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Episode 11914th September 2023 • How Not to Screw Up Your Kids • Dr Maryhan
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1 in 5 children aged between 10-18 years is self-harming and the numbers being admitted into hospital is rising - particularly in younger children. As parents what do we need to know about self-harm? What causes it and how we can help our children and teens if they self-harm?

Here are the highlights:

(1:15) What is self-harm?

(3:30) What are the signs to look out for?

(6:30) 1 in 5 children is initially self-harming

(7:55) Why do children and teens self-harm?

(13:20) What to do in the immediate and short-term

(21:00) Medium-term action points

(24:20) Look at the fundamental roots of why they have self-harmed

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Hello, and welcome to the how not to screw up your kids podcast. So pour yourself a cuppa, find a comfy seat and enjoy the conversation. This is episode 119. And today's episode self harm is a more difficult conversation to have. But I thought it was really important. We've had some listener questions that have come through. And I think it's a subject matter that but certainly not touched on before, and is quite a crucial one and one that is sort of happening much more often. So I'm going to talk you through it. There's a lot to digest in this podcast, we're going to cover a lot of ground what it is the signs, how many children does it affect? Why do they do it? How can we help if you suspect that your child is self harming, or you've got concerns, then what you might want to do is just sort of work through this in piecemeal, maybe listen to the whole episode, and then come back to it for certain bits that might be particularly helpful. I hope that you do find this really helpful. But it is a difficult subject. So I think let's dive in. So I want to start initially with what is self harm, we've probably all heard it, it may well be something that you're aware of yourself, because maybe it's something that you've done when you were younger, maybe your child is maybe you're aware it's happening in your child's school, or maybe you are completely and utterly oblivious to it, but you've heard it. So in in essence, self harm is some form of intentional damage, or heart, you know, hurt to their body. So it's about children injuring themselves. Now, we typically think of it as cutting, but it can also mean you can also be hitting, burning, scratching, bruising, head banging, hair pulling, is doing things that harm your body in some way. Now, if your child self harms or your teen self harms, it does not automatically mean that they are having suicidal thoughts. But it is a serious pattern of behaviour. And so it should be treated as such, with professional help sought when needed. And we'll talk about that as we move on. Now, some might say that self harm is attention seeking or a child is being overly dramatic. Now, my view is even if we accept that even if we say this is a child that or a teen that's being overly dramatic about a particular challenge that they're facing, or they're just attention seeking a less compassionate view personally. But if we look at it in that perspective, it still says it still tells us something about how that child or how that teen is experiencing life and a glimmer into their inner world. And so we shouldn't be dismissing it, we shouldn't be viewing it in that light, but actually seeing it as an opportunity to connect, you know, children's behaviour gives us a window to that in a world. And that needs some form of support and attention and unpicking so I don't think is a particularly compassionate way of viewing it. And my view is that we still need to look at it in that way. Because children should have children and teens should be enjoying life, they should be enjoying their friendships, their outside interests, and resorting to particular measures to get attention means that we need to, we need to act in some way. So that's in essence, what self harm is, what are some of the signs that as parents we should be looking out for. Now, the important thing to remember here is that children who self harm will often do whatever they can to hide it. So we just need to be vigilant to changes in their body, and also changes in their behaviour. These are just some of them, but just just be aware of what that might look like. So you know, some of the obvious things will be unexplainable cuts, wounds or scars. So things that we notice on their body that we can't really explain, you know that our child or teen can't really explain where they are it there might be multiple wounds in the same place in your child's body. Now quite often, when we think about self harm in the form of cutting, we often think it's likely to happen to the arms, but actually what we find is it can it can occur in all sorts of places. You know, if you think about if you're trying to, if you're self harming and you're trying to avoid anyone being able to see it, you then what might happen is it might be near the top of your near at the top of the legs. So it's just being aware It's unexplainable cuts and wounds. It's multiple wounds that might happen in the same place. Maybe you notice that they're collecting or frequently carrying around with them, either lighters, or sharp tools in some ways nail clippers, safety pins, those sorts of things. Maybe you'll notice that they're wearing long sleeve shirts or long trousers or long skirts when the weather is warm, and it jars a little bit in terms of what they're wearing isn't congruent with what the weather demands. It might also be that you find


