Self-harm, a new epidemic

Self-harm or non-suicidal self injury (NSSI) is a deliberate, self-inflicted injury to body tissue resulting in damage, but without any suicidal intent.  

The injury can be superficial (e.g. skin tear, bruising) or can be disfiguring, with subsequent scarring to skin. 

There is some debate amongst healthcare professionals about whether deliberate self-harm is really an attempt at suicide or a precursor to a suicide attempt. According to Laye-Gindhu and Schonert-Reichl (2005), NSSI frequently occurs in adolescents who, at other times, have contemplated or attempted suicide. As a result, there is a significant risk of suicide and suicide attempts among teens that engage in NSSI. 

One recent study found that 70 per cent of teenagers engaging in NSSI had made at least one suicide attempt and 55 per cent had multiple attempts. However, the non-suicidal and suicidal behaviours serve distinctly different purposes. Some adolescent inpatients report hurting themselves specifically to stop suicidal ideation or to stop themselves from actually attempting suicide. Favazza (2006) conceptualizes self-injurious behaviors without suicidal intent as “a morbid form of self-help.”

Until recently, many social media sites portrayed NSSI as harmless and an acceptable expression of personal distress. Images and posts on Facebook, Instagram and Pinterest became so pervasive and widespread that the number of teenagers requiring medical treatment from self-harm injuries rose dramatically. 

Consequently, in the past few months, pictures depicting self-harm, eating disorders, etc., have been removed from these sites and replaced with suicide prevention hotline numbers. Contrary to what many people think, tattoos and piercing are not a form of non-suicidal self-injury, but are considered a form of creative, independent self-expression, whilst NSSI is a sign of emotional distress and a method of dealing with the distressing thoughts. 

Non-suicidal self-injury is a global issue and affects every age, gender, socio-economic and ethnic group. 

It is estimated that 17.2 per cent of children and teenagers, 13.4 per cent of young adults and 5.5 per cent of adult self-harm. In the U.S., up to 37 per cent of teenagers and 20 per cent of young adults admit to self-harming to help them cope with extreme stress and emotional pain.

Other reasons why a child/teenager self-harms is to relieve stress or pressure, to express feelings, to gain a sense of control, to distract and/or purify him/herself, to feel excitement, and/or to cope with anxiety and negative feelings. It might also give the teenager the experience of being “real.”

There are more than 16 forms of documented self-harm to the body, however, the most common sites a child/teenager uses are the hands, arms, legs and stomach. NSSI can be:

  • carving, cutting, picking of skin
  • tissue scratching, biting of skin (usually by children)
  • burning skin with matches, cigarettes
  • embedding objects under the skin 
  • banging, punching, hitting objects or oneself with the intention of causing pain and injury to the skin

Self-harm or NSSI is not a mental illness/disorder, but is associated with depression, post-traumatic stress disorder (PTSD), anxiety disorders, eating disorders, substance abuse, and borderline personality disorder. Other risk factors that increase the risk of self-harm include a history of trauma, neglect, or abuse. 

An important point to remember, is that whilst self-harm behaviour in children/teenagers with development disorders and intellectual disability is common, it is not considered a form of non-suicidal self-injury because the child/teen is not usually cognizant of the behaviour.

NSSI is a temporary escape from emotional distress that can result in numerous medical problems and lead to a lifetime of maladaptive coping if the behavior is not addressed and treated. Some of the risks of NSSI include:

  • Becomes habit forming and possibly a compulsive behaviour
  • Cutting is contagious especially amongst females 
  • Infection, bony injuries, disfigurement and scars
  • High risk of blood borne transmitted infections if sharing objects (e.g. razor blade)

Signs your child/teenager may be self-harming:

  • Wearing clothes that cover the body (i.e. long sleeve shirts) when the weather is hot
  • Being more secretive or less communicative
  • Changes in eating habits
  • Changes in sleeping patterns
  • Keeping sharp objects on hand
  • Statements of hopelessness or helplessness
  • Difficulties in relationships
  • Unexplained cuts, scratches, bruises, or other wounds

If you suspect of discover that your child/teenager is engaging in NSSI, do not shame, embarrass or scold him/her. Be supportive and understanding, talk with and listen to him/her, try not to become upset or blame others, show compassion and love.

