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Self-injury in Children

Kinsey could stand in a field, arms upraised, and butterflies would come to rest on her arms and fingers, like something out of a Disney princess movie. She had a special connection with animals and spent free time outdoors talking to squirrels and admiring birds.

Kinsey’s mom, Cheryl, attributes this special sensitivity to why her daughter tended to be emotionally volatile, churning with unexpressed feelings. Kinsey’s tender-heartedness extended to her relationships. She was often frustrated with people, whom she took at their word. She would hurt deeply when they didn’t come through.

Over time, the little girl who craved the outdoors with arms outstretched spent more and more time alone in her room, texting, arms covered with long sleeves or bandages.

One day, Cheryl noticed that an elastic bandage covered her daughter’s arm. “What happened?” she asked.

“Oh, nothing.”

“Kinsey, let me see your arm.” Cheryl felt a sense of foreboding. Underneath the bandage, a web of scabs slivered across Kinsey’s arm, dainty and slight, like Kinsey herself. Thin red lines replaced the kisses of butterflies.

An athlete and straight-A student, Kinsey confessed that she had been cutting herself with scissors for months. Cheryl’s sixth-grade daughter was self-injuring.

“I know God was with me at that moment, because I wanted to freak out,” says Cheryl (hers and Kinsey’s names have been changed for this story). “Her dad and I sat her down and told her that we loved her, and we would get through everything together.”

Harvard psychologist and self-harm expert Matthew Nock, Ph.D., defines self-injury as “all behaviors that are performed intentionally and with the knowledge that they can or will result in some degree of physical or psychological injury to oneself.” Self-injury is not a one-time event, but a pattern of behavior, a coping mechanism, a release.

Typically, we hear about self-injury in cases of teenage girls who cut, but recent studies have revealed a rising trend of self-harm occurring among children as young as 5 years old. Parents may be missing self-injury signs in their third-grader simply because it’s never crossed their minds that it could happen.

University of Denver child clinical psychology student Andrea Barrocas, along with a team of psychologists from Rutgers University and the University of Denver, published a study on self-injury in July 2012. They questioned more than 600 third-, sixth- and ninth-grade boys and girls and their parents regarding self-injurious behavior. Two significant and surprising points surfaced in the results: Third-grade children – kids of 7 and 8 years old – self-harm at a rate similar to young adolescents, and up until the sixth grade, boys are almost as likely as girls to self-harm.

Elementary school-aged children are self-injuring at rates that are too high – some studies suggest a percentage as high as 8 percent – for parents to ignore.

“It’s a lot more prevalent than people realize,” says Lori Vann, LPC, who has a practice in Carrollton and specializes in counseling people of all ages who self-harm. She tells about a time when she was speaking at an area school district and introduced herself to the counselors and teachers. “I said, ‘How many of you guys think you have students who are self-injuring?’ None of them raised their hand. I told them, ‘Well I’ve got some news for you, because I‘m seeing your kids in therapy right now.’”

People could miss the signs of self-injury because they’re only looking for cutting, Vann says. “We need to change the way we see self-harm. Children self-injure by scratching, picking, biting, burning, banging, poking their skin, pulling their hair or even pulling out their eye lashes.” Self-injury, she adds, could be disguising itself as scabs that don’t heal, pock-marked skin or fresh bruises.

Kinsey told her mom that she learned how to self-injure from her friends in school. “Not everybody cuts, Mom,” she said. “My friend uses her nails. She scratches.”

Why do they do it?
“There was a boy,” Cheryl says with a sigh. “And there was a girl on Kinsey’s basketball team who caused drama between Kinsey and that boy. Kinsey’s strong but relationship-needy.” Kinsey was jealous and confused, wondering why her “boyfriend” – she was too young to be allowed to date – spent so much time with her basketball teammate. She became despondent and withdrawn. Cheryl wonders if something in her parenting had caused Kinsey to feel such low self-esteem that she would respond by self-harming. “She has emotional frustration, and she doesn’t know what to do,” Cheryl says. “When she cuts, it all goes away and she can move on.”