sort of tissues or clothing or bed linen that has blood on it. Now obviously the odd bit is is normal typical, we scratch off, you know, we accidentally get scratched or cut ourselves but it's where you're noticing more or bandages that might be hidden in the bottom of their, you know, they've got a sort of been in their bedroom or you're noticing it on their clothes, they might be spending continuous isolated time in their room. Now, obviously, that's, that's a natural part of teen behaviour, what we're looking for is a pattern, a collective pattern of a number of these, not just one, just if you've got a child or teen, where there's no other evidence, and they're spending a huge amount of time in their bedroom, that is a typical teen paying, we want to encourage them to spend time with us and not be in their bedrooms isolated for hours on end, because they just don't think it's a healthy thing for them anyway. But when you start to see that as well, you may also see that they're very withdrawn from their friends, they're not really spending time doing the things that they might typically enjoy doing. You may notice aspects of their just general mood not being the same, they might be particularly low in mood or particularly angry and fiery. So it's that though, we're looking for real Mark shifts, which we're going to be we're you know, we're aware of how our children typically are. Another sign can be that they may begin to wear a lot of jewellery, or particularly bandanas and things that are another way of rather than wearing long sweet sleeves can be an easy way of hiding scars. So those are sort of the signs we're really looking for shifts and certain signs of behaviour. So we know what it is. We know what the signs are. How many children does this affect? Well, there's lots of sort of different data. But in general, the latest data is suggesting that one in five children yet, that's one in five between the ages of 10 and 18, is intentionally self harming, and self harm hospital admissions. For children aged between eight, we're seeing a real increase in younger children, hospital admissions for children aged between eight and 17 in the UK jumped 22% in one year. And we know of course, that when we're talking about hospital admissions to a&e, it's only the tip of the iceberg because if we've seen an increase of 22%, there is a whole another level below the surface that are just never presenting to me. And so it is something that we should all be vigilant for, without obviously trying to scare the life out of you. But it is something that we need to be aware of, because we are seeing an increase. And the increase seems to be impacting the lower age groups, the other age group seems to be much more, it's still occurring. But it seems to be more static, rather than this big increase, which sits very much with our understanding and our knowledge about mental health and the increase in terms of mental health issues. And that's impacting more and more younger children. They're feeling more and more desperate in terms of what they resort to. So we know what it is, we know what signs to look out for. We know how many children it typically affects. So I guess the big question then is just why Why do children and teens self harm in the first place, and there isn't really one single clear cause, it's often a way of alleviating emotional distress. It's almost like shifting the inner pain that they experience. So the pain that they experience internally and shifting it to external pain. For others, it's a cry for help. And some teens say might say that they feel quite numb. And so actually by self harming and causing some form of self injury, it forces them to feel what we know is for whatever the reason is that your child or your teen may well be so self harming is the relief from the self harm is temporary, and it's very short lived, which is why they will typically repeat the self injury multiple times, it's being aware that in essence, a child or teen is in some form of emotional distress. And that really can for some become the mechanism for relief for others, they'll do other things. So but the underlying aspect of it that we need to be thinking about is its emotional distress. That could be bullying, it could be mental health, it could be anxiety, it could be depression, it's a mechanism that they have used. And there are other alternative mechanisms that are more healthy, more appropriate, more useful at this stage. We're not making any judgments, we're just simply trying to understand why it happens. So the next obvious thing is what should we do, and I broken this down into three areas, because there's obviously the immediate if you find if you discover that your child is self harming, or you suspect, your child or teen is self harming, there's the immediate stuff that you need to deal with. And then there's what I would call things like the short term issues and then the longer them sort of medium and longer term, things that we look we ought to be looking at doing. So it's sort of keeping that in mind. The first thing to think actually, before I go into the immediate the short and the medium and longer term is the first thing we need to remember is that resorting to self injury for your child or your teen feels like the old


