Self-harm: «Parents must not look away»

Mr Schmid, how many young people in Switzerland display self-harming behaviour?
behaviour?

We have investigated this in the Child and Adolescent Psychiatric Research Department at UPK Basel . There are many adolescents here who say they have already hurt themselves once. Around 4.5 per cent have done so at least four times in the last six months. In child and adolescent psychiatric clinics, the figure is as high as 50 per cent and 38 per cent of young people living in socio-educational residential groups.

What is the function of this behaviour?

The most common cause of self-harm is the cessation of intense states of tension, unpleasant feelings or circling around negative, stressful thoughts. Severe states of tension are also accompanied by a loss of body awareness in those affected. With the help of self-harm , those affected can feel themselves again and calm down.

We know that girls are affected more often than boys. Which age group is particularly at risk?

Self-harm usually begins after puberty and usually only after the first menstruation. In this phase of life, there are often difficulties in regulating emotions, body image and one's own body schema change. In addition, self-esteem is more unstable in this developmental phase and critical self-esteem processes occur more frequently.

Contact with peers is very important at this age. The feeling of rejection by others has been identified in several studies as a trigger for self-harm. In addition, adolescents and young adults are much more susceptible to group dynamics.

Does that mean that some people learn self-harming behaviour from others?

So to speak. However, it is important to understand that no young person self-harms simply because others do it, but that behind it are very central needs such as belonging. To overcome self-harming behaviour, it is much better to work out these needs and provide for them.

Affected adolescents hurt themselves in order to end intense states of tension, unpleasant feelings or circling around negative, stressful thoughts.

What factors lead to increased self-harm?

Risk factors include stress in the family, stressful life experiences and little social contact in the classroom. Factors that protect against self-harming behaviour, on the other hand, are good social integration, positive leisure activities, in particular involvement in sports clubs or music groups. These all appear to be protective factors. Good self-esteem and a high expectation of self-efficacy, i.e. the belief that one can solve problems, are also associated with a lower risk of self-harm behaviour.

As a parent, how can I recognise whether my child is at risk?

Parents should be concerned if their child withdraws a lot, often seems depressed and irritable, loses interest in hobbies, withdraws from friends and avoids their parents. You should listen carefully if they repeatedly devalue themselves and make negative comments. Of course, it is also very noticeable when teenagers only wear long-sleeved clothes in midsummer and avoid showing their legs and arms, for example by no longer going swimming.

How should parents react if they observe this behaviour or even discover injuries in their child?

It is very important not to look away and not to pretend not to notice anything. It is also important not to reproach the child, but to express your concern, to persevere, to make and maintain an offer of a relationship, even if the person concerned cannot accept it immediately.

Putting away dangerous objects such as knives or scissors, on the other hand, is not very promising. Affected young people will always find something they can use to hurt themselves if they really want to. It is much better to make binding agreements with the person concerned about what can be done if the tension and pressure to scratch increases and to offer help.

As a mum or dad, when should I seek professional help? What could this look like?

It is certainly good to motivate young people who have self-harmed more than once to seek professional help. It makes sense to emphasise in this conversation that you are concerned and want him or her to get help and to accompany the search for help as parents with the necessary presence.

All successful therapies, regardless of the therapeutic school of thought, have in common that they focus on self-perception of feelings and interaction patterns and help adolescents to better recognise their feelings and needs and to express themselves better, even in difficult social interactions.