‘Blood on the sheets’: When you should suspect your child is hurting himself

Cutting, or self-harm, starts off as a coping mechanism. “Self-harm is usually a symptom or sign of something else being wrong. Self-harm is any behaviour where the intent is to deliberately cause harm. Common behaviours include self-cutting, swallowing objects, self-burning, taking an overdose, running in front of cars, hanging, etc. The child or young person may be stressed, anxious or depressed and feel things are building up within them, so much so that they desire a ‘release’. Self-harm becomes a way of coping with difficulties and of gaining control of a situation,” explains Dr Waleed Ahmed, Consultant in Child, Adolescent and Adult Psychiatry, Dubai-based Priory Wellbeing Centre.

A startling study in 2011 found that one in 12 young people were self-harming and that around 10 per cent would continue to do so well into adulthood.

The study, which was conducted at the Center for Adolescent Health at the Murdoch Children’s Research Institute in Melbourne, Australia, followed a sample of people aged from 15 to 29 between 1992 and 2008.

Paul Moran, of King’s College London’s Institute of Psychiatry, was quoted by Reuters as saying that a combination of hormonal changes during puberty, brain changes in the mid-teens with the final development of the pre-frontal cortex - the brain area associated with planning, personality expression and moderating behaviour - and environmental factors such as peer pressure, emotional difficulties and family tensions appeared to be key factors influencing the decision to self-harm.

Another study in 2013, published in the peer-reviewed journal BMC Psychiatry, followed 3,964 kids aged 12 to 16 over a period of a year and found that 27 per cent of young adolescents reported thoughts of self-harm and 15 per cent reported at least one act of self-harm.

Overall, self-harm is a way of expressing very deep distress (which cannot be easily put into words).

- Priyanka Dang

The reports of self-harm in children ever since the COVID-19 pandemic began have only risen as they find themselves cut off from their peers and dealing with excessive time and energy.

Priyanka Dang, Clinical Psychologist at Open Minds Psychiatry, Counselling and Neuroscience Centre, adds that a child who is indulging in self-harm is suffering. The unhealthy behaviour may be a way to:

“Overall, it is a way of expressing very deep distress (which cannot be easily put into words),” says Dang.

She adds: “It is rarely one single event or experience that causes a young person to self-harm, but a multi-faceted combination.”

Risk factors

Both Dang and Dr Ahmed explain that research has shown that the experiences most closely linked to self-harm in young people are:

Is self-mutilation an addiction?

It can become one, explain doctors. “When a person inflicts pain upon him or herself, the body responds by producing endorphins, a natural pain-reliever that gives temporary relief or a feeling of peace. The addictive nature of this feeling can make the stopping of self-harm difficult.

“Young people who self-harm still feel pain, but some say the physical pain is easier to stand than the emotional/mental pain that led to the self-harm in the first place,” says Dang.

Dr Ahmed says that some older adolescents report feeling numb inside or experience a feeling of ‘emptiness’ inside and the physical pain helps them to feel ‘something’. “These seemingly short-term ‘beneficial’ effects over time may make it difficult for someone to stop self-harming, even though there are overwhelming longer-term negative effects of self-harm on one’s mental and physical health. But, like all mental health conditions and difficulties, children and young people who self-harm can be helped by providing psycho-education, support, talking therapies and in some cases, using medications.”

Is self-harm tied to any disorders?

It is. The doctors list the disorders that may be linked to self-harm:

What are the red flags you should be aware of?

There are always signs of a suffering person’s pain – some obvious, others less so. But if you find that any of the following is true for a young person you know, be warned, something may be seriously wrong.

How do you address self-harm in kids?

Don’t panic. This is imperative – knee-jerk reactions are never a good thing. “Get medical attention, if needed,” says Dang.

She adds that it’s important to ask the child how he/she would like to be supported. Explain that you are not angry, but concerned, that you are there for them. Try to understand their emotions and experiences, without judging them, rather than focusing on their self-harm, she says.

“Consider that any amount of self-harm might be a sign that they're feeling extremely distressed,” says Dang, adding, “Let them be in control of their decisions but get them medical attention if needed.”

Offer to listen and talk to your child and try and understand what’s causing them to self-harm – be mindful that they may not have figured this out themselves; communicate to them that you are taking this seriously but also are ready to give them space too.

- Dr Waleed Ahmed

And, encourage them to speak to a mental health professional about self-harm.

Dr Ahmed stresses the need to talk about things. “Offer to listen and talk to your child and try and understand what’s causing them to self-harm – be mindful that they may not have figured this out themselves; communicate to them that you are taking this seriously but also are ready to give them space too,” he says.

Build trust. “It is important to establish trust with your child – if they don’t trust you, the behaviours could become more secretive,” he says.

Finally, “Address any urgent issues like an overdose, or severe self-harm appropriately by contacting emergency services,” he adds.

The family fallout

Once discovered, the realisation that a child is hurting themselves is a huge burden to bear. “A whole lot of emotions can be experienced – shock, sadness, anger, guilt, helplessness, etc. In some cases, it could impact the parents’ own mental health and, in such circumstances, they should probably seek help for themselves too,” says Dr Ahmed.

He adds: “Parents may have to take time off work to accompany their child to clinical appointments. It can also put a strain on parental relationships. Siblings may worry excessively about their brother or sister who is self-harming. Younger siblings could be at risk of harm if sharp objects or medications are found by them or if they tried to stop their brother or sister from self-harming.”

Is it my fault my child is hurting herself?

Don’t play the blame game. It can be distressing to think your child is hurting herself, but it’s important to try to help her instead on trying to assign blame. Dang says: “Finding out that your child is self-harming can be an incredibly distressing, or even a traumatic experience as a parent. It’s okay to struggle with feelings of anxiety, confusion, sadness, anger, frustration, guilt, or shame.

“Pay attention to the signs of stress, such as headaches, stomach aches, difficulty sleeping, or depression.

“Take time for yourself when you are upset.

“Do things you enjoy, such as going out with friends, exercise, hobbies, etc. Learn to identify and accept your own feelings. It may help to write them down.

“Find an outlet for your emotions, such as talking to a friend, relative or therapist. You may find other emotions coming out as anger – be careful that your child does not think this is directed at them.

“Most importantly, don’t give up on your child.”

Do not do this

Dang says don’t ever tell your child that they are ‘doing this for attention or to manipulate you’.

Don’t command them to stop doing it right away.

Don’t threaten them with dire consequences.

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