The next step is to make an appointment with a doctor and remove any sharp objects, drugs, alcohol, etc. If the injuries require medical attention, take the child/teenager to the hospital immediately. 

Treatment Plan

According to Peterson, Freedenthal, Sheldon and Andersen (2008), NSSI was previously believed to be a characteristic of severe psychopathology; however, it now appears that self-harm is associated with a wide variety of externalizing and internalizing conditions. Therefore, effective treatment is grounded in a collaborative understanding of the function of the NSSI for the adolescent. Affective, psychosocial, biological and cognitive factors are addressed through psychotherapeutic, psychopharmacological and skill-building strategies appropriate for each person.


  1. Laye-Gindhu A, Schonert-Reichl KA. Nonsuicidal self-harm among community adolescents:   understanding the “whats” and “whys” of self-harm. J Youth Adolesc. 2005, 34(5)447-457
  2. Favazza AR. Self-injurious behavior in college students. Pediatrics. 2006, 117(6)2283–2284 
  3. Peterson J, Freedenthal S, Sheldon C, and Andersen R. Nonsuicidal Self injury in Adolescents. Psychiatry (Edgmont). 2008, Nov: 5(11): 20–26

Mental disorders in kids

Recent statistics show that one in five children/teenagers have a mental illness and 50% of all mental illnesses will shows signs by age 14 years old and 75% of all mental illnesses will show signs by age 24 years old. 

Depression in the younger generation has increased steadily for the past 50 years, approximately 20% of children have an anxiety disorder, and suicide in teenagers has increased 28% since 2000. 

Suicide is now the second leading cause of death in children ages five to 24 years old. Children as young as six and seven years old are being diagnosed with major depressive disorder, generalized anxiety disorder and obsessive-compulsive disorder. 

I know this sounds scary; however, by using proven treatment methods and using appropriate recovery supports, 70% to 90% of children/teenagers will experience a significant reduction of symptoms and 45 to 60% make a complete recovery. Of those with a mental illness of less than one year, the recovery rate increases to 80%. 

Risk factors for a child/teenager developing a mental illness:

  • genetic predisposition
  • early environment
  • current environment
  • loneliness, isolation, social exclusion
  • homelessness, poverty
  • mental illness/suicide in the family
  • addiction in the family
  • history of trauma
  • history of aggression/crime in the family or in the community
  • involvement with drugs, alcohol, or tobacco
  • deficits in social or cognitive abilities
  • bullying, cyberbullying, social rejection by peers
  • poor academic performance, learning disorder, developmental delays
  • poor family functioning, low parental involvement, little to no attachment to parents or caregivers, little to no support from family members

There are more than 200 mental illnesses/disorders listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders 5th edition). The most common mental illnesses diagnosed in children and teenagers are anxiety disorders, mood disorders, obsessive compulsive disorder and eating disorders.

Anxiety Disorders

Whilst there are a many different anxiety disorders, the most common disorders in children/teenagers are generalized anxiety disorder and social anxiety disorder. The symptoms are as a result of the body’s flight-fright-fight response to danger. In an anxiety disorder, this danger response is overactive and happens even when there is no danger or threat.

Mood Disorders

It was generally believed that signs and symptoms of depression occur around the age 13 years and older. However, recent information reveals that children as young as six years old are presenting with a mood disorder, specifically depression and dysthymia. It is estimated only 38% of children/teenagers with a depressive disorder receive help. It is important to point out that depression in a child/teenager is slightly different from adult depression and should not be confused with normal childhood/teenager mood changes. 

Obsessive Compulsive Disorder (OCD)

OCD is a disorder in the signaling area of the brain. Contrary to popular opinion, children and teenagers can have OCD; in fact, it is increasing with children as young as three to four years old displaying repetitive, compulsive and obsessive behaviours. Being a neat freak is not OCD, colour coding your socks is not a little OCD. OCD can severely impact a child/teenager’s daily life and lead to isolation, increased anxiety, depression, suicidal thoughts, panic disorder. Children with OCD are also at increased risk of being bullied.

