The Mental Health Foundation reports that 10% of young individuals self-harm.
So, it is likely that two or more pupils in every secondary school classroom have self-harmed at some point.
A Unicef report from 2021 states that more than 65% of young South Africans have experienced some sort of mental health crisis but have not sought help.
According to the report, 25% of respondents did not believe that their mental health issue was significant enough to warrant seeking help, while 20% did not know where to find assistance, and 18% were concerned about what other people might say.
In the opinion of child psychiatrist Dr Terri Henderson, a member of the South African Society of Psychiatrists (SASOP), self-harm is a cry for help that should never be ignored, dismissed as attention-seeking behaviour, or construed as “acting out”.
“Contributory and co-occurring challenges for a teen such as depression, anxiety, post-traumatic stress disorder, ADHD and substance misuse often lead to self-harm as one of the methods teenagers engage in to cope with their undiagnosed and untreated mental health conditions.”
According to her, the onset age depends on the stage of puberty, rather than the chronological age, when self-harming manifests.
“The number of teens presenting with self-harm infliction is increasing significantly due to heightened depression, and stress experienced amongst teenagers, availability to medication, alcohol and drugs, and the social transmission of the behaviour via social media channels,” said Henderson.
Research shows that 50% of teens who self-harm will most likely to do it repeatedly. Young people who self-harm do not seek treatment, because they are afraid of the stigma attached to the behaviour and the reaction of their parents, peers and other adults, fear of being criticised or viewed as a burden to carers, and ashamed of their self-harming behaviours.
The purpose of self-harm is to cope with difficulties in life. Henderson notes that symptoms of self-harm are often hidden to avoid being able to recognise scarring, especially new scarring.
She said: “It is a behavioural pattern or coping mechanism that is difficult to break.”
What triggers self-harm?
Self-harm is frequently linked to perfectionism and self-criticism, which creates a situation wherein hurting oneself is used as a form of self-punishment and serves as an example of behaviour for vulnerable teenagers, said Henderson.
The inability to control one’s emotions as a result of a combination of invalidating home surroundings and emotional fragility contributes to self-harm, said Henderson.
She pointed out that an increase in emotional disorders and risk-taking behaviours, child and family adversity, emotional neglect, maladaptive parenting, disruptive, unsupportive home environments, exposure to negative life events like parental separation or divorce, loss of a parent, the experience of any form of abuse, past or present bullying can trigger self-harming behaviour.
“This, coupled with childhood traumas of abuse and neglect, contribute to chronic hyperarousal, increasing the risk for emotional dysregulation. The rate of self-harm is six times greater amongst the LBTQ+ teenage community due to an increased prevalence of mood disorders, substance misuse, victimisation, bullying, and social stress.”
Why teens use self-harm to cope
Teenagers who self-harm express their pain in a real and physical way, allowing them to understand it and it “helps” relieve rage and other negative emotions. All of these provide an escape from emotional suffering, give a sense of security or control, as well as reduce emotions of guilt, loneliness, self-hatred, and depression.
Signs to look out for
Some clues may assist parents in identifying signs of self-harm in their children or teens, said Henderson, but it’s okay for them to be confused, angry and feel helpless.
Attempting to hide scars by wearing long sleeves regardless of the weather or flinching in pain if their arm is touched.
There are also signs of mental distress including depression, increasing isolation, withdrawal from activities, friendships, schooling, and sports, a decrease in self-care behaviours such as bathing, changes in sleeping and eating patterns, irritability, or markedly erratic moods.
Treatment
According to Henderson, if self-harm is identified and seems to be limited to one or two incidents, a short-term treatment plan with a family doctor or psychologist would be sufficient.
However, in severe or recurring cases especially if there is concomitant suicidality, specialist support and intervention is required.
Group or individual dialectical behaviour therapy is an effective therapeutic intervention.
“As a parent, your role is to provide support and make changes that allow your teen to know that you support them one hundred percent. You are not able to fix them, but walking with them through support and treatment is going to get you and your teen into a much better and healthier mental health space.”
Contact the South African Anxiety and Depression Group at 0800 567 567 to speak to a counsellor if you are worried about your teen.