directly inflicts damage to their own body tissue without the intention of suicide. It is also important to note that self-injury can include certain behaviours and acts that do not involve visible injuries. This is often associated with young people, sometimes beginning from pre-adolescent years. However, there are adults and older people who also engage in self-harm.
‘he is ALWAYS looking for attention’.
‘she is just experimenting’.
‘Just ignore him, and he’ll stop’
Sound familiar? These are common statements adults and family members tend to make when self-injury makes an appearance. Dismissive statements, because many of us find it difficult to comprehend, because “in our times, what self-harm, men? These are all these new age fads”, because; stopping to pay attention and listen might aggravate the problem. The stigma around self-harm also tends to be pervasive because we dismiss it as ‘drama’ that we do not need to deal with.
Taking a step back to think about why your teenager might be hurting so much also needs to be an option, an important step that requires urgent consideration.
Reasons for Self- Injury
- Young people often engage in self-injury when they are in a great deal of emotional distress and they do not have the necessary support and tools to cope. Harming oneself can be a form of release and relief. Difficulties in relationships, the experience of loss in close relationships, physical illness and disability, and problems around sex and sexuality can also be reasons as to why a young person may self-harm.
- An adolescent struggling with domestic violence at home, parental separation, abuse, loss etc might use self-injury as a way of coping, because they often feel like they do not have anyone to talk to. It is their way of being in control, when all control and power seems lost. This is especially true in young people who have experienced physical, emotional and sexual abuse. Harming themselves is a way to be in control of their body.
- Communication of needs and wants in family relationships can be difficult for a young person. Self-injury might be a way of communicating distress and other needs to a parent/s. The behaviour we often label as ‘attention seeking’ can actually be a way to influence other people to change their behaviours towards the young person, when other ways of communicating seem difficult. In Sri Lankan culture, we must also acknowledge that assertiveness and the expression of one’s feelings are not everyday practice. This makes it difficult for an adolescent to find his/her/their feelings/needs heard.
- Depression, intense loneliness and isolation can lead to feelings of emptiness and young people often talk about feeling numb inside. Harming themselves can be a way for them to feel alive. It can be a way for a young person to ‘feel something’, when everything else seems dead inside. Self-loathing can also be a reason as to why a young person might injure themselves, intentionally.
- A young person may also engage in self-harm to switch off from thoughts/memories that may be disturbing. The physical sensations felt when self-harming can switch their attention from thoughts and feelings that cause them distress.
- Another important consideration is that self-harming behaviour may be a strategy for young people to ward off suicidal thoughts. The act of harming oneself can delay them attempting to take their own life, and can also be a way to ride through suicidal thoughts until they pass.
Another perspective through which we can look at self-harm is through the lens of identity and belonging. It is known that young people often engage in self-harm in order to feel like they belong to a sub-group (i.e. their peer group in the classroom) and they often find it helpful to define who they are as a person and to find a sense of identity. The scars left behind help them connect with others who might have had similar experiences. This creates sub-groups within sub-groups. Self-harm can be a way for a young person to feel strength and power, because they own their experience of self-harm, often hidden from other people. It becomes a person language through which they communicate pain and distress. It also can have a protective feature where most young people describe the act of caring for one’s wounds/injuries after self-harm as soothing and protective.
Types of Self-Injury/self-harm
- Skin picking
- Hair pulling
- Punching a wall/door
- Banging one’s head on a hard surface
- Binge eating
- Overdosing on prescription medication
- Substance misuse
- Risky sexual behaviour/other risky behaviours
Helping your adolescent cope with distress(practicing these skills with themregularlycan help them learn how to cope with distress in the long run)
T- Tip the temperature
(to calm down quickly, one can try holding one’s breath and putting their face in a bowl of ice water or hold an ice pack on their cheeks for about 30 seconds– this activates the mammalian dive response which prompts a relaxation response)
(intense exercise can help get rid of negative energy stored in our body due to strong emotions. Intense running in one place, jumping jacks, fast paced walking etc can help release endorphins which combats anger, sadness and anxiety)
P- Paced breathing
(Another way to calm down is to breathe deeply into one’s stomach. Inhale for 4 counts, hold your breath for 2 counts and breathe out for 6 counts, slowly!)
P- Paired muscular relaxation
(While breathing deeply and slowly, tensing and relaxing each muscle group in the body (5 secs each) can help one relax and release muscle tension caused by distress)
(Dialectical behaviour therapy, Marsha Linehan)
Other alternatives to self-harm
Holding an ice cube in one’s fist can bring about similar sensations to what one would feel when cutting, for example. Drawing around the area where one wants to cut with a red marker pen can symbolize blood that can help one feel relieved.Screaming into a pillow, crying, writing in a journal etc can also be helpful ways of coping with distress.
PL– Treat physical illness
E– Balanced eating
A-Avoid mood altering drugs
S– Balanced sleep
MASTER– Engage in activities/hobbies that give you a sense of mastery.
(Dialectical behaviour therapy, Marsha Linehan)
Self-harm and associated issues can bring about distress, anxiety and other difficult feelings for parents and young people. Early intervention, compassion and validation can help a young person ride the waves, calm the internal storm and journey towards recovery and well-being. This is a collective effort, where family also needs to be involved in a non-intrusive, yet validating manner.
There is help available in Sri Lanka for both adults and young people who self-harm both in the government healthcare sector and in the private sector. Seeking help early often brings positive outcomes.
Mental health helplines
- Sumithrayo: 0112692909/0112696666(9am-8pm, 365 days)
- 1333: Crisis support service (24 hr., 365 days)
- Shanthi Maargam: 0717639898(24hr, 365 days)
- National mental health line: 1926(24 hr., 365 days)
Speak to a Counsellor, Psychotherapistor Psychologist. They are often available in private practice, but can also be found in private hospitals. There are also non-governmental organizations that provide free counselling services. The above professionals are not allowed to prescribe medication and they primarily use talk therapy to help people cope with and resolve issues.
(Remember: check their credentials before seeking help. You have the right to ask questions from your therapist/counsellor).
Speak to a Psychiatrist. A Psychiatrist is a medical professional who has done their basic medical training and then gone on to specialize in Psychiatry in their post-graduate training. They often treat mental health problems with medication and some Psychiatrists are also trained in psychotherapy. Be sure to check their credentials and whether they are registered with the Sri Lanka Medical Council and whether they are board certified to practice in Sri Lanka. They can be found in most government hospitals and in private hospitals.