Eating Disorders

Children as young as seven to eight years old have an eating disorder. It is estimated that 35% of teenage girls have an eating disorder, which equates to seven in 25 girls. Of all children/teenagers with an eating disorder, 10% are male – this rises to 35% with males who binge eat. There are three types of eating disorders: anorexia, bulimia and binge-eating. Eating disorders can lead to some very serous medical problems and research is finding that this disorder usually goes together with other mental disorders/illnesses (e.g. depression, anxiety, substance abuse).

What can a parent(s) do?

The most important thing a parent can do is to talk with and listen to your child/teenager’s concerns, fears, etc. Sit close, make eye contact, look at the body language, offer a caring touch or hug. Hear what is being said, or not being said (silence can speak volumes), be non-judgmental and open minded, do not invalidate or laugh, be responsive not reactive. 

Your child/teenager needs you to believe him/her, be kind, supportive and understanding, offer reassurance and show love. The child/teenager needs to know that you will be there, that you will help him/her and that you will do whatever it takes to help him/her manage the symptoms of the mental illness, improve health and well being and recover. 

Once you have spoken with your child/teenager, the next step is to schedule an appointment with a doctor for an assessment and physical examination. Additional things to do will be to make appointment with a psychotherapist, implement the treatment plan, follow up with the school, talk with child/teenager’s siblings and any family/friends who play an active role in your child/teenager’s life.

Toxic stress and our kids

It seems every time we turn on the television or read the news headlines there is mention of another teenager who died by suicide or committed a crime while under the influence of drugs or was involved in a school shooting. 

Mental illness and suicide in children and teenagers are increasing rapidly, which begs the question: Why?

Decades of research and studies have determined that there is no one single definitive reason for developing a mental illness, rather it is a combination of factors that influence brain growth and development: genetics, early environment (in utero) and current environment. For example, genetics play a significant role in the development of schizophrenia, alcohol intake during pregnancy increases the risk of a child having fetal alcohol syndrome. However, it is the current environment that the child/teenager lives in that appears to have the most impact on a child/teenager’s mental health and brain development and increases the likelihood of mental illness.

A child/teenager’s identity is shaped by environment, relationships, experiences and natural abilities. The way a child is parented and the relationship with parents, guardians, and other adults has a significant impact not only on brain development but also on how the child attains milestones, develops healthy relationships, and copes with stressful and challenging situations. Kids learn by example, and a mentally healthy child will be confident, have self esteem and positive self worth, quality of life and function well at home, in school and in the community. 

Unfortunately, many children live in, and are exposed to unsafe, abusive, and scary environments. Back in the 1990s, research revealed that when a child/teenager encounters stressful situations over and over again, the stress response shifts into overdrive and resets on high creating more inflammation in the brain, which predisposes him/her to developing health problems in later life, e.g. mental illness, obesity, chronic health conditions, etc. 

There are three types of Adverse Childhood Experiences (ACEs): 

  1. Abuse: physical, emotional, sexual
  2. Neglect: physical, emotional
  3. Household Dysfunction: divorce, substance abuse, mental illness, mother treated violently, incarcerated relative

In the early 2000s, the National Scientific Council on the Developing Child coined the term “toxic stress”  to describe extensive, scientific knowledge about the effects of excessive activation of stress response systems on a child’s developing brain, as well as the immune system, metabolic regulatory systems, and cardiovascular system. 

Experiencing ACEs triggers all these interacting stress response systems. Specifically, the chronically stressed brain releases a hormone that shrinks the size of the brain directly affecting the amygdala (fear processing) and the hippocampus (stress, memory, emotions). Also, brain cells which are part of the immune system start producing neurochemicals that lead to neuro inflammation. In the child/teenager who has experienced mental and physical suffering, these inflammatory chemicals continually flood the body from head to toe. Consequently, when a child experiences multiple ACEs over time, especially without supportive relationships with adults to provide buffering protection, these experiences trigger an excessive and long-lasting stress response, which can have a wear-and-tear effect on the body, like revving a car engine for days or weeks at a time.

