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[Music]
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hello and welcome to another Health
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Essentials podcast I'm John Horton your
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host growing up isn't easy and kids
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often experience intense emotions as
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they work to find their way through an
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increasingly complicated world this
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journey can be painful and many teens
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try to dull that Pain by inflicting a
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different kind of hurt a physical hurt
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upon themselves this self harm can be
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done through cutting scratching burn
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learning or other damaging actions it's
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a behavior that is both shocking and
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scary today we're going to talk with
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adolescent psychiatrist Zed Khan to
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better understand the why behind self
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harm and how you can help children who
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are deliberately injuring themselves Dr
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Khan is one of the many experts at
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Cleveland Clinic who visit our weekly
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podcast to chat about health issues
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affecting families so with that let's
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explore why so many children turn to
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self-inflicted pain to do out the
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struggles and stress in their lives
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[Music]
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welcome to the podcast Dr Khan uh thanks
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for stopping by the chat yeah thanks so
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much for having me John so when it comes
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to to children in self harm um I mean
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the numbers are just startling uh
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studies I saw show that almost one in
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five teens injur themselves um that
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that's just way higher than I ever would
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have imagined yeah you know I think I
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felt the same way when I first heard
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about this uh but the data has been
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pretty consistent over the years at
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around that 20% number you mentioned
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engaging in some level of self harm and
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actually some of that data may be
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outdated um as well as recent studies
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over the pandemic are showing this
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number is increasing uh to over 27% of
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teens during the early years of the
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pandemic wow well well that that's why
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we're having a discussion like this and
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why it it's so important to talk about
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it uh because I don't think people truly
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realize just how prevalent uh it is um
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even I guess if it's happening in your
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home um so so given that uh can you talk
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a little bit about how kids might harm
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themselves and then what they do to hide
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it yeah yeah
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so the most common thing we think of
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when it comes to self arm is cutting or
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scratching right uh banging banging
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their heads hitting objects or biting
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their limbs can be common um burning
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with lighters or matches is something
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that I see fairly often and then there's
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also skin picking or hair pulling which
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can be a form of like self harm too less
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common in children but often in adults
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you see like excessive body piercings or
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excessive tattoos uh and then there's
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like a broader definition of self harm
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that I think includes more ma
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maladaptive coping skills like
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overeating like drug use and poor
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self-care though to me I think this is a
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little bit too broad and the the
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research that we use now has created a
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new term called non-suicidal
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self-injury which is intentional and
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non-socially acceptable behavior is
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meant to damage the body in minor or
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moderate ways uh without having suicidal
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intent and to decrease this feeling of
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psychological distress and so most of
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our data regarding self harm now comes
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under that definition you mention a lot
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of those things and they seem like the
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the sort of actions that would leave
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some obvious marks I we talk about
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cutting and scratching and things like
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that uh but then I know a lot of what I
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read too said that a lot of times people
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don't know that this is going on so I I
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take it there's some signs that when
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when kids do this they take steps to to
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Really conceal it and those are kind of
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like red flags for you yeah the first
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thing I'll say is it's really hard
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because kids are smart and they and they
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know how to hide things right they're
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they're very smart when it comes to
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hiding things so I I three kids so yeah
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yeah and so when I I often see my
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adolescent patients controlling the
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placement of the cuts in addition to
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finding you know creative ways to cover
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them up so they'll attempt to cut in
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places that are less likely to be seen
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such as their legs or their inner thighs
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um or even their stomachs so areas that
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are typically covered uh and I remember
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when I was in high school several years
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back uh people would wear those slim
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blackl rubber bands on their wrists in
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large quantities and that could often
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High a sort of scarring th self harm but
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those I think have gone away as fashion
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trends have changed more typically now
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you see like long sleeves or you know
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pants all year round um the other piece
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is that some of these scars often last
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for many years and so it's adolescence
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transition to adulthood to 18 some
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people get tattoos so they can more
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permanently conceal it so I mean if if
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if you see some of these later um you
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know as time goes on obviously there's
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fresh wounds that you can see but if you
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even see like the scars later you start
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noticing it on the arms or or like you
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said anywhere um is that still something
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you should worry about I think it's hard
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to know uh and it depends on I guess
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who's worrying and so I think you know
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if it's if this is a parent thinking
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about it it's always okay to ask
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questions and try to learn more about it
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um but but sometimes this could be kind
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of a while ago and many people who self
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harm actually don't end up harming again
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when you when you start looking at at at
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this and this whole notion of of of
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harming yourself it's just so difficult
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to imagine doing this to yourself um so
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so what drives a kid to start dabbling
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in behavior that just that just seems
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like it hurts yeah that's such a good
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question and I think my answer is that
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it depends so non-suicidal self-injury
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though prevalent is the end result of a
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large number of factors um including
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like a child's
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personality what we call like Adverse
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Events in their childhood that are
