Teenagers self-harm because it is a physical representation of the emotional distress they are in.
Psychotherapist and counsellor Liz Quish also says none of the teenagers she has worked with who have self-harmed has ever gone to the emergency department of a hospital.
She says the problem “is much bigger than people realise. I have had 130 teenagers [as clients] and not one of them has gone to A&E”.
She says the only time a teenager who has self-harmed would go to hospital is if they had cut themselves very deeply and might need stitches.
Many do not cut so deeply that medical help is needed; instead they use plasters, antiseptic wipes and Sudocrem.
The injuries "represent their emotional distress and the cutting, the scars, the burning, show the pain on a physical level. It needs professional intervention, because the severity of it can increase.
“It is a coping mechanism but it is a flawed coping mechanism and you need to introduce more nurturing coping mechanisms. If self-harm is not addressed – and early intervention is the key here – it is very, very hard to break the cycle of it.”
It is a secretive act and can be going on for months, even years, before an adult is aware of it.
The triggers vary from teenager to teenager, and Quish says her experience is that it can be due to “struggling with sexual identity and all the anxiety around that: Am I gay? Am I lesbian? I’m not sure. What will my parents and friends think? And all that dilemma is playing out in their head.”
The role of social media in bullying is also a major factor. "When I was in school, bullying stayed in school and when you went home you were safe. Now social media is constant and adolescents are being bullied in their bedrooms," she says.
Another major trigger is exam-related pressure from parents who want their children to go to college even though “college is not for everybody”.
Whatever the trigger may be, Quish is clear in her belief that unless the problem is addressed “without a doubt we will end up with more teenagers taking their own lives”.
In her book, Overcoming Self-Harm and Suicidal Thoughts, Quish takes a holistic approach in offering practical advice for parents, teachers, youth workers and others working with vulnerable teenagers who self-harm and have suicidal thoughts.
She describes the self-defeatist syndrome where teenagers are anxious, scared, tired, overwhelmed, angry and isolated and have a very negative view of themselves and their abilities along with a great sense of hopelessness and inadequacy.
She addresses nutrition and alternative therapies and says this holistic approach is because “none of us is one-dimensional”.
“All research is there to show the talk therapy works but people need self-help skills beyond the talk therapy,” she says.
The book is also intended to advise parents who discover their child is self-harming and Quish emphasises the importance of professional help.
“The teenager will say ‘I will stop’ but generally if they have been self-harming for a while they are not able to stop because they haven’t any other coping mechanism, and until we get to the root of what is causing the distress, self-harming will continue.”
Figures supplied by Temple Street Children’s University Hospital show that of the 12,688 children and adolescents aged under 16 years who attended in the first three month of this year, 70 had a suicidal intent/self-harm diagnosis.
A total of 47 were girls, there were 23 boys and most were aged between 14 and 16.
This compares with 63, made up of 45 girls and 18 boys, during the final three months of last year. Again the highest number of patients were between 14 and 16 years of age. In that quarter, 12,027 children and adolescents attended the ED.
The higher rate among girls is also found in the National Registry of Deliberate Self- Harm report for 2013. It has access to data from the acute hospitals in the country.
It found there was a striking pattern in the incidence of self-harm when examined by age. The rate was highest among the young. At 619 per 100,000, the peak rate for women was among 15 to 19-year-olds. This rate implies that one in every 162 girls in this age group presented to hospital in 2013 as a consequence of self-harm. The peak rate for men was 510 per 100,000 among 20-24.
Gender differences in the incidence of self-harm varied with age. The female rate was three times greater than the male rate in 10 to 14-year-olds and 79 per cent higher than the male rate in 15 to 19-year-olds. The female rate of self-harm was again higher than the male rate across the 45 to 59 year age range.
However, in 25 to 34-year-olds, the male rate was 23 per cent higher than the female rate.
Since 2009, the registry has recorded a significantly higher rate of self-harm in men in this age group compared with women.