How to Support a Child or Teenager Who Self-Harms

As a therapist who works with children and young people, I often come across clients who self-harm. Perhaps you're reading this as a parent or carer, reeling in shock, having just found out from your child's school that they are self-harming, or as a young person who has discovered your friend is hurting themselves. Seeing someone you love suffer is heart breaking.

In my experience, parents' and carers' initial reactions when faced with the reality that their child deliberately injures themselves are, understandably, disbelief, horror, fear and bewilderment. Unfortunately to the young person, this often appears to them as anger and leads them to shut down communication. Unsurprisingly, this issue can evoke a lot of fear and emotion in those who come across it. In this piece, I want to give a brief overview of this commonly misunderstood issue and how you can support those who self-harm.

First I must expose the most common myth around self-harm, that those who do it are suicidal. It is not necessarily the case that those who self-harm have intention of ending their life. It sounds contrary, but the harming is usually what keeps them alive. This is because self-harm is usually a coping strategy, albeit an unhealthy one, to block out overwhelming feelings. In short, it can stop feelings from becoming so overpowering that suicide seems the only escape. However, those who self-harm are more at risk of suicide than those who do not, particularly if their underlying problems aren't resolved. Knightsmith, 2015 .

That self-harm is an attention seeking behaviour is another misconception. Self-harm is generally done in secret, is a cause of great shame and guilt for the sufferer compounding their misery and can remain hidden indefinitely. Sufferers may choose areas of the body that are rarely seen such as the top of the thighs. Yes, some sufferers may appear to not hide their wounds, but that does not equal "showing them off". I believe passionately that all behaviour is communication and that a person whose injuries are visible is screaming out that they are struggling with life.

So what is self-harm? People usually think that self-harm is someone cutting themselves, but there are many other ways of hurting yourself including

• Burning
• Biting
• Alcohol and drug abuse
• Head banging and hitting
• Taking personal risks, such as having unprotected sex
• Picking and scratching
• Pulling out hair
• Disordered eating, both overeating and restrictive diets
• Overdosing and self-poisoning NSHN, 2008