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outside of their control um School
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stressors interpersonal or relationship
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stressors stressors at home you know
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cyber bullying and like interactions in
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social
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media and I think the medical field has
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a tendency to pathologize the individual
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for systemic or societal issues so for
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example like non-binary and transgender
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youth have some of the highest rates of
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non-suicidal self- injury and suicide
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attempts of any demographic but there's
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nothing inherently suicidal about those
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groups right so it's how our society and
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our political system interacts with
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marginalized communities that leads down
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the road to self-injury as well it
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speaks to the stresses like you said
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that that people just that that you
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carry through life and and sometimes it
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just it seems like it just gets too much
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at times and and the self harm is a way
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of kind of trying to trying to address
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that yeah so the common story that my
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patients tell me is that self harm is a
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way to see and show what they're
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experiencing internally and so for some
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this can decrease all the pressure
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they're feeling and they're able to move
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on from it but others uh feel more
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intense feelings of rejection and guilt
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shame or even anger afterwards which are
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really difficult to handle yeah I was
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going to ask you that like from when
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you've talked with people when when when
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they do this is it the sort of thing
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that when it's when they're engaging in
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it then that it just that it actually
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brings relief which just seems so you
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know unnatural to think about it that
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way but but they basically use a
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different kind of pain to release
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Another Kind yeah and our body you know
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is well adapted
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to pushing through physical pain you
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know there's already a very a
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already-made system of releasing certain
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things that that decrease the pain in
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your body that you know allow you to
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feel better to feel more calm and
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sometimes I think people realize that
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that is something that's helpful even
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for the internal pain which maybe we
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don't have a good system yeah now you
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had mentioned to just the overall
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stresses and that you or that like a
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study saw like an increase in self harm
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uh during the pandemic I mean that that
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really does seem to drive home the point
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that there are these external forces
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that just kind of add all this stress
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and and you know this just it it kind of
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grows out of it and and that's
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absolutely true though not everyone
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under a large weight of stress or even
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you know abuse and things like that will
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turn to self harm so it has to be like
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the right mix of factors with with the
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right person so we start to understand
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the why of people self Haring um
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researchers are are trying to see if we
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can predict who is at risk to self harm
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for the first time and maybe even
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intervene before it happens wow are
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there any triggers that you might that
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might indicate that somebody would be
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prone to doing that yeah so the most
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recent research has studied how self
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harm can be a way to for people to
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distract from these rotating intrusive
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thoughts as well as a way to avoid
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dealing with what's going on in their
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own
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lives and so our knowledge is still
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evolving uh we've known for some time
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that two things seem to predict
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non-suicidal self- injury really well
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those were dis inition and what's called
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like high intensity negative moods so
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the F for the first this inhibition is
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measuring someone's ability to regulate
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their own emotions and their and their
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own behaviors and those who self har
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feel this urgency to act and then
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struggle to inhibit those strong
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emotions the other piece is the high
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intensity well moods or what we call
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negative affect that for these people
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they use non-suicidal self-injury as a
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means to cope with really intense
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emotions now can self Haring escalate
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over time or or or even lead to a
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potential suicide attempt yeah
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absolutely so non-suicidal self injury
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is one of the strongest predictors of a
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future suicide attempt especially if
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this nonsuicide self injury would be
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considered severe uh with multiple
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instances maybe using different methods
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like using the concealment that we
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talked about in terms of numbers 70% of
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those who engage in non-suicidal self
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injury will attempt suicide once and 55%
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will attempt multiple times wow well
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that that that's a that's that's a very
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staggering and in sobering number yeah
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and some have this escalating course
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because things are often kept secret and
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so they're struggling on their own and
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because of that they struggle to slow
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down or stop the self Haring which is
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more likely to lead down the road of uh
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the Suicidal Thoughts as well well I
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mean obviously everything you've said
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this is it's a it's a very serious issue
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and it it seems like a little bit of a
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of a of a somebody asking for help um so
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so if you see signs that that a teen is
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self Haring uh what should you
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do yeah so this can be so hard because
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most parents have spent their whole
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lives trying to protect their kids from
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danger and the impulse is try to fix the
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problem quickly but often that's not a
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very effective thing to do and at least
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initially when it comes to talking to
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kids about self harm your primary goal
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is to gain information you know so be
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curious not judgmental and asking
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questions and really trying to listen
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more than you speak so try to find out
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how often it's happening when was the
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last time ask if they're having any sort
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of Suicidal Thoughts because if if they
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are this should lead to an immediate
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trip to the emergency room um but but if
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they're not you know there's other
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mental health professionals in every
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parent's life that can help out uh one
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of which being the the child's
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pediatrician and it does seem so hard
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like bringing that up I that I can't