So, after reading all this information, let’s look at the world today, the world our children and teenagers live in. The world is ravaged by wars, poverty, natural disasters, unemployment, fake news, threat of global warming, migration, anti-Semitism. Crime is escalating, homelessness and economic hardship is increasing, sex/human trafficking is widespread. Then, add in the opioid crisis, gangs, the constraints of school work, the impact of bullying – especially cyberbullying, and the influence of social media, and we have a world full of confusion, hatred and very little regard for the health and wellbeing of others. As adults, many of us feel frustrated, uncertain and concerned. No wonder our children and teenagers feel that they have little control over their lives and their future. 

Our children and teenagers are being exposed to life situations and stressors their parents never experienced. Even bullying in school has become more widespread and more dangerous. Furthermore, bullying is no longer confined to school, because cyberbullying is an ever present, constant and predatorial threat in kids’ lives. Research is beginning to show not only a connection between bullying and mental illness, but also that students who are bullied have smaller and less developed brains. Children and teenagers are being bullied and victimized at an alarming rate. Every seven seconds a child or teenager is bullied. Make no mistake, bullying is a very real and harmful threat, and it increases a child/teenager’s risk of developing a mental illness significantly. 

Many kids I have spoken to say they feel lost; they have no clear direction and purpose in life. I believe adult expectations, the competitive need to be bigger – better – the best, and the constant need to live stress-free and to be happy is a major problem. We have become a world where entitlement, popularity, good looks and acquiring material goods is the norm. We expose children and teenagers to life problems, the horrors of the world, and yet we rarely sit down with them and explain right from wrong, good from bad. Practically every child and teenager owns a phone or tablet and social media has become the surrogate parent, the teacher, and the babysitter. We seem to think that giving our kids whatever he/she wants, treating them as if they are our best friends and confidantes, will make them happier and feel loved. Sadly, this is not true. 

The only way we can truly help support our children and teenagers is by listening to them, hearing what they say, be understanding, non-judgmental, and compassionate. Help them to problem solve, to be assertive and to be kind. Be there for them, tell them how loved they are, show them. Our kids need help now. In the words of John Fitzgerald Kennedy: “Children are the world’s most valuable resource and it’s best hope for the future.”

If you want to take the ACEs quiz, please check out this site.

The 3 M's of mental health

In the past few years, there has been a lot of dialogue about brain health or mental health.

Many people still have difficulty acknowledging that brain/mental health is an essential component of physical health, of life, and consequently, those of us living with a mental illness, continue to be subjected to the myths, misconceptions and stigma that surrounds the topic of mental illness.

It is frustrating and at times inconceivable that in 2020, there are people who, despite all the educational resources available, continue to believe that mental illness is contagious, or a sign of weakness or wrongdoing, or is a sign of Satan! Well, guess what? We are all born with a brain and a body and they are one. Our body represents physical health and our brain represents mental health; without a brain, we could not function, because we would be dead. So let’s be very clear, mental health is an essential component of healthy living. It is normal and it is essential to our continued existence. 

Mental health is the ability to successfully adapt to challenges that life creates for us. We all experience happy feelings and negative feelings; this is what makes us human. Every single day, each of us experiences a whole gamut of emotions and stressors, and it is our ability to recognize these responses, learn from them, understand and adapt our lives that enable us to develop coping strategies and empower ourselves to move forward into the future. Our life experiences and learning response to stressors is an important part of maintaining good mental health.

The Brain

The brain is the most important organ in the body, it is the master control centre and has six domains of brain function that work together like a well-oiled machine. The six domains are:

  1. Thinking: problem solving, organizing
  2. Physical: respiratory, circulatory, nervous system, genitourinary, muscoskeletal
  3. Emotion: sad, angry
  4. Perception: the five senses
  5. Behaviour: acts of kindness, acts of aggression
  6. Signalling: being responsive; think flight fright fight response

Everything we think, feel, do, and experience involves the brain. You cannot separate the mind and body, they are one, they work together, so any environmental stressor will lead to a brain response. For example, a feeling of sadness often results in muscle tension, worrying can result in a headache. 

What is Mental Distress?

