Self-Injury in Children and Adolescents

“We’re treating a lot of middle school children with NSSI behaviors, especially girls, but we’re also seeing increasing numbers of young boys and young people who identify as part of the LGBTQ+ community,” says Dr. Bernacki. “The pandemic, smartphone and social media use, and the resulting strain on relationships have likely played a role in the increased incidence.”

Common factors that elevate risk for self-harm are psychological stressors, adverse childhood experiences, and a history of intense reactive emotions, according to Dr. Bernacki.

“Without a strong foundation for emotion regulation, young people may turn to self-injury to express their emotions in a way they can control,” she says. “Sometimes, they’re seeking the reaction that it elicits among parents or caregivers. But others may go to great lengths to conceal their actions, and these situations are even more worrisome, as they’re more likely to lead to suicidal ideation.”

Medical and behavioral health providers need to consistently screen for self-injury behaviors, according to Dr. Bernacki. If identified, she offers this advice.

Involve both a psychiatrist and a therapist in treatment. Medication may be needed, as depression is commonly an underlying factor. Therapy should aim to understand the reason for the behavior, identify the function it serves, explore ways to address the underlying issues, and offer tools for obtaining the function safely using coping skills. CBT is a great place to start for younger patients, while DBT is an excellent modality for emotion regulation and distress tolerance.

Create a safety plan the patient can use to identify warning signs, access coping tools they can use effectively, and know who to turn to when additional support is needed.

Engage parents in treatment. If parents are unaware of the behavior, the child or teen may want a provider’s support in informing them.

Educate parents about creating a safe home environment, including removing access to sharps and medications. Assist parents in developing their own coping skills and assuming a nonjudgmental approach when interacting with their children.

Discuss lifestyle strategies to decrease vulnerability to mood changes. These include getting enough sleep, ensuring good nutrition, instituting a balanced media use plan, and encouraging productive activities like hobbies or sports.

“It’s important for providers and parents to consider the whole picture to see where they can best foster the change that needs to happen,” says Dr. Bernacki. “If outpatient behavioral health providers are seeing patients regularly without any improvement, it might be time to step up to an intensive outpatient or partial hospital program.”