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even imagine uh almost a more difficult
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discussion to have with your child when
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when you notice that this is going on
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and and you have to somehow address
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it yeah and
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so I think parents and caregivers may
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feel confused angry or helpless when
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they see that their signs that their
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child or teen is engaging in self harm
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and they realize their child needs help
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but really have no idea where to begin
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as you know so I think talking about it
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really is a first place to start and
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talking to your child about this is
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really hard and I tell parents all the
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time like you can do hard things you
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already have and this is just another
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one thing to do uh and as I said before
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try try your best to be curious not
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judgmental and if you're not sure what
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to say try to reflect back what your
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child is saying to you rather than place
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your own judgments um on what's being
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said which which is very difficult if
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you're if you're a parent and you are
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that that that concerned yeah um if you
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do see this that this is happening um I
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know you mentioned seeking professional
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help like how soon should you do that
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once you kind of maybe you have this
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discussion and and you realize that that
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that self harm is happening yeah so I I
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really want parents to feel empowered to
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reach out to your doctors or therapist
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whenever you're concerned here and so I
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would say try to find out more
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information as quickly as you can and
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then reach out to your doctor either
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through my chart or through you know a
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phone call to the office with whatever
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information that you have and then they
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can decide what the next step might be
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such as do they need therapy do they
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need Psychiatry do they need to be
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involved in some sort of you know
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intensive therap programming um and if
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your child has active suicidal thinking
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or is feeling unsafe at home this is
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that's a suicide risk and it's a good
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time to visit the emergency room yeah
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now now if you have this discussion W
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with with your child and you start
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talking about it and and you know they
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say oh I'm GNA stop and do whatever and
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and they just don't I take it that's
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then in
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immediate you try to get them in to see
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somebody yeah so like I said I think
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going to your pediatrician is a really
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good place to start they can start that
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process and see how often it's happening
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typically parents aren't the first ones
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to find out and it's often like friends
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or a trusted family
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member but yes I think trying to get in
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um to a therapist or a psychiatrist or
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looking for those referrals uh is is a
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good place to start no I know you know
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discovering that that your kid is self
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Haring uh just has to be just such an
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emotional and traumatic moment if you're
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you know for parents and
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caregivers um what advice do you have
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for them as they kind of work through
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this process with with their child yeah
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so I think I would say two things one is
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that try to find the ways to look after
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yourself so that you're able to care for
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your children right because if you're
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not caring for yourself you're not able
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to do much for other people and do the
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pieces of self self-care that work best
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for you seek out support with your
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family um consider seeking out your own
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therapist or o additional support and
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remember your child's caregivers also
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have adult resources too you know and so
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that's a good place to start for you uh
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and as most self harm happens when teens
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are alone this may be a chance to start
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the strengthen your relationship ship
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with your own child by spending more
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time together doing things you both
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enjoy together and having more of that
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quality time well that that's quality
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time is always I think a solution for
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for so many things um in in life so that
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that's that's some great advice so so Dr
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Khan if if you see that your child is
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self Haring I mean what are there some
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resources available that you could kind
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of lean on to kind of help through this
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process yeah thank you for asking this
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so I think one common resource I
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mentioned is the crisis text line
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741741 you can text home to that number
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and when you do that a trained worker
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will reach out to you and you can
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discuss next steps and help with
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establish safety when really in crisis
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uh there's also the National Alliance on
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Mental Illness which has a greater
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Cleveland chapter Nami Greater Cleveland
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and their website has lots of resources
00:16:24
information you can chat on the website
00:16:26
or there's a help line to call as well
00:16:27
for more help and information
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information and then our our own uh one
00:16:32
of the child psychiatrists in our
00:16:33
section at Cleveland Clinic Dr tatana
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Falone recently wrote a book called a
00:16:38
parent guide to prevent suicide in your
00:16:40
loved one which has really practical and
00:16:43
actionable advice from an expert in the
00:16:45
field uh and you can find that on Amazon
00:16:48
those are great tips as far as resources
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people can can lean on Dr Khan um and
00:16:53
and gosh we've covered so much here
00:16:55
today um so is there anything else that
00:16:58
that we missed or or they you like to
00:17:00
add regarding children self Haring and
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and what you can do uh to help them yeah
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so I think I would say that self harm is
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primarily a way to cope with intense
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emotions when all else fails and
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typically self harm peaks in early
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adolescence so that 12 13 years old and
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then Trails off as kids get older so
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research shows a really large safety
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factor for a child is whether they have
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one trusted caring adult in their lives
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so try your best to be that person that
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they can turn to because our job as
00:17:34
parents and caregivers is to help kids
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learn healthy adaptive ways to cope with
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stress as they grow and if we can model
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caring conversation and strengthen our
00:17:44
relationships along the way our children
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will be better for it and that's
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fabulous advice so what what what a
00:17:50
perfect way to end so uh thank you very
00:17:53
much for spending some time with us
00:17:55
today and and sharing this really really
00:17:58
important information
00:17:59
yeah thanks so much for having me on
00:18:00
here this is a great
00:18:04
discussion signs of self harm and
00:18:06
children should not be ignored consider
00:18:09
the actions a silent shout for help talk
00:18:11
to your kid if you see signs of
00:18:13
self-injury get them evaluated by a
00:18:15
healthc care professional these aren't
00:18:17
easy discussions or steps to take but
00:18:19
they're necessary if you liked what you
00:18:21
heard today please hit the Subscribe
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button and leave a comment to share your
00:18:25
thoughts till next time be well
00:18:35
[Music]
