Cutting, punching, pulling, and burning are some examples of self-harm that are increasingly common among children. Self-injury is not a pathology on its own, but rather a symptom, an accompanying phenomenon, so there are no statistics on how many minors are affected. In Dr. Nikoletta Várnai’s experience, however, more and more young people are involved: In the Pediatric Psychiatry Ward, in the early 2000s, self-harm was observed on average in one or two children per week; however, this has increased to four to five cases daily.
It’s not uncommon for children to be admitted from the emergency department after having suffered deep wounds or serious injuries.
There are three to four times as many girls as boys who self-harm, but boys tend to hurt themselves more severely. The phenomenon is most common in 16–17-year-olds, but it also occurs in the 12-13 age group.
A child with a completely average, healthy personality development can also be affected at a more difficult stage in life, the head physician points out. The essence of self-harm is that physical pain relieves the inner, psychological pain that the children might be experiencing. Or, as many experts put it, it at least temporarily shakes them out of the constricted state of consciousness, the feeling of emptiness that weighs heavily on them.
This inner pain, this feeling of emptiness, can be linked to anxiety, depression, eating disorders, or even more serious psychiatric conditions, and there may be biological, psychological, and social reasons behind them, highlights Dr. Nikoletta Várnai. These include genetic predisposition, bad parental examples, lack of coping mechanisms, financial or other difficulties in the family, but also the influence of social media, including bullying and online abuse. Self-harm is also becoming more and more common because this topic is no longer seen as unusual among children; it is also spreading online as a solution to problems, and young people are talking about it and even helping each other with practical ideas. Also, the world is no longer a safe place for children, as epidemics, wars, and the climate crisis have become part of their everyday lives, and they hear and talk about these issues at home, at school, or elsewhere.
There is no seasonality in self-injury; children come to the center all year round, always for different reasons, points out the head psychiatrist. Those who have a family problem or need a framework feel compelled to self-harm during the holidays or the winter and summer school breaks. Others, on the other hand, benefit from the school breaks and the distance from school and classmates; they use self-harm to relieve their anxiety during the school year.
If children deliberately hurt themselves, it should always be taken seriously. Not only because it is a cry for help, but also because self-harm can become habitual as a response to crises, and over time, non-suicidal self-harm can turn into suicidal self-injury.
This is very important for parents to bear in mind if they are worried that asking for help might stigmatize their children.
How can parents detect self-harm, and what can be done in such a case? As the psychiatrist points out, it can be suspicious if children are reluctant to wear short sleeves, short pants, or a swimsuit despite the heat, or if they lock or seclude themselves in their rooms for extended periods, while, for example, their school performance is deteriorating or they neglect their friends. It is an even more alarming sign if parents find bloody pieces of clothing in the laundry basket, let alone a blade among the child’s belongings. In such cases, Dr. Nikoletta Várnai advises parents to find an opportunity for an open conversation with their child during a quality-time activity, for example.
With teenagers and tweens, parents should take every opportunity to talk. If it is the children themselves who initiate a conversation, parents should put aside everything else and listen. These are crucial moments, and if parents are attentive, it is possible to prevent children from choosing self-harm as an apparent solution to their problems.
The child and adolescent psychiatrist emphasizes that victim blaming should be avoided at all costs. It is important for children to feel that self-harm is not their fault and that they can rely on their family to solve the problem together.
If our child is withdrawn or secluded and we suspect a problem, we should seek help, the psychiatrist emphasizes. Parents can consult the family pediatrician, school psychologist, pedagogical professional service, or even seek support from a family therapist. In the case of severe self-injury, it is essential to take the child to a doctor or call an ambulance and discuss the suspected self-harm at the point of care. The professional will be able to assess how to proceed.
Éva Haiman
Translation: Judit Szabados-Dőtsch
Photos by Bálint Barta, Attila Kovács – Semmelweis University
