Adolescent Self Harm and Suicide

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People who self-harm deliberately hurt their bodies without the conscious intention to die. Self-harm occurs on a continuum of seriousness. At the milder end of the spectrum, self-harming behaviours include mild to moderate self-injury and at the extreme end, attempted suicide. Self-harm is not normally triggered by one event but rather a set of circumstances that leave young people feeling overwhelmed and unable to manage their feelings.

Children and young people within the child protection system and out-of-home care may be particularly vulnerable to self-harming behaviours due to their past or current experiences of abuse, neglect and trauma.

Understanding terminologies

There are a number of different terms describing the phenomena of self-harm:

  • non-suicidal self-injury – is when a young person hurts themselves and makes it clear they do not intend or wish to die
  • deliberate self-harm – is when a young person injures themselves and there is uncertainty about their intent to die
  • attempted suicide – is when a young person injures him or herself and expresses a strong desire to die
  • self-injurious behaviours – are specific types of injuries that occur among people with intellectual disabilities.

Methods and frequency of self-harm

  • Self-harm activities include cutting, head banging, medication overdose, smothering, strangling, hitting, burning, scalding, jumping from heights and self- battery.
  • The most common method of self-harm among male and female adolescents is self-cutting.
  • Boys are more likely to engage in self-battery and girls are more likely to cut themselves.
  • Some young people harm on a daily basis, others a few times a year and others only once.
  • Evidence from Australian studies suggest that six to seven per cent of young people aged 15–24 years engage in self-harm in any 12 month period.1
  • Non-suicidal self-injury is most common for females aged 18–25 and for males aged 25–34. Outside of these peak periods, rates of non-suicidal self-injury are similar between genders.2
  • Non-suicidal self-injury generally decreases into adulthood.
  • Most young people self-harm at home and after school hours.

Reasons for self-harming

* Most self-harm is in response to intense pain, distress or overwhelming negative thoughts, feelings or memories.

* Self-harm is a way for young people to manage their emotions and release their frustrations, tension or anger.

* Self-harm may bring relief in the short-term however the feeling of relief generally doesn’t last because the problem causing the distress is not being addressed.

What are the risk factors?

Common risk factors for those who self-harm are similar to those who complete suicide. The risk factors are:

* history of self-harm or previous suicide attempt

* mental or substance use disorders

* impulsivity

* child abuse or neglect.

What are the warning signs?

Although young people might try to hide their self-harming behaviour, there are some obvious and less obvious signs that someone might be self-harming. These include:

psychological signs

  • obvious changes in mood
  • changes in sleeping and eating patterns
  • loss of interest in once enjoyable activities
  • decreased participation and poor communication with family and friends
  • problems with boyfriends or girlfriends
  • low self-esteem
  • hiding or washing their own clothes
  • avoiding situations were exposure of arms or legs is required (e.g. swimming).

physical signs include

  • unexplained injuries such as scratches, cuts or burn marks
  • unexplained physical complaints such as headaches or stomach pains
  • wearing clothes that cover arms or legs even in hot weather.

If a young person displays some of these signs it is important to ask them directly about self-harm and thoughts about suicide.

Signals of suicide risk among young people are not always clear. The final trigger may not appear too serious on its own but when considered against other problems it tips a young person over the edge.

Remember not to view risk or warning signs in isolation. Try to understand what is going on for the young person.

Is self-harm contagious?

  • Research suggests young people in residential care or who are hospitalised may copy the self-harming method of others in their environment.
  • Australian evidence suggests that young people vulnerable to self-harming behaviours congregate or group together.3
  • This grouping of friends with similar vulnerabilities may explain increased rates of self-harming among a particular population group rather than a contagion effect.
  • When working with young people who self-harm it is important to ask them about their friendship network because their peers may also be self-harming or at risk of doing so.

What helps?

  • There is very little evidence about the most effective ways to prevent the reoccurrence of self-harm.
  • Small scale studies suggest that cognitive-based therapy and mentalisation-based treatment (which focuses on helping people generate alternative perspectives to their own experience of themselves and others) are effective in reducing the reoccurrence of self-harming behaviours.
  • No data suggests that medication of any kind can decrease the reoccurrence of self-harm. Some antidepressant drugs, including Paroxetine and Venlafaxine, can increase the risk of self-harm in the short term.

Despite the absence of evidence on the effectiveness of interventions, experts working in the field believe the things that probably make a difference are:

  • whether a young person has a motivation or desire to change their behaviour
  • managing substance abuse if present
  • engaging support from family and friends
  • promotion of positive moods
  • promotion of healthy sleep.

De-bunking the myths

There are many myths that surround self-harm. Some of the most common myths include:

  • ‘It is just attention seeking’. Most people self-harm in an attempt to change how they are feeling rather than trying to get attention.
  • ‘It is a fashion trend, emo or goth thing’. Self-harm has been studied for decades. It is not a new behaviour that arrived with a certain trend amongst any particular youth sub-culture.
  • ‘People who self-harm are mentally ill’. Self-harm is a behaviour, not a disorder or illness.
  • ‘Self-harming behaviour is suggestive of an underlying psychological problem’. Too many young people who self-harm do not meet the criteria for any specific mental illness diagnoses.

Do young people who self-harm seek help?

  • The myths and stigma that surround self-harm cause many young people to keep their behaviours a secret. They rarely seek medical assistance.
  • Young people who self-harm are also reluctant to confide in adults. They are more likely to turn to a friend rather than to a professional.
  • Telephone helplines are a common source of support because they provide consistent non-judgemental advice and users are able to maintain a degree of control over the disclosure of self-harm.

What is the relationship between self-harm and suicide?

  • Some people argue that self-harm is the opposite of suicide, that it is a way of coping with life rather than ending it.
  • There is an equally compelling argument that they are part of the same continuum and that self-harm may lead to suicidal behaviours in individuals experiencing more distress than they can effectively manage.
  • In most cases self-harm does not lead to suicide. It is estimated that between 40 to
  • 100 times as many young people have engaged in self-harm as have actually ended their own lives.4
  • However, people who self-harm are 100 times more likely than the general population to die, or attempt suicide, in the subsequent year.
  • Increased frequency and severity of self-harming behaviours can signal escalating risk.
  • Given these relationships between self-harm and suicide, self-harm presents an opportunity to engage with young people and prevent future suicide.

What can I do?

Useful practices for practitioners working with young people who self-harm include:

  • being with: maintain an engaged and attuned connection with the young person
  • understanding risk: actively use pre-existing knowledge about the young person and their situation and be alert to risks and warning signs to determine whether suicide is an issue. Ask the young person directly about self-harm and whether they are suicidal
  • communicating: communicate your concerns about the young person to colleagues, managers and other professionals
  • building supports: work with the young person to identify and strengthen supports among other family, friends and professionals.

To learn more about suicide, read the presentation of keynote speaker Dr Philip Hazell ‘An overview of self-harm and suicide’.

1. De Leo, D., & Heller, TS. (2004) ‘Who are the kids who self-harm? An Australian self-report school survey’, Medical Journal of Australia. 181 (3): 140-144.

2. Martin, G., Swannell, S., Hazell, P., Harrison, J. and Taylor, A. (2010). ‘Self-injury in Australia: a community survey’, Medical Journal of Australia. 193 (9): 506-510.

3. Fox C, Hawton K. Deliberate self-harm in adolescence. (2004). Jessica Kingsley

Publishers: London.

4. Hazell, P., Franz, C., Lewin, T. (1993). ‘Friends of adolescent suicide attempters and completers’, Journal American Child Adolescent Psychiatry. 32 (10): 76-81.