Dr Janis Whitlock If a parent suspects  that their child is self-injuring,   there are three basic things to pay attention  to. One is shifts or sustained moods that   are concerning, the second is physical  evidence that a child is self-injuring,   and the third is overall life engagement.  So, let me unpack these a little bit. Self-injury is strongly tied to how people  feel, even though not all people who self-injure   show it, one of the signs that somebody is  self-injuring is – or is at risk of self-injury,   is negative mood. So, you might notice this  as a downturn in mood that you can’t quite   explain, and they’re being more closeted,  they’re hiding themselves away more,   they have more negative moods, or you might  notice there’s just a sustained negative mood.   It’s hard sometimes to tell whether or not  that links to self-injury, but it is a sign   that someone could be at risk of self-injury,  or other kinds of negative coping mechanisms. You might also notice external signs of  self-injury. This can show up as cuts or marks   on the body that are clearly not attributable  to anything else. So, you might see patterns,   for example, often they’ll – people will cut in  vertical lines or horizontal lines that are all   parallel to each other, or there could be a symbol  or something that looks very clearly patterned. It’s common for people to cover wounds, so it  – the constant use of wristbands or things that   make it hard to see skin is another sign. It’s –  this is especially visible perhaps in the summer,   when we might expect people to be wearing  short sleeves or shorts. If you have a person   in your life who consistently won’t wear short  sleeves or shorts, even though it’s hot outside,   then that can be a sign, especially if  you’re seeing some of the other things. Lastly, it’s helpful to take a look at how engaged  they are in their lives. Are they still seeing   friends? Are they pursuing hobbies? Are they able  to go to work and school normally? If you start to   see interference in these areas, then it’s helpful  to keep an eye out for signs of self-injury or   other kinds of negative coping methods, especially  if you know your child’s at risk for it [pause]. Sometimes parents are hesitant to talk about  self-injury with their child, and this makes   perfect sense, it’s not the easiest thing to  bring up. The risks of not talking about it,   however, are that your child is likely  to become increasingly more distressed   or agitated. Self-injury is a technique that  people use to cope with negative feelings,   or feelings that they can’t control  that feel very overwhelming. So,   using self-injury to cope can help for a  little while, but it’s often a short-term   fix for something that’s deeper and not  likely to be remedied by self-injury. It’s not uncommon for people who self-injure  to need support and therapeutic treatment,   to deal with some of the other underlying  issues. So, the earlier you can do this,   the better it is, which means you’re going to have  to probably have a conversation with your child,   if you notice or suspect something’s happening.  The other thing is that self-injury can be a   risk factor for suicide, so it really is  helpful to address it early and upfront.   Self-injury does not lead to suicide,  it doesn’t mean your child is suicidal,   but it can be a risk factor for suicide,  so that’s just something to keep in mind. The benefits of talking about it  are manyfold. In a lot of cases,   self-injury is a bid for connection. Even if  it doesn’t seem like somebody wants to connect,   even if they’re not really responsive, and  they’re not super warm or upfront in answering   your questions, it’s pretty clear from the  research that self-injury is a sign that   someone feels alone, is not able to process  emotions coming up on their own healthily,   and really does want a connection with another  person. And, most interestingly, there’s a lot   of research that shows that parents are really,  really important parts of the healing process,   no matter what happened before. Often that bid  for connection is really for parents [pause]. So, if you’re going to first  approach a conversation,   you want to be careful about how you do this.  The most important thing for you to do is to   be sure you’re in a good headspace. If  you approach the first conversation,   or any conversation, but especially the first,  because you’re feeling scared, guilty or angry,   all of which are common responses for parents,  it’s probably not going to go very well. A lot of young people who self-injure are  worried that their parents are going to   be really freaked out, and this is  understandable, because self-injury   can look and feel very much like a suicide  attempt. So, when you start a conversation,   you want to feel grounded, centred,  and in a loving space, because the   most important thing for you to communicate is  unconditional love, care, and a desire to help. The other thing to take to a conversation is to  not focus on the behaviour. The goal should not   be to get your child to stop self-injuring as  a result of that conversation. Especially for   somebody who’s been self-injuring for a while,  and for whom it works, I guarantee they’re not   going to stop right away. And it’s not ‘cause  they don’t want to, it’s because it has become   a dominant coping mechanism, it’s fast and  easy, and it can become pretty habitual. The goal of that first conversation, and any  conversation, should be on forging a connection,   making sure that you’re leaving the door open, and  communicating that you care and you want to help.   