A couple of months ago, we posted a piece on attention-seeking self-injury that seemed to inspire parents across the nation to email us with questions.
One parent in particular struck us as the kind of parent we see a lot in treatment: concerned, caring, and genuinely looking for the best way to help her daughter.
Linda requested a follow-up piece on what families can do when they determine that their son or daughter is engaging in self-harm for attention.
Linda, this is for you, and for all the other parents out there who don’t know whether they should take their families to therapy when they come across this kind of problem.
Normal adolescent development. Nowadays, most therapists would probably classify adolescence as the years between ages 12 and 26. During this time, in a relatively normal rearing environment, kids should be focused on developing their identities.
Ideally, most teens have reached this stage having developed what we call basic trust (a sense that the world is relatively safe), autonomy (a sense of “I can” that develops around age 2), initiative (the motivation to take action without prompting), and industry (a sense of satisfaction in “work” usually achieved through academic tasks).
Erik Erikson identified these “psychosocial stages of development” as the ones that should happen before a kid hits adolescence, implying that in order to form a solid identity, a kid needs to feel basically safe, autonomous, motivated, and able to work. With these in place, normal identity formation can begin.
Identity development. Before adolescence, because we’re too young to comprehend the idea that individuals are unique snowflakes and each of us needs to discover our true selves, we automatically adopt the identities our parents give us.
At 12-ish, we become more sophisticated in our thinking and are able to take in abstract concepts like individuality, selfhood, and best (or worst) of all, parental fallibility.
Our parents fall off the pedestal. Our peers become more important now that we realize our parents won’t be around as long as they will.
It begins to sink in that we’re going to have to support ourselves one day, and we “rehearse” what an adult version of ourselves might look like.
We stand out from the crowd. We conform to the crowd. We try to strike some balance in between. We fight against our parents by insisting on adulthood, and we fight against the demands of the world by insisting on childhood.
The truth of our growing up is sobering. We are confused, upset, frightened, and angry.
It becomes less frequent that our parents spot the excited child inside us that may not emerge again for several years.
Additional stressors. Perhaps as some kind of cruel joke, nature decided that we should form our identities right around the time our bodies and brains are going through intense growth spurts.
Thanks, nature! As if we don’t have enough to deal with already!
Puberty hits most of us around age 12 or so, and our bodies start becoming unrecognizable. (I tell my teens that it’s like drinking the polyjuice potion in Harry Potter.) Our hormones are going nuts, our moods are out of whack, and embarrassing urges sometimes get the best of us.
Add to that the normal adolescent brain growth spurt, and you have an increase in risk-taking behaviors, an apparent loss of long-term planning, and a deepening realization of mortality and the pointlessness of life.
Now try to pay attention in class and be a socially responsible individual. Ha! May I remind you that this is the second time in your life that you need to be sleeping for an average of 10 hours per night (the first time was infancy), but you need to finish your homework and be up by 6:00 to catch the bus?
May the force be with you, young Jedi.
Parental assistance. In healthy families, parents take on a different role at this time.
They recognize that their kids no longer need them as much for making decisions, completing tasks, or thinking through a problem. They step off a little, and instead hang out in the background to admire from a distance.
A different kind of help is needed now. At this point, teens need to know that what they’re feeling is normal, and that it gets better. They need reassurance that life isn’t pointless, and that these ups and downs are part of growing up. They need you to stand still so that they can push against you—without this dynamic, they’ll have difficulty forming their own identity separate from yours.
Instead of demanding to speak with the other kid’s parent, now you say, “I know. It totally sucks, doesn’t it?”
You’re there during the break-up with comfort and some ice cream. You’re around when they embarrass themselves with a hug and a movie.
You recognize that most questions are rhetorical. “What’s the point?” “Why should I even try?”
You nod and say, “Yeah. This part is really hard. Let me know if you want to shoot some hoops.”
Parental authority. But you don’t hand over the reins. This is still your house, and you are still in charge. When she sneaks out at night, you still ground her. When he speaks disrespectfully, you still scold him.
And if you see that something absurd or harmful is being done simply to seek attention, you do what you’ve always done: Either tell them to knock it off or ignore it completely.
These same rules apply for attention-seeking self-harm.
It’s tough, because this particular behavior involves blood and injury, and reminds you a little too much of suicide. Check to make sure it’s not—ask a therapist if you need to—then pull yourself together enough to handle it exactly the same way you would handle anything else.
Promiscuous clothing? Send her upstairs to change. Overdramatic tattoos and piercings? Ignore it. Provocative posts on social networking sites? Impose time limits and threaten to disable the account. (Follow through with the threat if you need to!)
Attention-seeking self-harm? Say, “If you have something to say, use your words.” Or say, “This is not how we get one another’s attention. Think of something less obnoxious, please.”
And be unapologetic. This is not how we get attention.
Therapy? Everything I’ve written above is easier said than done, I know. Self-injury is scary, and most parents don’t want to take the chance that they’ve misdiagnosed their kid.
If you’re not sure, it’s probably worth it to go see a therapist. A good one will be able to determine rather immediately which kind of self-injury this is, and if it is indeed attention-seeking, he or she will probably send you home with some reassurance that you are the parent and it’s okay to assert your authority here.
If you need some “booster” sessions just to make sure you’re responding appropriately, there’s no harm or shame there.
My advice to Linda and all the other parents out there: Don’t be afraid to be the parent.
You have a responsibility to give your son or daughter the best chance of success you possibly can, and that means instilling in them socially appropriate behaviors.
Society tends to look down on attention-seeking behavior because it’s associated with immaturity, selfishness, and arrogance.
Attention-seekers, all grown up, don’t do very well. Peer groups reject them, teachers can’t stand them, and employers don’t hire them.
Don’t let that happen to your teen. Instill in them the values of direct communication, respect for others, and humility. And if you need some therapeutic assistance with this tall order, we’re happy to help.
If a therapist determines that your son or daughter is engaging in the more serious rage-based self-injury, request family counseling, and get ready to address some deeper issues that could be at the root.