Only option and is not necessarily about what is going on for your child or your teen right now, but is more likely to be a culmination of a whole host of issues, which have now built up into this big issue this big challenge. So, I want you to try and think of it in the same way as the bucket analogy I've given you before. So let me just talk you through the bucket analogy, and then I'll explain how it relates specifically to self harm. So I've talked before about this idea that we all have a bucket, and that bucket begins to fill throughout the day, the whole idea is with your children. And we often think about the bucket when our child who then has a complete and utter meltdown or a tantrum or loses their temper, or storms off or says something unkind. And what usually happens is, we think about what happened just before they had that outburst. And that's where we seek to kind of solve the problem, or we seek to kind of reprimand them for the way that we they've spoken to us. My view, and this is just my view, is that self harm is a similar sort of perspective. So maybe you've got a child who's not feeling particularly confident, they've never been massively confident. And then maybe over a period of time. So this isn't sort of happening in days, this is like over and over and over, maybe they have challenges in their self confidence around friendships, maybe when they were at primary school, they've now moved on to a secondary school. And it sort of seemed to be okay at the beginning. But those sort of friendship issues have continued. And now let's compound that with, they're moving into examination years, and they're noticing that they're not doing as well academically as their friends. And maybe they started noticing that there's parties that are happening, or maybe there's lots of talk about boyfriends, and then now their bucket is filling and filling and filling. So what then happens is, let's say is we discover that our child or our team has been self harming. And we think about it in relation to a conversation, maybe we had to them about had with them about them not being invited to a party, or us putting our foot down about them not going to a party, because they've not been studying enough, our focus then becomes on the party and then not studying, whereas actually, this issue has been building up for a period of time could be a year could be three years, four years, five years. So what we need to do, what we just need to bear in mind when we start looking particularly at how we resolve this longer term is there's the immediate stuff that we need to deal with, because that's what we're being presented with. But if we're going to help equip them. Remember, the whole idea behind this podcast is how can we raise resilient adults, we're working with the end in mind, we can't just fix the immediate thing, and then go, phew, thank goodness, we don't need to worry about that anymore, we have to get to the root cause we have to deal with the fundamental aspects of what's been filling that bucket because it will fill again, it's an underlying lack of confidence, as you know, difficulties in terms of self belief, or resilience to be able to see themselves as a wonderful human being that doesn't necessarily need to be part of the popular group, I just want you to think about that within this context. And what we're doing is as we start dealing with the immediate things that will drain the top of the bucket, but it won't empty it. It's the short term and the medium and the longer term that will help them empty that bucket more regularly, and then ensure that it doesn't when it does fill up, they're able to resort to different strategies, rather than the self harm. So I hope that one, that's a helpful way of framing it. So what do we do in the immediate? Well, in the immediate, we need to have the conversation and we need to be prepared for that conversation to be fiery for there to be a lot of emotions, a lot of anger, and potentially a child who refuses to admit refuses to engage, won't have that conversation. It's about returning back to it. And have you really tried to have that conversation. Now I'm concerned, I feel that there, you might be hurting yourself. And I just want to understand I want I'm here to help. We're having that conversation, where we're seeking to understand, and we're not seeking to judge and I'm telling you that it can feel really difficult. Of course, we want to say to our child or our team, that that's not an appropriate way to behave that that's not helpful. And do they not know what damage they're doing to themselves? Of course, we want to do that because we want to protect this precious bundle. But we have to kind of park that and really sort of engage in that conversation from the perspective of I don't really understand, I want to understand, help me understand I want to be here as a support. I'm not judging what you're doing. You're clearly having an extremely difficult time. And I've not realised that to help me understand. So it's really approaching it on that perspective and not being afraid to have those conversations. If you hear that there's been self harm in your child's year group. And it does tend to you know, certainly from my observation, if it if it happens in a particular year group, it tends to quite often have a bit of a ripple effect. So don't be afraid to have that conversation. We often sort of have this misconception around anything, whether that's mental health, whether it's self harm, whether it's around alcohol, drugs, sex, that if


