Paracetamol overdose and cutting are the two most common forms of self-harm reported for children and young people. Self-harm becomes more common after the age of 16, but is still prevalent among younger children.
Self-harm may indicate a temporary period of emotional pain or distress, or deeper mental health issues, which may result in suicide. A great deal of the research and policy literature on the subject does not distinguish between self-harm with the intention of committing suicide and self-harm without that intention (sometimes called self-injury or self-mutilation). In this article, self-harm is used to include both types of behaviour.
Girls have been found to be much more likely to self-harm than boys. This means that much of the research into risk factors for self-harming has focused on girls and may not always reflect why boys self-harm. However, some factors that affect boys more than girls have been identified. These include problems concerning studying, money and housing.
Parents can be unaware that their children are self-harming. It is usually a private act and many children and young people who self-harm may not seek medical assistance or approach medical services. If the young person does not seek help or present at A&E departments with clear indications it can be difficult to recognise self-harm. However, one study of attempted suicide cases among 15-year-olds found that they were twice as likely to go to their GP than 15-year-olds who did not attempt suicide. They were also much more likely to present to their GP with mental health concerns or upper respiratory tract infection, for which there were no physical symptoms.
Self-harm episodes can be triggered by either specific events or more general feelings of distress. Children aged five to 10 were more likely to self-harm if they had experienced stressful life events, such as witnessing domestic violence, having a family break-up, being placed in care, their parents or carers had an unwanted pregnancy or bereavement. Child abuse, both physical and sexual, has been found by several studies to be an important factor in the self-harming of some young people.
Children and adolescents are also much more likely to harm themselves if they are around other people who self-harm. Self-harm by friends or family has been found to trigger self-harm among adolescents. Self-harm behaviour can also have a group dynamic. Young people may get into self-harming groups at school, college or elsewhere and it may also form part of “rituals of initiation”. Research shows that many children and young people who self-harm are also experiencing problems at school, such as work or exam pressures, but bullying is the most common issue.
Among five- to 15-year-olds, self-harm has been found to be about twice as prevalent among children from the lowest socio-economic income group and those living in rented accommodation. Socio-economic adversity or deprivation has also been found to be a significant independent factor associated with self-harm among adolescents and young people.
When asked why they self-harm, children and young people put forward many reasons. They may have issues with self-esteem or they may feel frustrated and angry. Many say they cut or burn themselves, or perform other forms of self-harm, because it is a form of escapism, a release or relief from the pressure of mental, emotional or personal problems. Self-harm may provide a physical release from unbearable emotional or mental pressures. Some see it as a strategy to protect themselves, an effective means of coping. It makes the unmanageable manageable. Some describe it as suicide prevention strategy because it provides enough temporary relief from a range of pressures for which suicide may be thought to be the only release. However, some young people also say that self injury can be performed as a punishment, something that is “deserved”, either for something that has happened in the past or something that is happening in the present.
Young people have also said that self-harming can “feel good” and that they do not feel that they should stop as the action performs an important and worthwhile function for them and does not harm anyone. Professionals may therefore face a difficult challenge with young people who self-harm because they may feel a responsibility to protect children from harming themselves, but their intervention may be neither wanted nor reduce the self-injurious behaviour.
● SCIE research briefing 16: Deliberate self-harm (DSH) among children and adolescents: who is at risk and how is it recognised.
● National Self-harm Network
● Young Minds
● Young People and Self-harm
● Young People and Self-harm: a national enquiry
● Trust for the study of adolescence
● British Psychological Society
● Self-harm by children and adolescents most often involves overdoses (self-poisoning) and self-mutilation (such as cutting, burning, scalding, banging heads and other body parts against wall, hair-pulling and biting).
● Repeated self-harm is associated with risk of suicide.
● Four times as many girls as boys self-harm up to age 16, although this reduces to twice as many among 18- to 19-year-olds.
● The following are the principal factors associated with increased risk of self-harm among children and adolescents: mental health or behavioural issues, such as depression, severe anxiety and impulsivity a history of self-harm experience of an abusive home life poor communication with parents living in care or secure institutions.
● Common triggers for self-harm include experience or memories of stressful life events, such as being abused, witnessing domestic violence, disruptive or abusive relationships with parents, problems with boyfriends or girlfriends, going into care, unwanted pregnancy or problems at home or school.
● No single factor has been shown to predict self-harm. However, a combination of external pressures from home and school life, emotions such as anger, guilt or frustration, and mental or behavioural issues such as depression, conduct disorders or impulsivity, may lead to self-harm.
● Many children and adolescents who repeatedly self-harm consider it to have a positive purpose, a way to relieve unbearable pressure or pain. Some young people view it as a suicide prevention strategy, a means of protecting themselves. It is also seen as a coping strategy over which they have control.
● Self-harm can also be a means of communicating pain and distress to others.