2023-11-07-How to prevent and promptly detect children's "self-harm" behavior? - Hu Xiu Net

How to prevent and detect children's "self-harm" behavior in a timely manner? -

How to prevent and detect children's "self-harm" behavior?#

This article introduces the common occurrence and reasons for self-harm behavior in adolescents, and provides some advice for parents to deal with their children's self-harm behavior.

• Self-harm behavior is not about wanting to die, but a way to seek help and express inner pain.

• Self-harm behavior has a high level of repetition, and early intervention and prevention are crucial.

• Parents should avoid blame and avoidance, and rebuilding trust and good communication can greatly help children.

Self-harm, just mentioning these two words or referring to it, is enough to make people feel anxious and uneasy.

The majority of adults, especially parents, cannot understand: why would someone hurt themselves, doesn't it hurt?

And witnessing or experiencing a child's self-harm behavior is even more difficult for parents to accept, why is it my child? What is wrong with them?

I. What is self-harm?

The core definition of self-harm is the act of intentionally harming one's body. The full name of some official terms is "non-suicidal self-injury," which refers to intentional self-harm behavior without suicidal intent.

These self-harm behaviors come in various forms, including common physical cutting, with wounds usually located in easily concealed areas such as the upper thigh, inner thigh, wrist, inner arm, inner elbow, and other hidden areas. They also include deliberate risky behaviors and unprotected sexual behaviors.

In recent years, with the development of the Internet, the phenomenon of self-harm on the internet has become more and more common. Research by Chinese scholars has shown that the self-harm rate among Chinese adolescents is increasing year by year, and the detection rate is higher than in some Western countries. Adolescence is a high-risk period for self-harm.

Different from purposeful suicide, the occurrence rate of self-harm is three times higher than that of intentional suicide. Although some scholars have believed that there is a close connection between self-harm and suicide, we still need to recognize that most self-harmers do not want to end their lives.

II. Characteristics of self-harm occurrence

  1. Self-harm has a high level of repetition, and after the first occurrence of self-harm behavior, most self-harmers will choose to repeatedly self-harm in the following period of time, and some scholars even classify self-harm as highly addictive behavior. This makes early intervention and prevention of self-harm particularly crucial.

  2. Self-harm behavior is often preceded by intense emotional distress, which includes visible distress such as intense conflicts and frustrating events, as well as hidden distress caused by traumatic experiences triggered by situations. The latter is usually more difficult to identify and understand.

  3. Not all self-harm behaviors occur with the self-harmer's awareness. Some self-harm situations may involve dissociative states, where the self-harmer is not aware that they are harming themselves.

Therefore, when we panic and see wounds on children, but they deny it, do not rush to consider these denials as lies. Self-harm in a dissociative state often has more complex pathological factors, which means it takes more time and attention to rebuild emotional connections with self-harmers and help them stop harming themselves.

  1. After self-harm, there is often a sense of relaxation, satisfaction, and numbness.

  2. Most self-harmers have contradictory experiences with self-harm. While experiencing emotional release, they often also experience shame from stigmatization and exposure of scars. Therefore, many self-harmers will try to hide their scars and remove any traces of self-harm as much as possible.

III. Rethinking self-harm

Most self-harm survivors believe that wounds and bleeding can bring comfort and release stress and pain in moments of self-harm. They regain a sense of control and retaliate against the imagined objects of anger. The emotional experience of self-harmers is extremely painful and sensitive.

This also means that when we first encounter self-harming adolescents, we should first abandon criticism and blame, and see each wound as a silent language. Self-harmers are expressing their inner struggles and pain through this painful language. Self-harm is a painful expression and a cry for help.

IV. Reasons for self-harm occurrence

  1. Physiological reasons

The so-called immaturity of adolescence is first manifested in the underdevelopment of the brain and nervous system. Among the four regions of the brain, the prefrontal cortex responsible for higher executive functions is still developing during adolescence and does not reach maturity until the age of 20 or more. The prefrontal cortex is the source of self-awareness, insight, judgment, and future planning. It also enables us to assess danger. The immaturity of the prefrontal cortex makes adolescents more prone to emotional instability, impulsivity, communication difficulties, and a tendency to seek stimulating and risky behaviors.

