Increasingly I am being asked by concerned parents and girls about the issue of self-harm, so this week I’m bringing you an abridged version of the section in my book The Butterfly Effect that looks at what drives some girls to hurt themselves, the warning signs to look out for, and what we can do to help girls in crisis.
Trigger warning: The following post contains references to self-harm that may be a trigger for some people.
What is self-harm?
Self-harm is when a girl purposely injures herself, usually in secret. There are many different ways that a girl might do this, including cutting, burning, biting or branding her skin; hitting herself or banging her head; pulling her hair out; picking and pulling at her skin; or picking at old sores to open them up again.
Self-harm warning signs
- Cuts – especially small shallow parallel cuts on the arms or legs – for which there is no adequate explanation
- Other frequent and unexplained injuries, such as burns or bruises
- Starting to wear long sleeves or pants all the time, even in warm weather
- Sudden aversion to going swimming or getting changed in front of other girls
- Hair missing, where it has been deliberately pulled out
- Mood changes, depression, anxiety
- Spending a lot of time alone
- Notable difficulty dealing with stressful or emotional situations
- A drop in school performance
Why do girls self-harm?
While each girl’s situation at home, school, with friends and in the community influences her life in a unique way, there are underlying factors in our culture that are putting more teenage girls at risk than ever before. Being part of society means meeting certain expectations; around adolescence girls begin to be more fully aware of the pressure to fulfil these expectations, which were mapped out before they were even born. Girls can hardly miss the messages about what it takes to be an ideal girl or the ideal woman. Unable to match the ideal no matter how they try, many girls begin to loathe themselves for falling short.
To try to meet the expectations of who they should be, teenage girls may have to tame themselves, blunt themselves. They learn that if they express anger, they will turn people off, because feminine, good girls are agreeable, not cranky. Even though on the surface a girl may appear sad, happy or indifferent, she may really be bottling up rage. Where does girls’ suppressed anger go? For some, it may become depression, drug or alcohol abuse, or self-aggression such as anorexia, bulimia, self-harm or suicide.
In some cases, self-harm is a form of risk-tasking and rebelling, or even of being accepted into a peer group. In others, it is a sign of deep psychological distress, a way of coping with painful, overwhelming feelings. If a girl finds it hard to express emotions such as anger, sadness or grief, marking her body in this way may be her desperate attempt at self-expression. A girl numbed by depression or trauma may self-harm in order to feel something again. It can also be a cry for help. A girl who doesn’t know who to ask for help, or how, may be using her injured body to send a message. And as with eating disorders, there are girls who self-harm because they feel that they are not in control of aspects of their life; for them, self-harm is a way of asserting control.
During the act of hurting herself, a girl may feel as though she is releasing pent-up steam, as if opening the valve on a pressure cooker; the act brings a temporary sense of relief. But self-harm also brings with it guilt, depression, self-loathing, anger, fear, and isolation from friends and family.
Self-harm doesn’t necessarily mean that a girl is suicidal, but all cases of self-harm need to be taken seriously. Self-harm can be related to mental health issues including depression, psychosis, bipolar disorder and borderline personality disorder; to a trauma such as physical or sexual abuse; or to some other source of deep psychological pain. Self-harm may also do lasting physical damage. While girls rarely need hospitalisation because of self-harm, they may give themselves lifelong scarring as well as nerve damage.
What can be done to help?
In the short term, if a girl self-harms she needs to learn ways to cope when the urge strikes. Her therapist is likely to suggest ideas such as counting to ten or waiting 15 minutes, to give the feeling a chance to pass; saying ‘No!’ or ‘Stop!’; relaxation techniques such as yoga; or going for a run or doing some other kind of hard physical exercise. Another accepted short-term solution is to choose an alternative to self-harm, such as squeezing ice cubes between her fingers until they go numb, eating a chilli, standing under a cold shower, having her legs waxed or drawing in red on her body instead of cutting. Crucially, the underlying reasons why she self-harms need to be uncovered and worked through with a professional, who will also help her to develop healthier ways of identifying, coping with and expressing painful emotions.
There is much we can do to help prevent girls finding themselves at crisis point; and no matter how troubled a girl is, she can turn her life around. The key is communication. By strengthening a girl’s connections – to her parents, the rest of her family, her friends, community and school – we can give her the best chance.
Girls regularly tell me that what they want more of is their parents’ time. They want their parents to listen. Sometimes when we ask our daughters what’s wrong, we get a blank gaze or a huff or a slammed door, and we give up. Don’t give up too quickly. Your girl may be sending out all the signals to push you away while actually she needs you to keep asking, giving her attention, showing her you care. Therapist Martha B. Straus urges: ‘When she’s at a loss for words, guess and guess again.’ Many teen girls have a limited vocabulary for expressing their feelings, but we can help them. It can take something as simple as ‘I feel really angry about this – do you?’ to open the floodgates.
One of the most helpful things you can do is allow her to express all her emotions, rather than choking on her darker feelings until they turn into despair. ‘When girls can be angry,’ Straus writes, ‘they can also be reassured they are worth such powerful feelings – there is someone in there worth being mad about.’
- Seek professional help. A good starting point is your GP, for a referral to a relevant specialist, local adolescent mental health team, counsellor or community health centre.
- Be consistent. Set consistent boundaries, but also be consistent in your loving. Even if she takes a drastic backslide in her recovery, she needs to know that you still love her.
- Banish secrecy. Maintaining a shroud of secrecy around a crisis is not helpful to girls.
- Build networks of support. A girl’s networks may include doctors, therapists, adult mentors, relatives, school counsellors and friends.
- Celebrate. When a girl is on the path to recovery there may be frustrating and disappointing setbacks, but there will be victories, too. Take heart in them. And celebrate.