Dr. Smith: Understanding self-harm

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

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.

Just Posted

Chilliwack prolific offender wanted yet again

B.C.-wide warrant issued for David Allen Geoghegan

One man, two women charged with stolen pickup downtown Chilliwack

None of the three have criminal history in B.C.

Chilliwack-Hope MP says new summer jobs grant application no longer includes ‘values test’

Those with anti-abortion beliefs left out last year because of requirement to respect the Charter

Agassiz Community Gardens hoping to find new home at old McCaffrey school

The society has been looking for a new location since its previous gardens were sold in October

RCMP asking for public input in upper Fraser Valley

Chilliwack, Agassiz, Harrison and Hope residents can share their thoughts on local policing

VIDEO: U.S. Congress to probe whether Trump told lawyer Cohen to lie

At issue is a BuzzFeed News report that about negotiations over a Moscow real estate project

Charges upgraded against mother of murdered B.C. girl

Kerryann Lewis now faces first- rather than second-degree murder in the death of Aaliyah Rosa.

Explosion sends B.C. firefighter to hospital

Kelowna fire crews responded to a blaze at Pope’sGallery of BC Art & Photography on Friday

Book a ride on a driverless shuttle in Surrey or Vancouver

Automated vehicle demos are being offered, as the two cities plan pilot projects with the shuttles

Heavy snowfall expected on the Coquihalla

Snowfall warning in effect for the Coquihalla Highway, from Hope to Merritt

Rare ‘super blood wolf moon’ takes to the skies this Sunday

Celestial event happens only three times this century

Arrest made after historic B.C. church hit by arson

The fire at the 150-year-old Murray United Church in Merritt was considered a possible hate crime

Missing man from Crowsnest Pass could be in Lower Mainland

58-year-old Stuart David Duff was last seen on Jan. 6, 2019.

B.C. dangerous offender in court for violating no-contact order, sends letter to victim

Wayne Belleville was shocked to see a letter addressed to him from his shooter, Ronald Teneycke

Most Read