It is the inner signal of stress/anxiety e.g. a test. It is called a stress response and as part of good mental health, if we learn how to manage these stress responses it helps us develop skills to help in the future. 

What is a Mental Health Problem?

This occurs when a person faces larger stressors than normal, for example the death of pet or moving to a new school. When faced with large stressors people will experience many different emotions many of them negative e.g.angeralong withsubstantial difficulties in other domains such as thinking (nothing will be the same), physical (insomnia, aches/pains), behavioral(angry outbursts), emotion (sadness). A mental health problem is more acute than mental distress and lasts longer, however, with appropriate treatment such as counselling, a good support system, and (possibly) medications the issue should resolve within a few weeks to a few months. 

What is a Mental Disorder?

A mental disorder arises from a complex interplay between one’s DNA (genetics) and environment: external/internal. It is the result of a disturbance in one or more of the six domains in the brain and results in difficulties with the control of feelings, thinking, behaviours. It is important to remember, that most children and teenagers with a mental illness will get well and stay well with the ‘right’ treatments; however, some mental illnesses, because they affect how the brain functions such as schizophrenia, sometimes needs more complex treatments. It is also important to remember that a person can have all 3 M’s at the same time. For example, Jim has schizophrenia (mental disorder), his dog just died (mental health problem), and he has an exam tomorrow (mental distress). 

A disorder of the thinking and perception domain is schizophrenia. With depression there is a disorder of the emotion domain. A teenager with ADHD and/or substance abuse has a disorder in the behaviour domain, whilst a child with a panic or anxiety disorder has a problem in the signaling domain. 

How to Promote Good Mental/Brain Health in Children and Teenagers

Maintaining good mental health should encompass a holistic approach and meet the child/teenager’s physical, emotional, social, cultural, spiritual and educational needs.

  • Healthy diet
  • Daily exercise
  • Restful sleep
  • Outdoor play
  • Stress management and relaxation techniques
  • Encourage creativity and self expression: writing, drawing, painting, building
  • Time out from social media sites and devices
  • Safety: helmet, pads, alcohol/pills in secure location
  • Regular assessments and visit with health care provider
  • Fluids: 6 to 8 glasses daily
  • Family time and socialization with peers
  • Express validation, compassion, encouragement and love
  • Help them to develop a positive mindset

By supporting and nurturing a child/teenager’s emotional, social and educational needs, we help them develop a value system, become self aware and confident, develop responsible decision-making skills, form healthy relationships, and create positive life experiences for self and others.

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About the Author

Tracey is a retired nurse, speaker, author, peer specialist and mental health/stop bullying advocate and educator. In 2017, she wrote a column for Castanet called Dementia Aware and in 2018, she published her first book Escaping the Rabbit Hole: my journey through depression. From 2017-19, she was a regular guest on well-known author and radio host Peter Rosenberger’s show Hope For the Caregiver on iHeart Radio. She is also the Purple Angel Dementia Ambassador for the Okanagan. B.C. and NAASCA Ambassador for B.C., Canada.
Since the release of her book, Tracey has become a staunch advocate for Mental Illness and Mental Health Awareness and Bullying and completed the course, Bringing Mental Health to Schools. She has met with children, teenagers and young adults to talk about bullying and mental illness and was one of the ‘Break Out’ presenters at the TEACH 2019 Conference in Jacksonville, Florida. 
Her website www.traceymaxfield.comwas recently awarded the silver medal for Best Author Website 2019 at the eLit Awards and her book was a top 10 finalist in the Non-Fiction category at the Author Academy Awards. Tracey has appeared on ABC, NBC and FOX TV morning shows, live radio and over 60 podcasts in the USA, Canada, New Zealand and UK. 
Tracey has her own You Tube channel: Engage Educate Empower and posts weekly videos and blog posts about mental illness and bullying. In December 2019 she released her first on-line course about mental illness, suicide and bullying in children and teenagers. Her philosophy is to Engage children and teenagers, to Educate them about mental illness and bullying and to Empower them to develop confidence and skills to continue to move ahead in their own life journey
You can check out her videos, blog and on-line course at www.traceymaxfield.com.
She can be contacted at [email protected] 

The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.