A little over 10 years ago a clinical psychologist working for a Youth Specialty Service said to me, “You know what? It feels like every person I see deliberately hurts themselves.”

This surprised me – after all, we’re extremely well adapted to avoid pain, so surely causing it deliberately really goes against our wiring.

In fact, self-injury has always been with us. You can find accounts in historical texts as far back as people have been writing things down. It’s also the case that we’ve consigned self-injury to the realms of pathology – for a long time we only looked for it among people with a psychiatric diagnosis, or in prison, or with neurodevelopmental challenges. For example, a 2005 study reported that 48 percent of Auckland adolescent mental health ‘clients’ had hurt themselves deliberately, even though that may not have been the reason for referral.

No surprise there, right? After all, bad stuff tends to go together – if you’re depressed, you’re also more likely to be anxious. If you’re being bullied, you tend to report poorer self-esteem. All of these tend to go together to some extent, so it doesn’t help us to understand what causes what.

So, along with a growing bunch of colleagues and students, I’ve spent the last 10 years trying to learn a bit more. Early on, we found that self-injury isn’t confined to therapy rooms or prison cells. Forty-nine percent of more than 1200 16- to 18-year-old Wellingtonians told us they had deliberately hurt themselves at least once, without suicidal intent.

The best way to respond to these statistics, and to someone who hurts themselves, is “respectful curiosity”, say the experts. Which is not the same as freaking out and assuming the worst.

We should be concerned because self-injury comes with costs and consequences. But we know rates of things like suicidal thinking, or even diagnoses like depression and anxiety disorders, aren’t anywhere near as common as self-injury, so it’s not the case that a history of self-harm is an automatic sentence. The best way to respond to these statistics, and to someone who hurts themselves, is “respectful curiosity”, say the experts. Which is not the same as freaking out and assuming the worst.

For the last five years, we’ve been following a group of around 1000 young people aged 13-and-up as they move through secondary school, to try and get a handle on how self-harm fits into the good and bad things that happen in their lives, to find the developmental pathway to self-harm. About a third of them have told us they’ve done so, and three quarters of those young people have done so chronically.

Why do people hurt themselves? Like many things we do, self-injury can serve a variety of functions. Chief among them is to help manage one’s emotional experience. Maybe you’ve got a poorer grade than you wanted, or you’ve had a fight with someone – these generate powerful emotions. If you’re not well-equipped to deal with these, then hurting yourself can paradoxically help you avoid those feelings. And whatever caused them. The important take-home here is that hurting yourself isn’t ‘crazy’ – it makes sense, but there are other things that work better and with fewer strings attached.

These things, and self-harm, are the tools in our emotional toolkit. From following our 13-year-old participants we can see young people with fewer tools are more likely to hurt themselves as 14-year-olds, but it also shows that 13-year-olds who hurt themselves develop fewer tools. Perhaps because self-harm works (in spite of the downsides), or because it’s harder to ask for help when you worry what people are going to say if you tell them you’ve hurt yourself deliberately.

Our advice to adults, then, is to pay attention to the young people in your lives. If you think they’re more withdrawn than three months ago, ask them how things are going. If they have injuries that seem out of keeping, have a word. If they start wearing clothes that don’t seem right for the weather, ask them what’s up. Don’t assume they’re hurting themselves, but remember that respectful curiosity.

Where to get help:

– Lifeline: 0800 543 354 (24/7), Youthline: 0800 376 633 (24/7), text free to 234 (8am-midnight) or live chat (7pm-11pm)

– Kidsline: 0800 54 37 54 (24/7; Kidsline Buddies available 4pm-9pm)

– Suicide Crisis Helpline: 0508 TAUTOKO / 0508 828 865 (24/7)

– What’s Up: 0800 WHATSUP / 0800 942 8787 (1pm-10pm weekdays, 3pm-10pm weekends) or live chat (5pm-10pm)

– Healthline: 0800 611 116 (24/7)

– Samaritans: 0800 726 666 (24/7)

– Depression Helpline: 0800 111 757 or text free to 4202 (24/7)

– If you feel you or someone you know is at immediate risk, call 111.

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