The other thing you might explore is why? Most  kids want to tell you their why, even if they   don’t come out and say it right away, and even if  they don’t know exactly how to communicate it. If   you can, in a loving way, say you care, “I’m here  to support you, and I want to understand what’s   happening for you,” I guarantee that at some  point productive conversation will happen [pause]. So, effective communication strategies that  parents can use are these. No matter what   words you use, you want the message to be, “I  don’t judge you, I understand you’re hurting,   and I want to help you get support you  need.” It doesn’t matter what words you use,   that’s really the space you want to be in. We  have more advice in our book. My co-author,   Elizabeth Lloyd-Richardson and  I, called, “Healing Self-Injury   A Compassionate Guide for Parents and Other  Loved Ones,” so I would direct you there,   ‘cause we have a pretty extensive set of  chapters that deals with communication. You want to be sure to stay away from accusing  tones. You don’t want to – you want to use “I”   statements. “When I see wounds on your body,  it makes my heart hurt, because I love you so   much and I want your body to be helpful.” Or,  “I understand that it’s hard to talk about,   but I wonder if you can help me understand what’s  happening for you because I want to understand.” If you can use techniques that really speak to  your own desires and your own vulnerabilities,   and your own love and care, and not make it about  your child, it can really help them to come out   and want to share. Don’t push if your child’s not  ready to talk. It’s more important to keep the   door open and to communicate that you care, than  to get all the information that you want and need. If you worry that your child is imminently  suicidal or something like that, that’s different,   then you need to get therapeutic support  right away. But short of that, if your   child is self-injuring to feel better, then know  that you have time. You can keep that door open,   and you want to use every communication  opportunity as a way to do that, to keep the   door open for more, because it’s probably going to  be multiple conversations, not just one [pause]. So, yeah, in my years of working with parents,   the most frequent beliefs and emotions that  come up when they find out about their child   self-injuring are fear, shame or guilt, those are  really common. I’d say these come up quickly for   most parents, and for some parents, the shame  and the guilt can go right into anger. So,   those are all feelings that are completely  normal, completely understandable,   but they’re not the ones that you want to bring to  some of those first conversations with your child. Since most parents are usually finding out  sometimes years, but at least months, after a   child self-injures, then they’re going to have to  go through that initial phase of shock and worry,   at the time when their child’s far less worried,  because they know what this is to them and how it   works. That gap can be a little bit hard, and it  can cause parents to feel angry. They don’t know   why it’s not a bigger deal to their children, and  they don’t know how to deal with their – with the   feelings that are coming up for them. That’s  one of the reasons why it’s really important   for parents to have their own source of support,  and we’ll talk about that in a second [pause]. Yeah, guilt is probably one of the most common  feelings that people have, ‘cause, you know,   a lot of families have events or challenges that  parents are going to assume have something to do   with their child’s self-injury. So, if there’s  been, you know, a history of family challenge or   trauma or ongoing stress or something like  that, most parents will assume that that’s   a driver of the self-injury. It may be, it may  not be, it’s certainly normal to question that,   but it’s also something that is not a good  idea to process with the child until it’s a   safe conversation to have, and that’s usually a  little further in, not typically the first one. In order to support their child’s healing,  parents are really advised to make sure   that they have support for themselves.  