Sarah Feuerbacher, Ph.D., clinical director of the Southern Methodist University Center for Family Counseling, notes that kids often can’t comprehend their own pain. “A child does not have the ability … to understand extreme sadness, confusion or anger, but they do understand the pain of a boo-boo and also know how it heals,” she says. Through self-injury, the child can experience pain and healing in the body that she can see and feel, unlike the emotional pain she may be experiencing.

It’s important to note that most of the time, children who engage in self-injury are not suicidal. Barrocas addresses this misconception: “When a little boy is hitting his head on the wall because he’s really upset, he’s probably not trying to kill himself. He’s probably just trying to express some intense negative emotion, some frustration, and doesn’t have the words and doesn’t know how to express that effectively.”

Self-injury may also be an indicator of past or present abuse. “In my practice, 70 percent of my clients are self-injuring because of emotional abuse,” Vann says. The abuse doesn’t have to originate in the home, although it often does. The source could be at school, or at the hands of a bully, a caretaker or a family friend. Vann is quick to emphasize that emotional abuse is a strong cause of self-injury when children are taught to stuff their feelings because their emotions are not valued.

Brain chemistry can also be a factor, says Karyn Purvis, Ph.D., director of the Texas Christian University Institute of Child Development. “There may be a biological vulnerability,” she says. “Children who self-harm are generally more vulnerable from pre- or post-natal stressors.” Specifically, a stressful pregnancy and birth or early hospitalization can negatively affect a baby’s brain chemistry, causing a dip in serotonin, the hormone that regulates mood and the ability to multitask and plan. Researchers have found elevated stress hormones in infants as early as 1 month old.

“Cutting is a visceral, heartfelt, desperate act – these kids are desperate for connection,” Purvis says. “It is not a cognitive process.” Ironically, kids who cut are actually self-medicating. Self-injury provides a short-term solution to low serotonin levels, because when the body experiences pain, it responds with a surge of serotonin – causing the brain to feel calm and safe – in order to offset the trauma.

The overarching reason why children self-harm, though, is because they are depressed.

Cheryl recalls coming to grips with the fact that her daughter cut herself because she was despondent about school relationships. “I had to learn that as much as I would like to keep her a little girl, she is growing into a young lady with a heart that feels, and sometimes those feelings are not good feelings,” she says.

Telltale signs
It takes vigilance to discover that a child is self-harming, because children typically keep the habit a secret. In order to cope with an emotional world they cannot control, they manage the circumstances in which they self-harm. They take power over the one person they can –themselves.

Purvis evaluates possible self-injurers in part by asking questions: Was there pre-natal trauma or stress? Has there been a trauma? Has someone hurt the child? Is there regression, bed-wetting? “A constellation of behaviors might alert parents to risks,” she says.

These behaviors can range from a shift in mood and a preference for isolation, to wearing weather-inappropriate clothing and making excuses that don’t add up. Feuerbacher says children who self-harm can suffer from a lack of interest or motivation, poor concentration, increased problems at school, withdrawal from friends or family, irritability, anger or anxiety, and changes in energy, weight or sleep patterns.

The more obvious signs of self-injury are marks on the child’s body: bruises, cuts, scratches, burns, as well as hair and lashes that seem less voluminous. If the child is involved in sports or rough play, it is more challenging to distinguish normal cuts and bruises from self-inflicted ones. This can pose a special challenge in identifying boys who self-injure.

Boys do it too
Much of the conversation on self-injury has been directed at women and girls. This is with good reason; studies on adolescents show that teenage girls are three times as likely to self-injure as their male counterparts. But counselors are finding that before adolescence, boys are just as likely to self-harm as girls. What may differ is how boys self-injure. Feuerbacher says, “More often, elementary-aged boys will choose banging, biting or scratching over cutting or hair-pulling, which is more often the behaviors chosen by elementary-aged girls.”

Though formal studies have yet to specifically monitor this over time, anecdotal evidence suggests that boys tend toward impulsive self-harm, while girls lean toward premeditation. And while girls are more likely to receive treatment to counteract self-harm, boys tend to go undiagnosed and untreated.