The amygdala in the limbic system, which is responsible for emotional control and regulation, is easily influenced by sex hormones and adrenaline. The immature amygdala is also a major factor in adolescent emotional instability.

  1. Psychological factors

Self-harm, especially habitual self-harm, has formed a positive feedback loop: stress → self-harm → release and relaxation → continue to use this method next time. Habitual self-harm gradually increases the pain threshold of the body, reducing fear and pain, and ultimately damaging the body's pain management system, making self-harm easier.

In addition, although self-harm is not included in the DSM-IV diagnostic system, adolescents may already have some psychological disorders such as anxiety, depression, bipolar disorder, etc. during self-harm behavior, so relevant assessments need to be conducted after self-harm behavior is discovered.

Self-harmers often have low self-esteem and lack secure attachment relationships. The damage to attachment relationships prevents individuals from establishing trusting and supportive relationships with others. Self-harm, especially habitual self-harm, often goes through a process.

Most self-harmers lack effective and genuine communication and positive parent-child interaction. Novick proposed that emotional regulation is like the strength of muscles, which needs to be developed through a long process of emotional recognition, naming, expression, understanding, and tolerance in the parenting process. Most self-harmers have not developed a flexible internal emotional regulation system before this.

In addition, some individuals who have experienced abuse and bullying gradually use self-harm as an important defense mechanism. They often use physical pain to resist emotional pain or use self-harm as a way to redirect or express anger towards others. Sometimes self-harm can also be a means of self-punishment to resist the guilt of unacceptable thoughts and feelings deep within.

V. Vulnerable groups for self-harm

The occurrence of self-harm is closely related to the following issues:

Neglect and violence in early upbringing;

Traumatic experiences such as sexual abuse and major illnesses;

Interpersonal relationship breakdown;

Bullying, including physical, verbal, and cyberbullying;

Being trapped in family conflicts;

Poor parent-child relationships and attachment patterns;

Low self-esteem and perfectionistic demands;

Direct or indirect exposure to resources related to self-harm;

Lack of effective internal emotional regulation mechanisms.

VI. Recognition and prevention of early self-harm

Early self-harm behavior often leaves traces. Parents need to be vigilant when the following phenomena occur:

Unexplained scratches on the body, wearing long sleeves even in hot weather, deliberately avoiding exposing arms and legs;

Sudden appearance of wristbands or wrist accessories that are rarely taken off;

Searching for self-harm-related terms on the internet;

Sudden tattoos on the wrists or joints;

Sharp objects deliberately hidden;

Withdrawal from interpersonal interactions and loss of interest in social activities;

Issues with eating and sleeping;

Emotional fluctuations such as anxiety, depression, or sudden emotional outbursts;

Other conditions that are different from usual.

VII. Coping with self-harm

  1. Do not deny or avoid

Parents are often shocked and incredulous when they first discover their adolescent's self-harm. Some parents instinctively deny the self-harm behavior itself when faced with wounds, such as saying, "It was just an accidental scratch," or "This time is special, it won't happen again."

This denial is not due to a lack of concern but because the shock caused by self-harm exceeds the emotional capacity of parents. Denying and avoiding will miss the reception of the cry for help.

The psychological reality of self-harmers often differs greatly from reality. Self-harmers already have distorted perceptions of interpersonal relationships, emotional interactions, and emotional understanding. Therefore, denial and avoidance are often perceived by self-harmers as neglect and rejection, reinforcing their experience of low self-esteem and worthlessness.

In addition, although self-harmers try to hide their wounds, it does not mean that they do not want their inner pain to be seen. They are hiding the shame, not burying the pain itself.

  1. Avoid negative interpretations, blame, and mutual blame

The most difficult thing when facing self-harm at first is not to blame anyone. Do not blame the child, nor blame other caregivers. The purpose of reflection is not to find a scapegoat for the problem but to truly understand the reasons for the child's self-harm.