We have that conversation in some way we're promoting it, or that our children are much more likely to then resort to that, it's the exact opposite. Our children will be thinking all of those things. And if we don't have those conversations, they then don't get that informed information from us. So have that conversation, come back to it multiple times, if they're going to refuse to be honest, or refuse to talk or they get angry, they need to know that you love them, you're worried about them, you're there for them, you're seeking to understand and you're not making a judgement. So have that conversation. And part of the conversation that you're going to have with them as well, is just general hygiene around any cuts and scratches that they might have. So they can avoid infections. So it's a route at this stage, we're not saying you got to stop doing this, it's really about well, if this is what you're doing, then there's these are some important considerations about how we make sure that those cuts and those scratches remain clean, so we can avoid infection. And you may well even have that conversation around your child, or your teen speaking to you about ways that they can let you know when they have self harmed. So that's some of the immediate stuff. The other things that you want to be thinking about is ways of making your home safer by removing some sharp, sharp objects. But I would, what I would say within this context is it's not about you know, going through your child's room, and then just like getting rid of everything, you want to have a conversation with them about how you can help. Self harm happens in the spur of a moment in terms of when there's that emotion, those that bucket overflows. And so if you remove things that your child may have typically use, they may resort to other things that may be more more dangerous. So you're having that conversation around, this is what you're doing. This is how you're feeling. I'm here to help help you, what are the things that we could do so that when those feelings come back in in those moments, you are less likely to resort to those things. And we're going to talk about some of the alternatives that you can have conversations. But this is a problem solving. This is a collaborative conversation. This is not on your parent, I'm stepping in, you're hurting yourself, you're damaging yourself. This is a ridiculous thing to be doing. Not that I think any of you would say that. But you know, we don't want to go in in that authoritarian and therefore I'm taking charge and I am removing this. It's about how can we work together? How can I help you help yourself? And what are the things that we might put in place. Now, obviously, you could only have that problem solving conversation with your child or your teen, when they're in a moment of clarity. So you, you it's about finding, you know, you might not you might be in a situation where the relationship with your child, or at the moment that you try to have that conversation, they're really open, and you can have all of this conversation in one go. But you might also need to be patient and understand that you're going to have to come back to this time and time again, and have small parts of the conversation. And then another small part and another small part. Fundamentally, we're looking for a long term solution. This isn't about one big conversation and then it's over. One of the other things that you that is part of that sort of immediate and also short term is having that conversation with your child or teen about alternatives, other things that they could do in that moment, that they feel overwhelmed that they want to get that inner pain as an outward pain or that that relieving that numbness. These are literally straight lifts off the NSPCC website because obviously they have a hot they have a helpline. And these strategies I'm going to go through are not strategies that I've made up or the NSPCC have made up. These are alternative strategies that young children and teens have used themselves as alternatives. So this is just to give you some idea of conversations that you could be having and things that you could be talking about. So some have found painting, drawing or scribbling with red ink has been particularly helpful. Some have found holding an ice cube in their hands until it melts helpful. Some have found writing down feelings, those big feelings, and then ripping them up ripping the paper up afterwards. My mother always used to suggest that one with me, just generally in life is that it put that down. Others have talked about wearing an elastic band. So this could be like you know, not a hair scrunchie because that probably isn't sort of isn't going to work quite in quite the same way but in essence, either an elastic band or those hair ties that are that don't have the extra fabric. So wearing on the wrist and then snaps as you pull it and snap it just as a way of kind of relieving that urge to self harm. Others have talked about listening to music, others have punched and screamed into pillows. Others have talked to friends or family taken a shower, exercised or watch their favourite funny


Film, obviously, what we're looking at doing, and we'll talk about this in the medium term is really looking at the fundamentals of what's perpetuating and creating this need to then self harm. But these are some alternatives in that moment. So we've got the immediate things that we need to be looking at. And then we've got the short term and the medium and the longer term, if you're listening to this episode, and you don't have a child who is self harming, but you know, you have a child who is just generally has low mood, then you won't necessarily be needing to deal with the immediate issues. Although some of those alternative strategies can be just a good way of saying, you know, when our feelings are get really big, how can we deal with them. But it is helpful to look at the short and the medium term, because this is all about the root causes, what's creating this in the first place. So short term is if you've got a child who you know is self harming, or a child who is not self harming, but is low mood, and you're beginning to see them isolating withdrawn, and they're not always using the most appropriate strategies to help themselves, is seek out support for your child. Now, this could be a trusted, you know, a trusted teacher at school that they just talked to, maybe it's their former teacher, or it could be the counsellor at school, it could be your load, you know, it could be your GP, or it could be a therapist, you know, as a parent, where that support needs to be, it could be even a family member or somebody that they do you know that they have a passionate outside school interest. You will know what level your child is at and what they actively need, what they need, and have that discussion with them. All of the kind of the fundamentals is that it needs to be a relationship with someone that your child can be open and honest with. And they may be open and honest in a way that they aren't with you. It may be that you have the kind of relationship with your child that they will have that open and honest conversation with you, that is fine. But it is we must seek out support for our child. If they are self harming, we'll view it from one perspective. But our child, we need to be able to see it from a different perspective too. And sometimes, children and teens will find it much easier to have that open conversation really, sometimes not because they don't want to have that conversation with you. But they just don't want you to worry, that's one aspect. And then it's about agreeing with them in the short term, some behaviour changes that are appropriate to the to the struggle and the challenge that your child or teen is going through. So this could be it doesn't have to necessarily be. But it could be a reduction in social media use, they're being bullied online, or if there's a huge amount of comparison, and they're making a judgement of themselves against other people having a bit of a social media detox might be really helpful for them, it might not be helpful if it relates to something else that actually that social media use. And that connection with friends is really helpful to maintain. So it could be a reduction in social media use, it could be about coaching them to spend more time downstairs with a family so that you can be connected, it could be more contact points with trusted friends, it could be looking at more physical activity, it could be a reduction, certain sorts of junk food that might not be helpful for their mood. It's about taking that step back with your child and thinking about what are the things that actually goes back to that whole bucket? And that's going to be the resource to go with this episode is what are the things that actively fill your child's bucket? What are the things that are part of that build up to the challenges that are then creating this need to self harm? And so what are the things that can be due to that we can look at doing changes that then help drain that bucket and help begin to empty it. So it's it's looking at those behaviour changes appropriate for your child or teen which may well be very different to that for someone else. So it's that. And then the third thing that I would say in terms of the short term is that share what you know, with all relevant people and organisations, whether that's school, whether that's specific teachers, whether that's family, whether that's to do with people who help support you, whether you've got a nanny or childminder, whatever it might be, it's about sharing what you know, because there's your child will have multiple touchpoints. And it's really crucial that all of those people are aware of what is going on aware of what's been agreed you're doing this with the consent and with the support for your child, but it's really important that they know. So we've looked at the immediate, we've looked at the short term. Now look, let's look at the longer term. And this for me is really beginning to start working on the fundamental roots as to why this is happening. And that is potentially going to be part of something that you might do with them. It might be something you do collaboratively with school. My favourite approach is that it's something that you're doing. It's something that school is doing, but it's also something that you're getting professional support outside of the home. So this you've got this sort of lovely sort of three touch three big touch points that are looking at it and it's you know, the first one is just being there for them to talk through things and how they're fit.