It’s one of the first things that I ask   a parent when I’m working with them,  informally through their own networks,   or, ideally, especially if they have  a child who’s self-injuring regularly,   through therapeutic support. If there are events  or circumstances in the family history that bring   up guilt or worry for parents, then it’s  advisable for them to work that through,   work through their own issues, so that they can  be more present and available for their child. I will also say, one of the things that has  been most interesting for me as a Researcher,   working with families, is that we notice that  when families do meet this challenge, and the   parents get the support that they need, and  the child’s getting the support they need,   and they’re willing to stick in this process,  even though it’s uncomfortable, and, you know,   it can be a very dark feeling for a lot of  families, they will often come out stronger   and healthier as a family. Because they’ve had  to confront some of the stuff that was hardest   to talk about, and because they’ve gotten  the support that they needed to learn to   have the hard conversations. It can actually be  a positive experience in the long run [pause]. The biggest challenges in parenting  young people who self-injure. Well,   dealing with the uncertainty and the hiding that  so often accompanies it is really, really big.   Especially since parents are instinctively worried  that their child is going to make a mistake and   inadvertently end their life. You know, if you’ve  got a sharp implement next to your body, it’s   an understandable concern. So, parents can often  end up feeling like they’re walking on eggshells. The other thing that’s hard is that self-injury  is really cyclical for a lot of people. So, people   will go in and out of weeks – or days and weeks,  usually, sometimes months, where they have active   cycles of self-injury. And then they’ll have  periods, sometimes long periods, where there’s   no self-injury, at all, and it can feel like it’s  over, and then it can start again. So, this is a   normal pattern. It’s usually a result of somebody  using self-injury to cope with a short – in the   short-term with something, and then whatever it  was that was so triggering, kind of, eases off,   and the self-injury behaviour eases up, and then  something else triggers it, and it happens again. People don’t typically stop self-injuring  until they’ve figured out how to interfere   with that pattern, and fe – and help themselves  to understand what’s driving the pattern. So,   parents will often feel like, oh, phew, we’re  out of the woods, and then it starts again,   and then they get worried again,  and the cycle goes over and over,   and that feeling of walking on  eggshells is a real tough one. You know, the other thing that’s hard is  that it can go on for a while. It can go   on – off and on through these cycles, for  years sometimes, and there’s usually a lot   of work that needs to be done inside before  self-injury totally stops for some people. So,   parents have to learn to be patient, and learn  how to notice the subtle signs of recovery,   ‘cause it may not be that the  self-injury stops right away. We do, in the book that I referenced earlier,  “Healing Self-Injury A Compassionate Guide for   Parents and Other Loved Ones,” we have a whole  list of things in there that parents can look   for, that are, sort of, the subtle  signs that your child is improving,   or starting to deal with some of the underlying  issues. In general, these are things like noticing   that they’re dealing with their emotions a little  more positively, they don’t have such negative   language about themselves, or others, ‘cause  sometimes, sort of, a very negative worldview,   or a very negative skew, comes to be associated  with self-injury, and, sort of, the way that   people process emotion and thoughts. Engagement  in life, they pick up, are more interested,   more engaged, more uplifted. And the other  piece would be that they – yeah, that they   stop actually having si – physical signs on their  body, or that slows down a little bit [pause]. Yeah, social media and self-injury is tricky.  Social media and everything is tricky, so it   can really have a negative impact on self-injury  behaviour. It can also have a positive impact,   because sometimes people find communities that are  really supportive of their healing process. So,   in general, I recommend that parents be aware that  it’s probably a factor, for better or for worse,   and like the other communications messages that  we talked about earlier, I would really recommend   that you have conversation, when you can,  about how social media is or isn’t helping or   exacerbating self-injury behaviour, if only to  help the child to become aware of whether it’s   a factor. It may be if you’re worried about the  role of social media in your child’s self-injury,   I would really recommend you take  that to a – your child’s Therapist,   assuming they have one, which  I would very much recommend. So, if you have a child who self-injures, and  especially if they have been doing it for a while,   or they clearly regularly use it in some way,  they’re probably going to need therapeutic support   to understand it and to stop it. And it’s in  that context that some of these harder questions,   like those around social media, can be discussed.  