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.

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

A WestJet flight on the runway leaving Comox. Photo by Erin Haluschak
Aviation company seeks contracted employees to fill former WestJet roles at YQQ

Menzies Aviation from Edinburgh Park, Scotland, operates in 34 countries across the world

A cougar was spotted Monday near Queneesh Elementary. (WildSafe BC photo)
Cougar sighted Monday near Courtenay school

Conservation officers are warning the public to avoid the wooded areas around… Continue reading

Island Health chief medical officer Dr. Richard Stanwick receives a first dose of Pfizer vaccine, Dec. 22, 2020. (B.C. government)
COVID-19: B.C. seniors aged 90+ can start to sign up for vaccination on March 8

Long-term care residents protected by shots already given

COVID-19. (Image courtesy CDC)
SD71 to address COVID-19 exposures with virtual town hall

The meeting is set for Thursday, March 4

Courtenay Elementary is the latest school on a growing list that has COVID-19 exposures. Google Maps photo
Courtenay Elementary latest school on growing list of COVID-19 exposures

Exposure dates at the school on McPhee Avenue are Feb. 22, 23 and 24

Langley resident Carrie MacKay shared a video showing how stairs are a challenge after spending weeks in hospital battling COVID-19 (Special to Langley Advance Times)
VIDEO: Stairs a challenge for B.C. woman who chronicled COVID-19 battle

‘I can now walk for six (to) 10 minutes a day’

Cannabis bought in British Columbia (Ashley Wadhwani/Black Press Media)
Is it time to start thinking about greener ways to package cannabis?

Packaging suppliers are still figuring eco-friendly and affordable packaging options that fit the mandates of Cannabis Regulations

Provincial health officer Dr. Bonnie Henry updates B.C.’s coronavirus situation, May 8, 2020. (B.C. government photo)
B.C.’s weekend COVID-19 cases: 532 Saturday, 508 Sunday, 438 Monday

Fraser Health still has most, eight more coronavirus deaths

B.C. Attorney General David Eby speaks in the legislature, Dec. 7, 2020. Eby was given responsibility for housing after the October 2020 provincial election. (Hansard TV)
B.C. extends COVID-19 rent freeze again, to the end of 2021

‘Renoviction’ rules tightened, rent capped to inflation in 2022

Face mask hangs from a rear-view mirror. (Black Press image)
B.C. CDC unveils guide on how to carpool during the pandemic

Wearing masks, keeping windows open key to slowing the spread of COVID-19

Churches, including Langley’s Riverside Calvary Church, are challenging the regulations barring them from holding in-person worship services during COVID-19. (Langley Advance Times file)
Tofino Resort and Marina has temporarily shut down after several staff members tested positive for COVID-19. (Nora O’Malley photo)
COVID-19 confirmed at Tofino Resort and Marina

Resort apologizes to Hesquiaht First Nation for Valentine’s Day boating incident.

Det. Sgt. Jim Callender. (Hamilton Police Service screenshot)
B.C. man dead, woman seriously injured after shooting in Hamilton, Ont.

The man was in the process of moving to the greater Toronto area, police say

Wildlife advocate Gary Schroyen captured this picture of a one-year-old cougar in the Sooke Hills using a homemade trip camera. Vancouver Island is home to approximately 800 cougars, which makes up about a quarter of the total population in B.C. (Gary Schroyen photo)
Wildlife advocate Gary Schroyen captured this picture of a one-year-old cougar in the Sooke Hill using a homemade trip camera. Schroyen presents Animal Signs: The Essence of Animal Communication on Nov. 30. (Gary Schroyen photo)
Declining Vancouver Island cougar populations linked to wolves

Large carnivore specialist says human development still plays biggest role on cougar numbers

Most Read