Self-harm tends to be associated with cliched images of maudlin teenagers in darkened rooms. But primary school pupils also self-harm, according to recent research carried out by a child psychotherapist.
Linda Bean, who works for child and adolescent mental health services in north-east London, conducted detailed case studies of five children aged between seven and 11, all of whom self-harm.
Their methods ranged from cutting themselves with sharp objects to scratching or punching themselves and hitting parts of their bodies against a wall. Others were reckless with their health, failing to take prescribed medication or making themselves vomit. These methods are similar to those used by teenagers and adults. But unlike older self-harmers, young children often self-harm in public.
Ms Bean said: "I believe this underlines its function as a communication to us. However, the children were ambivalent ... They (also) wanted to keep it secret in order to protect themselves from being let down and having the shame of others knowing they are needy."
She found that the children shared an inability to manage their emotions and often felt overwhelmed by them. They saw emotions as treacherous, leading them into situations they had no confidence to cope with. Danielle described herself as modeling clay, rolled thinner and thinner until it broke apart.
The children found discussion of negative feelings particularly threatening, fearing what might happen if they expressed their emotions. Ania said she might "become an alien or a monster" who could "really hurt someone".
Others feared they would never be able to stem the flow of emotions that resulted. Bill worried that, if he ever began to cry, his tears "would fill up all the oceans of the world". Eugene said: "They (emotions) are like a grain of sand, but when I talk about it they get bigger and bigger."
All the children had also witnessed their parents or carers losing control and hurting themselves or other people. "Crucially, they learnt that unrestrained feelings could be catastrophic, both to themselves and to others," said Ms Bean. "This in turn fed their unhelpful belief that feelings can be dangerous."
Self-harm, Ms Bean believes, cuts off these feelings before they overwhelm the child. It is a way of anticipating anxiety, stopping it short and keeping it contained.
Eugene said of his sad feelings: "They are outside me. I don't want them unless they become happy."
Instead, the children channelled their emotions into their bodies. For example, while talking to a school counsellor, Ania jumped up and hit her leg hard against the radiator. But she was unable to link the discussion and her actions. Instead, she explained that she had "feelings in my tummy", and that hurting her leg made them better.
Ms Bean said: "Like Ania, all the children found it hard to pause and think before acting, which is a prerequisite for successful mood and behaviour control."
Also, because of bad experiences at home, they had not developed a habit of seeking adult help, relying instead on a repertoire of avoidance, repression and denial. Self-harm became a coping mechanism.
Primary children who self-harm are unlikely to trust adults. Teachers who suspect that a pupil is self-harming should therefore be careful to avoid expressing shock and horror as this merely reinforces negative expectations.
"While self-harming behaviour is alarming for adults, from the child's point of view it is just the tip of the iceberg," said Ms Bean. "What lies out of sight, in the private world of the family, is much more lonely, terrifying and dangerous."
- Linda Bean's research appears in the latest edition of 'Counselling Children and Young People': www.ccyp.co.uk
WHAT YOU CAN DO
- Recognise that children may use existing injuries to mask self-harm;
- Understand that it is intention, rather than the level of violence, that marks out behaviour as self-harm;
- Remember that children who self-harm are unlikely to trust adults and expect to be let down;
- Respond calmly to a disclosure of self-harm;
- Look at the child's wider experiences and difficulties rather than focusing on the self-harming;
- Help children to make connections between events and their emotions;
- Help children to label emotions;
- Understand that pupils may be ambivalent about self-harming and may worry about their neediness being exposed.