But, in general, it’d be – it’s good for you to   know that it’s often a player, to know,  kind of, where your child might be going,   and then, when you can, to  have productive conversations   about their perception of whether  it’s helpful or hurtful [pause]. So, seeking professional help is advised as early  as possible. So, if your child – if you – you   know, if your child self-injured once, you  found out right after, they say something like,   “Yeah, that I don’t. I tried it, but I  don’t ever want to do that again,” then   I’m not go – I wouldn’t recommend that you  go jump right into therapy. It’s – it isn’t   uncommon for young people to try it, and it’s  not uncommon for them to decide that they don’t   want to hurt their bodies. It’s actually  not an easy thing to hurt our bodies. So,   that’s not a situation in which I would  advise quick therapeutic responses. However, if you have a child who’s been  injuring, or clearly has a history of it,   or clearly prefers it to other coping mechanisms,   then therapy is probably going to be helpful.  The thing about therapy is that it’s not any   therapy and any Therapist. You really – the  thing that makes therapy particularly helpful,   especially for young people, is the relationship  between the Therapist and the young person. So, it’s worth taking time to be sure that there’s  good Therapist-child fit. And this is important   because there’s a lot of situations I see in which  that fit is not good, or the Therapist handles the   self-injury related pieces of the therapy poorly,  and the child won’t – stops therapy and won’t ever   go back, or says they won’t go back. So, taking  time to find the right person is important. The other – beyond that, Therapists who  specialise with children in your age group,   and/or dialectical behaviour therapy, which we  also call DBT, are often going to be probably best   positioned to address some of the thornier issues  that come with self-injury. And I will tell you,   as parents, a lot of Therapists won’t target the  self-injury behaviour as a primary therapeutic   outcome at the beginning. They’re going to  be most interested in trying to figure out   the psychological architecture,  basically, of what’s driving it,   and they may – and they are well advised to be  working at that level. And then, also, helping   the young person to recognise when the cascade is  starting, when they’re getting ready – you know,   when the set of events that set up the  self-injury are starting, and then come up with   other techniques for handling the emotion, or the  triggering incident, more productively [pause]. Oh, so, prevention, yes. Prevention  isn’t – is a really good question. I   would say we haven’t – there is no great  immunisation for self-injury or any of   the other things that young people use to  feel better. Self-injury, in particular,   though, is often about how young people  handle or don’t handle big emotions.  One of the things that I’ve noticed around people  who self-injure is they feel emotion strongly and   they feel it in their body strongly. So, if  two people, somebody who has the self-injury   proclivity and somebody who doesn’t, meet  a hard environment or a hard circumstance,   the person who has the self-injury proclivity  might be feeling it, like, at a ten on the   emotional Richter scale, where the person who  doesn’t have it might be feeling it at, like,   a seven. It is a subjectively big experience,  and they don’t want to feel those feelings often. And it’s somatic, it’s in their bodies, so they  – so, because they can’t discharge or dissipate   those emotions, it becomes – self-injury becomes  a physical way of quickly dispelling all of that   negative charge. So, it’s quick, it’s easy, for  a lot of people it works. It’s obviously free,   that’s one of the reasons why it’s super  easy to get engaged with and not stop. So, in terms of prevention, you’re going to want  to help young people learn how to recognise that   they have big emotions, and then, how can they  work with all that energy in a way that doesn’t   hurt themselves? I always tell parents and  young people I work with, in some ways,   the capacity to feel and perceive like  that is a gift. It really is a gift,   it’s just a gift that comes  with some serious challenges,   because you have to learn how to work with all  the emotion that turns into energy in the body. So, there are a number of ways that people – that  can learn to deal with this, parents who can –   parents needs to recognise that they’re role  models in this way. Often, parent, you know –   sorry, parents need to recognise that they’re role  models in this way. Often, young people who injure   come from families with big emotions. Either  they feel emotion strongly, or they don’t like   to express emotion, or both, and that’s actually  the hardest, when they come from families where   emotions are big, but they’re not – there’s not a  lot of positive and accepted ways to express them. So, you showing your child how you deal with big  emotions positively is really, really helpful. Be   aware that you are basically demonstrating how to  do that. Parents can also get their own support,   as I talked about earlier, for managing some  of the things that are coming up for them.  