Dr. Smith: Understanding self-harm

Why is my child doing this? What is going on with youth.

Dr. David Smith

Dr. David Smith

“Why would my daughter do this?”

That’s what bewildered parents plead to me and other mental health professionals in B.C. too often these days. The youth – often but not always – is a female  between ages 10 and 19 who is being treated for one of a variety of forms of self harm. Self-harm exists along a spectrum anywhere from self-injuries such as  cutting herself with a sharp object, repeatedly hitting herself, or burning herself, or sometimes even poisoning herself with medications or noxious substances.

In the last five years, children and youth rates for hospitalization and ER visits for self-harm have soared. This past November, a special Canadian study on self-harm found that since 2009 self-harm hospitalization rates for girls have increased by more than 110 per cent and ER visits by 98 per cent. While hospitalization rates for self harm were four times more common among girls, rates among boys had also increased substantially in the study.

What is going on?

While good research about self harm is just emerging, my mental health colleagues and I believe some reasons may be worth further investigation: feelings of disconnection among youth from loved ones and from themselves; youth feeling insignificant and unworthy; the dominant 24/7 online culture that magnifies bullying and social pressure and ramps up stress; and the normalization of self harm that youth find via the Internet. As well, self-harm, rather than being hidden or dismissed as in the past, is now being more recognized.

At the heart of most self harm is usually psychological pain and a disordered way of coping with unbearable feelings or an inability to regulate emotional responses under stressful situations (somewhat similar to various addictions or eating disorders). Youth will often tell me that only way to relieve their emotional pain is by hurting themselves. Sometimes it is the lack of feeling that compels them to  self harm. Youth will say they feel empty, numb, as if they don’t exist: “Feeling the pain feels better than feeling nothing at all.” For others, it gives a sense of control , that rather than being the victim of others inflicting pain on them, they are the ones controlling their own pain.

While self-harm occurs among B.C. youth from all sectors of society, it is more common among youth who are socially or economically disadvantaged: who have past trauma, neglect or abuse; who have other diagnosed mental health conditions or other illnesses; and who have uncertainty about  their sexual orientation or who have recently come out in the youth LGBQT community.

While self-injury such as cutting and burning is usually distinct from direct suicidal behaviour, youth who self-harm in these ways are many times more likely than the general population to eventually complete suicide. So it is very important that the youth gets effective help.

I am particularly concerned that self harm in the form of ingesting poison – taking high doses of over-the-counter medication, prescription medication or ingesting a noxious substance – often represents a true suicide attempt in youth. Parents and health professionals must take poisoning actions very seriously and ensure the youth gets appropriate, urgent help through emergency services.

In non-urgent self-harm situations, the first step is to see your family doctor or contact the Child and Youth Mental Health program provided by the Ministry of Children and Family Development in your region. Call Service BC at 1-800-661-8773 for the MCFD office nearest to you.

Good information and support can be found through links at the Canadian Mental Health Association (cmha.ca ), the Kelty Mental Health Resource Centre (keltymentalhealth.ca) and heretohelp.bc.ca. As well, an excellent resource is the website for the National Interdisciplinary Network on Self-Harm, led by Dr. Mary Kay Nixon, a Child & Adolescent Psychiatrist in Victoria (insync-group.ca).

Treatment focuses on addressing the underlying issues that are causing the pain and teaching the youth more effective coping skills and stress reduction techniques. Cognitive behavioural therapy, group therapy,  and dialectic behavioural therapy can be very helpful for these skills. Medications may be given if co-existing depression, anxiety  or psychosis are part of the underlying issues. Adults – parents, relatives, teachers, coaches, mentors – have a very important role in helping to support the youth to increase the youth’s feelings of connection. Teaching youth healthy ways to express feelings of pain and anger, and new ways to cope with life’s stresses can also help youth leave self harm behind.