Avoid responding to the child in a blaming or coercive manner, such as:

Are you threatening me with this method?

Filial piety is the foundation of filial piety, and what you are doing is not filial;

How could you do this?

If you do this again, I will...

Why did you do this?

You must have been influenced by...

Hand over your tools immediately and stop this behavior.

In addition, parents should also avoid blaming each other. Dealing with a child's self-harm requires parents to support each other. Being able to communicate opinions, clarify misunderstandings, and convey empathy through language can be a good demonstration for the child and help rebuild their sense of emotional security and enhance their confidence in dealing with emotional distress.

  1. Be cautious of excessive guilt and take protective measures

When faced with their child's self-harm, parents often fall into deep self-blame. However, excessive guilt hinders parents from thinking rationally about how to better help their child with this important issue.

Possible problems caused by excessive guilt: excessively satisfying the child's unreasonable demands, giving up parental authority and importance, relinquishing parental responsibility, believing that they are terrible and should be taken over by others. Parents need to know that even if the child is in pain, even if they isolate themselves and advocate for independence, parents are still the most important person who needs to be present.

Parents need to think rationally about what can truly help their child, and these things may be repeatedly rejected by self-harming children at first, such as healthy eating, regular sleep, necessary medical or psychological interventions, and removing sharp objects that can be used for self-harm from the teenager's surroundings. The implementation of these protective measures often cannot be achieved overnight and requires skills and methods. A gentle yet firm attitude is necessary, with empathy as a prerequisite. The core of negotiating protective measures is to convey to the child: I hope I can better understand your pain, and I hope I can help you express your pain and alleviate your suffering in a safer way.

  1. Patiently rebuild a trusting parent-child relationship, and the restoration of healthy communication will go through repeated conflicts

Dealing with self-harm issues will ultimately be achieved through communication. However, this communication often goes through a long process of trial and error, frustration, reattempting, and adaptation... This repetitive process. To achieve the ultimate rebuilding of the relationship, parents need to let go of some unrealistic expectations:

A deep conversation can bring about change → The accumulation of problems does not happen overnight, and solving them cannot be achieved through one or two deep conversations. The problems revealed in communication are the starting point for us to rethink and reflect.

Stopping criticism and conveying empathy can bring about change → Empathy alone is not enough. Stopping criticism is to give us space for reflection, and empathy can promote possible cooperation among family members.

Stopping self-harm is possible as long as there is concern → Self-harmers often go through intense emotional experiences before self-harm. When the initial positive interaction is established, self-harm behavior may still occur. At this time, on the one hand, do not rush to deny the value of the positive interaction that has been established; on the other hand, focus on the self-harm behavior that has just occurred: What did you experience before the self-harm occurred? What did you feel?

  1. Actively seek professional help

Adolescent self-harmers and their families face a very painful, frustrating, and discouraging situation. However, self-harmers and parents often have limited knowledge. Seeking help from professionals can provide safer coping methods than dealing with it within the family.

Secondly, it is necessary to have a reasonable view of professional help and set reasonable goals for seeking help. Seeking help does not mean that professionals have a universal method to end the pain. The above-mentioned reasons for self-harm still appear relatively general in front of each self-harmer. Each self-harmer is an independent individual with a rich soul.

Professional help can help parents regain competence, as well as improve their communication skills, understanding, and execution to better help their children. It can also help self-harmers and their families to re-understand and understand self-harm behavior, and to understand this unique individual. By finding the unique internal factors that lead to self-harm behavior, understanding the subconscious driving force behind self-harm, the meaning of emotions, and trying to establish new emotional regulation methods, self-harmers can gain more flexible emotional regulation abilities.

In addition, it is important to note that professionals cannot replace parents. Although self-harming adolescents may feel desperate, they have not given up hope for the future. They also do not want to push back their parents with their despair. Adolescent self-harm will be a key moment for parents to reflect on their parenting methods and adjust their parenting strategies.

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