When my then-12-year-old daughter showed me her hand with straight pins purposefully driven through the top of each finger, I did what most mothers would do under those circumstances: started crying hysterically. Which, as her therapist later told me, was precisely what I should NOT have done.

"You have to stay calm," the therapist said. "When kids are falling apart, they need their parents to remain steady."

However, it's hard to remain steady when you see your child in pain. It can be even harder to understand why they would deliberately cause that pain by cutting, burning, biting or engaging in other forms of self-harm.

To help the child who is self-harming, it is important to understand the reason behind the behavior. Self-harm is usually a symptom of something deeper and more complex.

The child who self-harms may do so to

  • Express emotional pain they can't express verbally.

  • Relieve the build-up of tension caused by anxiety, depression or other psychological or physical trauma.

  • "Feel" something other than the numbness of despair.

  • Feel a sense of control over their lives ("I'm going to hurt myself before someone else does").

What should you do when you discover that those scratches on your son or daughter's arm were not, in fact, caused by your overly playful cat (an excuse my daughter actually used)?

  • Make sure your child receives an evaluation by a mental health professional who can diagnose and treat any underlying psychiatric disorders.

  • Validate their feelings. Even if you think they're getting all worked up about nothing, that's not how they feel. Saying, "You must be in a tremendous amount of pain to want to do this to yourself" lets them know you recognize their distress.

  • Ask how you can help. If they say, "I don't know," be prepared to suggest some coping strategies. Remember, the part of your child's brain that helps them reason and make good decisions isn't finished developing until they are in their early twenties. Model problem-solving skills by saying, "Let's write down some things you might try when you feel like you want to hurt yourself." Potential coping strategies include: squeezing an ice cube, snapping the wrist with a rubber band, going for a walk, practicing breathing exercises, writing in a journal, screaming into a pillow, etc.

  • Be open about their self-harm. If you think they have been hurting themselves, ASK. But do so calmly.

Finally, don't be afraid to bring up the "S" word: suicide

It is natural to assume if your child is hurting themselves they are at risk of attempting suicide. It is also reassuring to know the majority of children who self-harm do NOT kill themselves. Whether you approach the subject indirectly ("Sometimes when kids are really upset, they just want to end it all. Do you ever feel that way?") or directly ("Hurting yourself is pretty drastic. Are you thinking of killing yourself?"), you need to know if this is something your child is thinking about. If they say yes, listen to them without judging, and then contact their mental health care provider or the crisis line in your area.

There are few things that can make a parent feel more frightened or helpless than seeing your child with razor cuts running up and down their arms.Just know your child is feeling even more frightened and helpless and is depending on you to know what to do. So take a deep breath, tell them that you will get through this together, and be the person they need you to be.

For more information on children and mental illness, visit the National Alliance on Mental Illness at www.nami.org.

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