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.

Just Posted

A young couple walks through the Othello Tunnels just outside of Hope. (Jessica Peters/Black Press)
Hope’s Othello Tunnels fully open to the public

Geological testing proved the area safe enough to open for the first time in more than a year

The Abbotsford International Airshow is back for 2021 with the ‘SkyDrive’ concept.
Abbotsford International Airshow returns for 2021 with ‘SkyDrive’

New format features a drive-in movie type experience, show set for Aug. 6 to 8

.
Fraser Health monitors long-term care vaccination rates amid local COVID-19 outbreak

COVID-19 transmission has largely been on the decline in Agassiz-Harrison

Jacqueline Pearce and Jean-Pierre Antonio received the BC Historical Federation Best Article Award on Saturday for their story about translating haiku written in the Tashme internment camp.
Article chronicling haiku in Japanese internment camp near Hope wins award

Tashme Haiku Club’s work was preserved and recently translated, authors write

Raeya Evie Duncan was the 100th baby born at Chilliwack General Hospital for the month of May. She is seen here with her parents Alysha Williams and Andrew Duncan on June 12, 2021. (Jenna Hauck/ Chilliwack Progress)
Baby boom in Chilliwack as record number of infants born at CGH in May

‘COVID babies are coming out,’ says dad of 100th baby born at Chilliwack General Hospital last month

Maxwell Johnson is seen in Bella Bella, B.C., in an undated photo. The Indigenous man from British Columbia has filed complaints with the B.C. Human Rights Tribunal and the Canadian Human Rights Commission after he and his granddaughter were handcuffed when they tried to open a bank account. THE CANADIAN PRESS/HO-Heiltsuk Nation, Damien Gillis, *MANDATORY CREDIT*
VIDEO: Chiefs join human rights case of Indigenous man handcuffed by police in B.C. bank

Maxwell Johnson said he wants change, not just words, from Vancouver police

For more than a year, Rene Doyharcabal and a small group of neighbours in Langley’s Brookswood neighbourhood have been going out every evening to show support for first responders by honking horns and banging pots and drums. Now, a neighbour has filed a noise complaint. (Langley Advance Times file)
Noise complaint filed against nightly show of support for health care workers in B.C. city

Langley Township contacted group to advise of complaint, but no immediate action is expected

A nurse prepares a shot of the COVID-19 vaccine at the Yukon Convention Centre in Whitehorse on Wednesday, March 3, 2021. THE CANADIAN PRESS/Mike Thomas
Vancouver couple pleads guilty to breaking Yukon COVID rules, travelling for vaccine

Chief Judge Michael Cozens agreed with a joint sentencing submission,

An inmate in solitary confinement given lunch on Tuesday, May 10, 2016. THE CANADIAN/Lars Hagberg
22-hour cap on solitary confinement for youth in custody still too long: B.C. lawyer

Jennifer Metcalfe was horrified to hear a youth had spent a total of 78 straight days in isolation

People line up to get their COVID-19 vaccine at a vaccination centre, Thursday, June 10, 2021 in Montreal. THE CANADIAN PRESS/Ryan Remiorz
Vaccines, low COVID case counts increase Father’s Day hope, but risk is still there

Expert says people will have to do their own risk calculus before popping in on Papa

B.C. Premier John Horgan listens as Finance Minister Selina Robinson presents the province’s latest budget, April 20, 2021. The budget projects $19 billion in deficits over three years. (Hansard TV)
B.C. government budget balloons, beyond COVID-19 response

Provincial payroll up 104,000 positions, $10 billion since 2017

COVID-related trash is washing up on shorelines across the world, including Coldstream’s Kal Beach, as pictured in this May 2021 photograph. (Jennifer Smith - Black Press)
Shoreline cleanup finds COVID-related trash increased during height of the pandemic

Great Canadian Shoreline Cleanup reports litter from single-use food packaging nearly doubled

Doctor David Vallejo and his fiancee Doctor Mavelin Bonilla hold photos of themselves working, as they kiss at their home in Quito, Ecuador, Wednesday, June 9, 2021. Doctor Vallejo and Doctor Bonilla suspended their wedding in order to tend to COVID-19 patients and in the process Vallejo got sick himself with the disease, ending up in an ICU for several days. (AP Photo/Dolores Ochoa)
Love, sacrifice and surviving COVID-19: one couple’s story

COVID hits Ecuadorian doctors who delayed wedding to treat sick

Cover of the 32-page Surrey First Peoples Guide for Newcomers, created and compiled by Jeska Slater.
New ‘Surrey First Peoples Guide for Newcomers’ seeks to ‘uplift and amplify’ voices

32-page guide launched Tuesday by Surrey Local Immigration Partnership (LIP)

Most Read