Feeling in those moments you're not looking to fix, you're literally looking to be a channel to work through their inner thoughts. So it's that having that connection time, and then it's about building their confidence, it's really looking at the root causes, they're helping them see and value who they are their self esteem, their, if it's an anxiety that's caused this, if it's a low mood that's causes, it's really looking at the fundamentals of helping them with who they are. And building that confidence. And it's small steps, it goes back to this ladder, and I talk about so often, what is the root cause? What's the underlying issue that's creating this? And what are the small things that we can do at the bottom of the ladder that can start building that self esteem, building that resilience, building that courage and that bravery? If it's around anxieties, building that self belief, what are the small things that can be done, and then what can we then build on and build on and build on to then help them feel that they're then worthy, capable, those are the sort of kind of fundamental building blocks, and that will be unique for each different child, because the fundamentals of you know, we talk go back right to the beginning, in terms of what are the underlying causes that created that it will be different for different children. And it's not necessarily even about dredging up the past. But simply understanding that these things have all like a domino effect, or, you know, the old snowball effect doesn't, it starts off with a little bit, but then life happens. And the environment happens, the more layers and layers and layers are built up on this. So what we're trying to do is strip back those layers and get back to that real core self belief, self love, self confidence, and that resilience and that ability to cope. So that when the next set of challenges occur, they've got those resources within them to help. I hope that that's been a useful episode, there's a lot of information, I will wait for feedback, please do write in contact at Dr. Mary, with specific feedback to see how helpful that's been because it may well be that I need to do a couple of other spin off episodes that tackle some aspects of it, it's a big topic, I've literally downloaded a huge amount of information. And so it may well be that you just need to come back to it multiple times to kind of gleam off what you need to know. But do please, please do feedback. So the gift of this week is going to be the bucket resource, which we've shared previously. Because I just think it's such a crucial part, you can use it in multiple ways you can use it with your child, so you're trying to actually help them realise on a general day to day, what are the things that fill their bucket that then overflow it that then lead to the self harm. So you can do it in that way, if your child is already self harming, and that you've got you can have that conversation. So the emptying aspect of the bucket or alternative strategies that that they could use, you could use it in terms of a reflective aspect for you to be able to think about, okay, what are the things that might have got my child or teen to this point, so that they're that now self harming? What a cut some of the things that I might be able to reflect back on that I can then share with a professional that might be supporting my child, so you can look at it that way. Or it could just be a mechanism that you use with a child who's not self harming or who but is beginning to feel overwhelmed as a preventative piece, so that they can understand what are the things that typically happen in terms of overwhelm, so that they can begin to find mechanisms in advance that they can use that help them when they're feeling overwhelmed that that are more sort of appropriate and healthy ways of dealing with difficulties. As usual, you just head over to my free resource library,, where you'll find the link to download the bucket resource. All you need to do is pop in your email address and you'll get instant access not only to this week's resource, but all the other free resources across all the other podcast episodes. As ever, if you have enjoyed this episode, I would be so grateful if you could follow and review this podcast so that others can find us and we can spread the love. So until next time





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