Okay, then the last thing I’ll say about  what parents can do for prevention is   really just helping their children manage  emotions and give voice to their emotions,   and have healthy outlets for physical  anxiety and energy that gets – I was   going to say trapped in the body, but that  their children are feeling physically. So,   help them find healthy outlets  for expressing themselves [pause]. What can parents do? So to take care of their own  selves while addressing their child’s self-injury,   is to just basically recognise support needs,  and go get it. And make sure that you take   time for self-care regularly, ideally daily,  especially if you have a child in your life   who’s self-injuring actively, and you’ve  got other family dynamics, you are going   to need more support and more self-care time  than you know. And it has to be a priority,   because all of that stuff that you have  ends up going to your child, basically,   so you want to be able to interface and interact  with your child from a healthy per – place. A lot of parents hold knowledge of their  children’s self-injury close, and they don’t share   it with other people in their network, because  they feel shame, guilt or worry. I would highly   recommend having at least one person that you talk  to as things come up. Professional support can,   and should be, a part of parental support  when needed, but having someone in your world,   whether it’s a family member or a friend, just to  bounce things off of, is really helpful, and it   helps to reduce shame, if that’s present, and that  has collateral benefits to your child [pause]. What resources? So there are a number of resources  in this area, an increasing number. And I,   you know, I – basically I would urge people to  check out our book. I say that not as a – I’m   very bad at self-promotion, but  I think our book is really good,   and it’s especially good for parents. We  designed it for parents, so that’s called,   “Healing Self-Injury A Compassionate  Guide for Parents and Other Loved Ones,”   and we have a lot of exercises in there, as  well as different techniques you can try. We also have a website. It’s called “Self-Injury  and Recovery Resources.” You can just type in   Cornell and self-injury and you’ll probably get  our website. There’s lots of written resources   on there. We also have a training that’s  specifically for parents and caregivers,   that’s two hours that you can take at your  own pace. And, again, it’s less a training,   sort of, more of an educational module,  but there are reflection questions and   other kinds of activities. And we have a bunch  of links on that site, for other resources,   and other web pages, so I would start  there, honestly. Beyond that, you know,   there’s more and more books on self-injury  in this area that I think are really helpful,   and I would go peruse your bookstore or Amazon  and see what speaks to you, to be honest. The most important thing is to believe up. You  want to hold the highest vision of what you   know your child’s life can be. Also, don’t  fall prey or give up to the idea that your   child’s life is going to be ruined, or to be –  it’s going to be less vibrant than it can be,   because of this experience. As I referenced  earlier, one of the most surprising findings   from the parent-child research that we  and other people have done is that it can   actually end up being a growth experience  for families, because they, you know,   wander into some of the harder terrain,  and they have more candid conversations,   and they learn to talk about hard things, and  that can leave them both more skilled and closer   together as a family. I’ve seen that happen a  lot, it’s actually not terribly uncommon. So,   believe up, don’t give up hope, and know that  it’ll – if you – know that it’ll be alright. The other thing I’ve noticed a lot is that parents  who care, who authentically care, even if they   don’t do it all right, even if conversations go  poorly and they have to circle back round and   try again, their children, the children who know  that they are loved, almost always do alright.   They either do really, really well, or they do  alright, depending on how much they’re struggling   with. So just have faith that it’ll be okay, and  get the support that you need, and don’t give up.