Having discussed the staggering increase in self-injurious behavior among adolescents, and on the heels of the tragic teenage suicides in our own communities, we are no doubt all left wondering what can be done.
To be clear, not everyone who self-injures is suicidal. That said, the correlation between self-injury and suicide is alarming. Research by Harvard psychologist Matthew Nock, PhD, found that 70% of adolescents who engage in self-injury make at least one suicide attempt in their lifetime (Nock et al., 2006).
So what should you do if you learn that your adolescent, friend, or student is engaging in self-injury?
1. Help them get treatment. At the very least, help them get connected with a psychologist or licensed therapist who can conduct a thorough risk assessment and mental health evaluation. A licensed clinician can determine if the individual is suffering from a mental health disorder like depression, and/or if they could benefit from some skills training in regulating emotions and managing stress. A clinician can also assess for suicide risk and respond appropriately. For more information on local emergency resources, please check out my previous post on this issue.
2. Help them get the right treatment. Unfortunately, not all treatments are created equal. Fortunately, there are some pretty effective treatments for self-injury. The treatment approach I recommend for self-injurious and suicidal behavior is Dialectical Behavior Therapy (DBT). The research regarding the effectiveness of DBT in treating self-injurious and suicidal behavior is substantive, and I don't know of any well-trained self-injury or suicide prevention specialists who would deny its utility. A good DBT program provides weekly individual therapy and skills training. Patients are also able to contact their DBT therapist any time outside of session for help managing urges to self-harm and using different skills to regulate their emotions. There are several DBT programs in and around the Bay area. My only recommendation here is that if you are seeking treatment for an adolescent, be sure to find a DBT program or therapist for adolescents.
3. Don't minimize, criticize, or ignore self-injurious or suicidal behavior. Parents and friends are often concerned about reinforcing this behavior, so they try to shut it down. While reinforcing the behavior is something that can happen, especially in peer groups, the damage done by invalidating or shaming someone is potentially worse. Instead, aim to be nonjudgmental and understanding. Don't be afraid to ask direct questions about how they injured themselves or if they have thoughts of suicide. If at all possible, try to encourage them to remove any potential means of self-injury such as razor blades, pencil sharpeners, or medications. Again, someone who is self-injurious or suicidal needs to be seen by a mental health provider. Your aim should simply be to help them get treatment, while remaining empathic and nonjudgmental.
4.Don't assume the role of treatment provider. This may seem to contradict my third point, but it's critical that you not assume the full responsibility of keeping someone safe from themselves. I most frequently see this issue arise in the context of close friendships in which one friend is self-injuring and the other is keeping their secret. If you are emotionally supporting someone who is struggling with these issues, then you need support too! DBT therapists meet weekly with other DBT therapists to get the emotional support and problem solving they require to do their jobs effectively. It can be gut wrenching and utterly depleting to watch someone you care about struggle with issues like self-injury or suicidality. You will not do them, or yourself, any favors by struggling alongside them in secrecy. If in doubt, defer to the age old wisdom of aircraft safety when helping others through a crisis - put your oxygen mask on first before assisting others.
I will continue to discuss the issue of adolescent suicide and self-injury on my blog over time as this is obviously a complicated matter. If you have any specific questions or thoughts, please leave your comments below.