On the Pulse

Cutting to Cope: What is Nonsuicidal Self-Injury?

5.24.2019 | Seattle Children's Press Team

A kid looks at their phone under the bed covers.

Today, nearly one in five children has a mental, emotional, or behavioral disorder. While some seek relief from their distress using positive coping methods, others may choose methods that are harmful and potentially life-threatening.

Dr. Yolanda Evans, an adolescent medicine specialist at Seattle Children’s, has been seeing a recent increase in teens coming into the clinic with self-injuries done through cutting, burning, pinching and scratching, among others.

“It’s possible that the increase may be partly due to the impact that social media and technology has on the current generation,” Evans said. “Kids might see their peers online engaging in self-harming behavior as a way to cope with their emotions, influencing them to replicate that type of behavior.”

In the age of viral internet challenges, such behaviors have become gamified, reaching an even broader group of young people. One called the ‘blue whale challenge,’ encouraged teens to complete 50 acts of self-harm over 50 days, ending in suicide by the final day.

However, while many believe that people who injure themselves always do so with the intent of suicide, Evans says that is a common misconception.

To help us better understand nonsuicidial self-injury, Evans explains what it is, how parents and caregivers can help their child or teen who may be self-injuring and suggests positive coping methods they can use.

Defining nonsuicidal self-injury

“Nonsuicidal self-injury is a term used to describe a way of coping that involves inflicting damage to one self to manage distress without intention of suicide,” she said. “Self-injury can come in different forms; a common form is cutting, which involves using a sharp object to superficially cut the skin on an area of the body, often done on the forearms, wrists, upper thighs and lower abdomen.”

Not meant as a suicide attempt, a person may self-injure as a way of punishment, to numb their negative feelings, and/or to take their mind off of the emotional pain, intense anger and frustration they may be experiencing.

In a study published in the American Journal of Public Health, researchers conducted an analysis of the Center of Disease Control’s Youth Risk Behavior Surveillance System data to assess the prevalence of, and factors associated with, nonsuicidal self-injury.

The several health risk behaviors that were associated with increased odds of nonsuicidal self-injury included, feeling sad; suicidal thoughts, plans and/or attempts; being electronically bullied; trying to change weight; being gay, lesbian, bisexual or unsure; smoking cigarettes; hard drug use; and being forced to have sex.

“We most often see nonsuicidal self-injury in teens and young adults and in females more than males,” Evans said. “This could be due to a variety of factors, such as the societal pressure around body image.”

Addressing the issue

If a parent or caregiver knows their child or teen is engaging in self-injury, Evans wants them to know that while it’s not typically related to suicidal intent, intervention is still extremely important.

“First, I suggest putting away any distractions, such as your phone, and calmly sitting down with your child,” she said. “Voice your concerns and ask them what their intent is or what issues they’re trying to solve by self-injuring.”

Second, Evans recommends attending to the injury by keeping it clean to prevent infection, and third, removing any items from reach that they have used to self-injure or ones they could use on impulse such as razors or other sharp objects.

Yet, it is important that parents and caregivers also understand the reverse side of self-injury that does signal suicidal intent.

“Signs to watch for include statements of despair such as ‘would anyone miss me or care if I was gone,’ giving personal belongings away, withdrawing from social contact, changes in eating or sleeping habits, written notes about ending their life, or a previous suicide attempt,” Evans said. “You should immediately seek medial care for your child or teen by taking them to an urgent care clinic or the emergency department.”

Promoting positivity and resilience

Introducing positive coping mechanisms is key to helping kids manage their emotions.

“Make sure they have trusted people in their lives they can talk to, whether that be you, a friend or mental health therapist. It has to be someone that they feel comfortable sharing their thoughts with and that won’t judge them,” Evans said.

Having a child or teen work directly with a mental health therapist can be effective, as they are able to provide specific therapies to treat mental health issues.

“Cognitive behavioral therapy and dialectical behavioral therapy are traditionally used for people managing depression and anxiety,” Evans said. “Dialectical behavioral therapy is associated with treating externalizing behaviors, such as self-injury, and involves learning how to be more aware of emotions and behavior patterns in order to make wise and thoughtful choices to cope with distress.”

Resilience, which is an individual’s positive adaptation to the experience of adversity, is also an important concept that can help kids and teens manage their mental health.

“Building resilience can be done in various ways, such encouraging your child to engage in self-care, set goals, accept change, or simply take a break and focus on something else that can take their mind off their worries,” Evans said. “Activities could include going on a walk, reading a book, listening to music, meditating or creating art.”

Resilience can help boost a child’s self-esteem and self-worth, giving them a sense of value and purpose in their lives.

With recent studies showing that nearly half of the 7.7 million children in the U.S. with mental health disorders are left untreated and the significant increase in youth suicide in recent years, Evans believes it is more crucial than ever that mental health is seen in the same way as physical health.

“It’s important to remember that having a mental health issue like depression and anxiety is not a choice,” Evans said. “Not only do we need to promote positive coping strategies to kids, we need eliminate the stigma associated with mental health by discussing it openly.”

If you are a Washington state resident and your child or family needs help right away, call the Washington Recovery Helpline at 866-789-1511. You can also call the National Suicide Prevention Lifeline, a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress, at 1-800-273-8255, from anywhere in the U.S.