Overcoming self-harm and suicidal thoughts

In a desperate attempt to cope with emotional distress, some teens resort to self-harming. A calm, compassionate response is needed, an experienced psychotherapist tells Marjorie Brennan.

DISCOVERING your child is self-harming is a frightening prospect for any parent but being informed is key to tackling this growing issue, says Liz Quish, psychotherapist and author of Overcoming Self-Harm and Suicidal Thoughts, a practical guide for parents, teachers and youth workers.

Quish, who has been working with children and families for more than 20 years, says teens self-harm due to psychological distress or emotional pain.

“They are challenged by something and they can’t cope with it. They don’t know how to express themselves so they will self-harm as a way to cope. Self-harming gives them a sense of control and release — the physical pain now correlates with the emotional pain.”

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The sense of hopelessness and inadequacy experienced by the teenagers Quish has worked with manifests itself in ‘self-defeatist syndrome’ which leads to them becoming anxious, angry and depressed and to engage in self-harming, sometimes considering suicide.

In her experience, the scenarios most likely to drive a teen to self-harm are bullying, in school and online; conflict in the home, exam pressures and confusion over sexual identity.

While she says cutting is the most prevalent form of self-harm, there are many other less obvious self-harming behaviours, including burning, biting and self-poisoning.

“Usually when you say it to the layperson about self-harming, they think cuts but there are so many more that are not visible, such as taking laxatives and purging,” she says.

Quish has also encountered behaviour termed body-bashing, which mainly occurs among young males.

It describes the act of bashing one’s body against a wall or throwing oneself down the stairs. It can also involve deliberately bashing against another person — for example, during team sports.

“It is not common but it needs to be highlighted and is something coaches need to be aware of. A boy may be bringing accidents on himself while he’s on the field because it is a safe way to release all the anger and pent-up emotion.”

Quish says behaviour such as pulling out hair is more common among girls because they can conceal it –using hair-slides to cover up bald patches and eyelash extensions if they are pulling out eyelashes.

Such secrecy makes it even more difficult for parents and other adults to know if their child is self-harming. Quish says it is important for parents to be alert to any changes in the emotional behaviour of their children.

“Every parent has disagreements with their teenagers. But, if before they would retaliate, tell you to get lost and slam the door and now suddenly they are retreating into their room and you are getting no reaction, then they may be doing something else to release the pent-up anger.”

Although self-harm can progress to thoughts of suicide, Quish says these rarely lead to the completion of the act itself.

Quish uses an integrative approach encompassing nutrition, complementary therapies, talk therapy and exercise, to help the teenagers she works with and says she can see tangible results quite quickly.

“I use cognitive behavioural therapy, solution-focused brief therapy and motivational interviewing, to help them to make the changes they need. I have found the three of those work very well together.

"With teenagers, I stress the educational aspect of CBT, in terms of ‘what you think affects how you feel and how you feel affects how you behave’. When they get that formula and they make the link it’s like a light goes on — it’s powerful to see.”

The prevalence of self-harm is difficult to gauge, says Quish, as the statistics are based on those who present with deliberate self-harm to emergency departments.

“I have worked with more than 110 teenagers in the last two years and none of them have presented to A&E. There is also the fear of bringing your child to A&E because they may be admitted to a psychiatric ward.

"Teenagers I work with ask if they’ll end up in a ‘white jacket’ in hospital. That idea is still out there. Parents do not want to expose their child to psychiatric services if it can be avoided.”

While Quish’s book looks at how different parenting styles can affect children’s social and emotional wellbeing, she also acknowledges external factors in the incidence of self-harm.

“Parenting is one aspect but there is also the whole social media thing. When I went to school, if I was bullied, I could go home and know that was the end of it until I went back to school the next day. Now children are coming home and they are getting Snapchat and Facebook messages, so they can’t get away from it.”

Quish says parents can be proactive by equipping their children with coping skills from a young age.

“You need to set limits and boundaries, that’s the best favour you could ever do them. Teenagers know when they hear the word ‘no’, they read that as ‘you don’t care about me’.

"They need to experience disappointment and hearing the word ‘no’ but they also need to know the foundation is strong beneath them in their family and they are loved and cared for.”

Signs a teenager may be self-harming:

* Looking for excuses not to engage in sports.

* Noticeable change in character.

* Talking about themselves in a negative way.

* Unexplained wounds, scars.

* Wearing long-sleeved tops and long trousers/skirts even in hot weather. Spending more time in the bathroom.

* Lack of engagement with friends.

* Plasters, antiseptics hidden in room.

* Blood spots on clothing and bed linen.

* Looking for reasons to avoid family functions and seeking opportunities to be home alone more frequently.

Soothing essential oils:

Basil can help exam nerves by improving concentration and counteracting listlessness. Bergamot is recommended for anxiety and low mood.

Frankincense, noted for its rejuvenating qualities and can help people who struggle with panic attacks and self-criticism.

Geranium is believed to be beneficial in stabilising mood swings.

Lavender, can help reduce stress and anxiety. Peppermint, widely used for nausea and migraine, can also be beneficial for those studying.

Rosemary, noted for its stimulating qualities, can be effective in inducing calmness and clarity.

Ylang Ylang is thought to aid confidence and can help with irrational thoughts and irritability.

From Overcoming Self-Harm and Suicidal Thoughts: A Practical Guide for Adolescent Years, by Liz Quish, published by Hammersmith Health Books, €14.99

If you are affected by any of the issues in this article you should contact your GP who will be able to refer you, or call the Samaritans on 116 123

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