Self-Injurious Teens

What to Look for and How to Help

03/31/2010  |  JULIA FRANKEL
special needs
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Few of us ever imagine that our wonderful children are going to grow to adolescence and do something as self-destructive as self-injury or mutilation, yet more and more parents find themselves facing this difficult scenario. Self-injury is defined as any self-inflicted action that causes bodily harm and can include scratching, cutting, burning, mutilating, hitting oneself or banging body parts against hard surfaces. Self-injury is a negative way of dealing with strong emotion; it is serious, addicting, can cause life-long consequences and can even be fatal. Think it can’t happen to your teen?

According to CNN.com, one in five teens admits they have purposely injured themselves at some time.

Who is at risk?

Any child, most often aged nine to 14, who feels the need to be in control, but is unable to cope with stress, suffers from low self esteem, or who has suffered a form of abuse is at risk. Since, for example, children rarely tell parents about sexual abuse, parents may have no idea that abuse is even an issue for a self-injuring teen. Teens with mental health issues including depression, anxiety disorders or obsessive-compulsive behaviors are at even greater risk, but any teen who wants attention, or who is just curious, could be at risk. Self-injurious behavior affects girls more than boys, but boys can be at risk as well. You may think that it takes years of discernable problems before teens begin to injure themselves, but that isn’t necessarily so. Something as simple as a breakup with a boyfriend or episodic teasing about weight or acne can trigger the behavior.

Self-injury is often diagnosed in teens who have been taught, or who have decided, often without realizing it, that expressing strong negative emotion is either unacceptable or un-cool. The more intelligent the adolescent, the more they tend to think, analyze and internally “decide” to try self-injury to see if they like it, or if it feels “cool.” Unfortunately, self- injury does provide a feeling of release, and can seem “cool” to peers. The self-injuring teen feels secretly empowered in the short term, but the positive feeling doesn’t last, and the behavior quickly becomes repeating and self-addicting. Parents, often at middle or upper class income levels, are especially shocked because the behavior has virtually nothing to do with intelligence, potential, lifestyle or material possessions.

What to Look For

Any unexplained injuries, such as cuts, scratches, burns, or bruises may be an indication of self-injurious behavior. Specifically, secretive behavior, overly complicated explanations or excuses, wearing long sleeves or pants in hot weather, embarrassment or shame when questioned about an injury, withdrawal or outbursts out of proportion to the inquiry should raise questions in your mind. If you find that your child is spending time, either personally or on the Internet, with others who self-injure, has had a change in eating or sleeping patterns and/or who is having difficulty at school, at work or in relationships, don’t wait: get professional help immediately. This is not the kind of problem that can be solved by removal of privileges, grounding or other disciplinary measures. 

How to Help

Even if it’s just little burns or scratches (teens often scratch or carve words that reflect their inner concerns, like “fat” or “stupid”) do not ignore the behavior. Look for a therapist who specializes in this area and who can help your child develop healthy alternatives to handling stress and problem solving. If you’re suspicious that your child is indulging in self-injurious behavior, try not to let your own emotions and concerns overwhelm the child. Stay calm, reserve your anger, and say, “I love you, and I’m worried about you. You don’t seem comfortable talking to me, so we’re going to find someone who can help you.” Self-injurious behavior represents underlying problems that take time to develop and cannot be quickly resolved. If, after a reasonable course of therapy, your child doesn’t improve or seems worse, don’t lose hope, or worse yet, give up on therapy.

There are solutions available to you. There are private treatment programs all over the country and local face-to-face support groups for parents as well. While private treatment programs are relatively expensive, remember; treatment programs are inexpensive compared to the life of your child.

Wilderness therapy programs (often eight to 12 weeks long) are a good starting point and a few therapeutic residential programs require completion of a wilderness-based program prior to admittance. Wilderness therapy provides an immersion environment that removes the distractions of everyday life and opens adolescents to the concept of talking about their problems. It brings teens back to the basics of survival and provides time for self-reflection, which speeds the therapeutic process. One of the first questions teens are asked is, “How did you get here?”

Upon completion of a wilderness program, most teens are less resistant to a therapeutic residential program because they have accepted the fact that they have a problem and are more open to finding a solution. In addition, they are grateful to have some level of modern convenience restored to their daily routine.

 After completing a wilderness program, the self-injurious teen would typically go on to a residential treatment center (RTC) or therapeutic boarding school (TBS) where treatment will average 12 to 18 months. Students are not classed by disorder in these programs. Students are there for many different reasons and disorders. The difference between therapeutic boarding schools and residential treatment programs is that RTCs are more clinical in nature. Children are much more closely monitored (because of the possible flight risk) and RTCs can provide medications on a daily basis. They often have a lockdown facility, especially for new students.

Therapeutic boarding schools are for children who are at less risk to themselves. The teens sleep in dorms (from two to six students per room). Some programs are on small ranches or farms and some are large facilities. Some programs utilize a mentoring system with students further along in the healing process to help new students along.

In all good programs, students are even monitored while sleeping. There are always “awake staff” to help students who want or need to talk during off hours.

Parents whose children practice self-injurious behavior often blame themselves, thinking, If only I’d paid more attention, done this or that. It is important to remember that as parents we make mistakes, but it isn’t necessarily something you’ve done wrong or left undone. It may be that your child has just developed this inappropriate coping mechanism over a long period of time and it wasn’t predictable on your part.

For others, the behavior is triggered by a particular event and we cannot protect our children from every emotionally upsetting and stressful situation. Some bright teens are just very sensitive and just can’t seem to let negative events roll off their shoulders like others can. A child’s self-injurious behavior doesn’t mean you are a bad parent.

As a parent who has been through some tough times with my five children, I always tell people who ask me for advice that in addition to finding a therapist for the child, to join a support group if possible. Meeting other parents face-to-face can really make the difference in your own mental health, which in turn, is helpful to the child as well. A significant number of programs offer, or require, parental involvement in workshops so that the good work that was done in therapy can continue when the child returns home.

Julia Frankel is a mother of five children who resides in central New Jersey. Two of her children attended therapeutic boarding schools and one also attended a therapeutic wilderness program. This experience led many people to reach out to her for help with their own teenagers. She can be reached at 973-488-7100 or [email protected].

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