Our society’s acceptance of boys as rough-and-tumble could be partly to blame for why more boys aren’t treated for self-injury. “I completely understand why it wouldn’t get caught,” Vann says. “Boys can play it off as ‘boys will be boys. Oh, they’re just more active, more aggressive.’ So if a boy comes home with more bruises and scratches on their body, it’s ‘Oh, I got into a little fight on the playground.’ It takes a discerning parental eye to know the difference between rough play and a pattern that suggests a deeper problem.”

Discovering that your child may be self-injuring can be frightening and overwhelming. Cheryl remembers “the guilt was overwhelming in the beginning. I kept asking myself, what did I do wrong, why would she do this to herself? I still carry shame when I go to basketball games. I wonder if the other parents see me as ‘the mother of that girl who cuts.’”

It’s easy for parents to beat themselves up. Sometimes abuse is present but undiscovered in the home. Also, parents can be adept at providing shelter, clothing, food and even extracurricular activities for the child but neglect the nurturing aspects of child-rearing: hugs, positive reinforcement, adoration and care.

But even the most nurturing parents can have a child who self-harms.

The way a parent responds to the news that their child self-injures has a huge impact on his chances of receiving help and recovering. “I’ve unfortunately heard many who say the child is only doing it to get attention,” Feuerbacher says. “Even if attention-seeking is part of their intention, that still screams a warning that the child is not all right, and attention should be given to them.”

Though Cheryl can sympathize with parents who don’t want to glorify self-injury, she recommends a caring approach that acknowledges the emotional struggle that leads to self-injurious behavior. She also attributes her ability to parent Kinsey through the self-harm journey to counseling – Kinsey still sees her counselor once a week – and faith. “I couldn’t do this without God,” Cheryl says. “And I share with Kinsey all the time, ‘God wants more for you than this.’”

Purvis recommends a three-pronged practical approach to parents. First, find a good therapist who knows that the parent must be involved in the healing process. Next, model the behavior that you hope to see in your child. If you’re frustrated about work, don’t mask it; instead, show your child the constructive ways (exercise, music, prayer) that you handle the frustration. This will give your child a strategy for when she’s frustrated.

Last, if necessary, talk to a naturopath about nutrients and supplements that will naturally increase your child’s serotonin levels. Some foods are natural building blocks to constructing serotonin, and supplements such as L-Theanine spray can augment the hormone as well.

Unplug, reconnect
Don’t despair if you’re worried about your child’s chances of becoming a self-injurer. Pyschologists and counselors agree that parents can take pro-active steps to create a loving and safe environment for their children to learn emotional balance.

Vann is a strong advocate for unplugging and reconnecting. Reinstitute the timeless practices of eating together every day sans TV or iPhone, and engaging in conversation. “Family dinner – when you sit down to dinner, all of the electronics are turned off. Period. Start the reconnection at that point,” she says. She also encourages parents to have dad-son dates, dad-daughter, mom-son and mom-daughter dates where the child feels special and has the parent’s undivided attention, “and it’s not just for 15 minutes.” You love your children, Vann continues, but when your head is buried in a smartphone or iPad, it communicates that the kids are less valued than the electronic gizmo. Make eye contact. Ask your children questions about their school life, friends and even where they are emotionally.

Feuerbacher gently reminds parents that “even caring adults can be reluctant to ask children if they’ve been thinking about hurting themselves. But it’s very important to ask, because just listening and allowing the child to talk about it may help him or her to feel less alone, less isolated and more cared about and understood.”

Purvis says that when parents are honest about their emotions and healthy ways to cope, and when they nurture their children – showing them they are loved and valued, and affirming their self-worth – this roots children in a quiet confidence to endure emotional ups and downs.

Kinsey still struggles with cutting and relapsed recently after a hard day at school. Though it is challenging for Cheryl to walk with her daughter through the process of therapy and healing, she is grateful for the benefits. “We have definitely spent more time together, we communicate more, I am more involved in her daily life,” she says. “This experience has changed our relationship in a positive way. I feel like my daughter and I are closer.”