Dr. David Smith is an adolescent and adult psychiatrist and the medical director of the Okanagan Psychiatric services for Interior Health. This series of columns on common child and youth mental health issues is a project of the Child and Youth Mental Health and Substances Use Collaborative. The Collaborative involves multiple individuals, organizations and ministries all working together across BC to increase the number of children, youth, and their families receiving timely access to mental health services. The Collaborative is jointly funded by Doctors of BC and the government of BC.

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Image courtesy CDC
Confirmed COVID-19 cases in Kitamaat Village

Haisla Nation Council said there are two confirmed cases they are aware of at this time

A coal-fired power plant seen through dense smog from the window of an electric bullet train south of Beijing, December 2016. China has continued to increase thermal coal production and power generation, adding to greenhouse gas emissions that are already the world’s largest. (Tom Fletcher/Black Press)
LNG featured at B.C. energy industry, climate change conference

Hydrogen, nuclear, carbon capture needed for Canada’s net-zero goal

Victoria’s Royal Jubilee Hospital took in two COVID-19 patients from Northern Health as part of a provincial agreement. (Black Press Media file photo)
Victoria hospital takes in two COVID-19 patients from Northern Health

Royal Jubilee Hospital takes patients as part of provincial transport network

An aerial shot of Cedar Valley Lodge this past August, LNG Canada’s newest accommodation for workers. This is where several employees are isolating after a COVID-19 outbreak was declared on Nov. 19. (Photo courtesy of LNG Canada)
52 positive COVID-19 cases now associated with LNG Canada site outbreak

Eight cases still active, 44 considered recovered

The Kitimat River in July. (Clare Rayment photo)
Good News, Kitimat!

Bringing some local good news to your week

Motorists wait to enter a Fraser Health COVID-19 testing facility, in Surrey, B.C., on Monday, Nov. 9, 2020. THE CANADIAN PRESS/Darryl Dyck
Another 694 diagnosed with COVID-19 in B.C. Thursday

Three more health care outbreaks, 12 deaths

A demonstrator wears representations of sea lice outside the Fisheries and Oceans Canada offices in downtown Vancouver Sept. 24, demanding more action on the Cohen Commission recommendations to protect wild Fraser River sockeye. (Quinn Bender photo)
First Nations renew call to revoke salmon farm licences

Leadership council implores use of precautionary principle in Discovery Islands

Ten-month-old Aidan Deschamps poses for a photo with his parents Amanda Sully and Adam Deschamps in this undated handout photo. Ten-month-old Aidan Deschamps was the first baby in Canada to be diagnosed with spinal muscular atrophy through Ontario’s newborn screening program. The test was added to the program six days before he was born. THE CANADIAN PRESS/HO, Children’s Hospital Eastern Ontario *MANDATORY CREDIT*
First newborn tested for spinal muscular atrophy in Canada hits new milestones

‘If Aidan had been born any earlier or anywhere else our story would be quite different’

(Pixabay)
Canadians’ mental health has deteriorated with the second wave, study finds

Increased substance use one of the ways people are coping

An RCMP officer confers with military rescuers outside their Cormorant helicopter near Bridesville, B.C. Tuesday, Dec. 1. Photo courtesy of RCMP Cpl. Jesse O’Donaghey
Good Samaritan helped Kootenay police nab, rescue suspect which drew armed forces response

Midway RCMP said a Good Samaritan helped track the suspect, then brought the arresting officer dry socks

People line up at a COVID-19 assessment centre during the COVID-19 pandemic in Scarborough, Ont., on Wednesday, December 2, 2020. Toronto and Peel region continue to be in lockdown. THE CANADIAN PRESS/Nathan Denette
COVID-19 vaccine approval could be days away as pressures mount on health-care system

Many health officials in regions across the country have reported increasing pressures on hospitals

(Needpix.com)
Pandemic has ‘exacerbated’ concerns for B.C. children and youth with special needs: report

Pandemic worsened an already patchwork system, representative says

Most Read