Mumbai: Mental health experts decode why kids hurt themselves

Aug 06, 2017, 08:53 IST | Kusumita Das

With the suicide case of a 14-year-old possibly prompted by an online challenge, mental health experts weigh in on what is fuelling growing self-harm among teenagers

Seventeen-year-old Aditi (name changed) doesn't look like she needs help. A class topper at a reputed IB school, she's attractive and comes from a privileged home. Among her list of challenges is growing up in the shadow of her elder sister, mundane conflicts with close friends and confusion regarding her sexuality, which according to psychiatrists, is most commonly experienced by adolescents.

The first time Aditi cut herself was during an 'experiment'. She and a good friend were talking about self-harm, and decided to give it a try. Since then, it became compulsive. By the time she reached out for help, she had 30 scars. She ensured she cut herself on the upper thighs so that the scars would remain hidden. Psychiatric diagnosis revealed that she was under extreme emotional duress and wanted to relieve herself from that pain. In fact, it was she who reached out to her mother, saying she needed counselling.

Aditi is a rare adolescent who reaches out for help. While the death of a 14-year-old from Andheri who killed himself over what some say was an anynoymous Internet challenge, has stirred up conversation on adolescent tendencies of self-harm, psychiatrists and psychotherapists in the city maintain that this behaviour has been common for a few years.

"It's more common amongst girls. In my 18 years of practice, I am yet to see a boy who indulged in non-suicidal self-harm. The common prompters are family stress, internal personality conflict, conflicts of identity and underlying depression. It's important that this is not understood as attention-seeking behaviour. It is a cry for help," says Dr Zirak Marker, child psychiatrist and medical director of Mpower, a mental health centre for youth. "The clinical term for such action is non-suicidal self-harm, where the person has no intention of killing himself. A higher percentage of kids that come to me have no history of trauma, bullying or parental pressure. There's, however, peer pressure. You try it once and you get hooked. Social media also plays a role. There are closed groups, online and offline, where conversations unfold. There are websites that tell you how to cut, where to cut, how to sterilise your blade, what sharp objects to use that won't leave scars, and exactly which part to cut at," he says.

The signs of self-harm are not always subdued. In 18-year-old Pratiksha's (name changed) case, there were signs of volatile behaviour, in the form of substance abuse, ugly fights with her parents, multiple sexual encounters, and a sharp academic decline. Unlike Aditi, Pratiksha kept her cuts visible, on her forearm, wrists and legs. Her parents took her to a counsellor and she has been under therapy for two years, without much improvement. In psychiatric parlance, she's a case of borderline personality disorder.

Fifty shades of self-harm
The age at which such tendencies begin to surface is 14, and continue into the early 20s, according to psychiatrists. The reasons are manifold. Sometimes, it is punitive, when they feel they are not good enough. It's also a way to numb the emotional pain with physical pain. Psychiatrist and psychotherapist Dr Sagar Mundada underlines two kinds of self-harm: impulsive and planned. "Impulsive self harm happens when you don't know how to tackle your emotions and you reach for a sharp object and cut yourself. Planned self-harm is common in cases of adolescent depression." The personality type to inflict self-harm can be broadly categorised into three kinds, Mundada says. "There are those who indulge in substance abuse, and therefore cut themselves to drown the pain of craving. So, we treat the addiction. For the psychotic kinds, medication is prescribed. For those with borderline personality disorder, we use the Dialectical Behavioral Therapy (DBT) where we try to identify the triggers for self harm and change their behaviour."

What guardians can do
"Talk, talk and talk to your children," says Dr Marker.

"Be hands-on in the sense that you establish a rapport with them, so that they come to you first [with any problem]. This is the only way, old-fashioned and most reliable. There are no short-cuts to this. More often than not the signs are not visible.

The child seems perfectly normal to the outsider. Vigilance is also required on the part of parents. They should quit thinking that this cannot happen to their child.

Everyone goes through distress, the point is to find healthier coping mechanisms," he adds.

Fortis Hospital has initiated a helpline as an extension of their school mental health programme. The helpline is centred in Delhi, but functions pan-India. Dr Samir Parikh, director, department of mental health and behavioral sciences, Fortis Healthcare, says, "Around 10 per cent of the calls we receive are self-harm related. It's a faulty coping mechanism for individuals. They think this is the only language to fight their distress. Game addiction is very common, and aggression is a first symptom to be displayed. There is evidence that when a young mind gets hooked to a certain interactive format, they tend to get influenced by it. Very few would actually go ahead and self-harm while under the influence of a game or a challenge. What needs to be discussed is how did we reach a stage where a challenge like Blue Whale could even surface? Why are we not better preparing our kids to handle emotional distress? I think the answer also lies in media literacy. Children must learn to filter media messages, question what they see and prevent faulty interpretations."

What's web got to do with it
Blue Whale and other deviant challenges find preys in the anonymous world of the Internet. They cash in on the anonymity of the medium to exploit targets. One way of doing this is through encrypted chat rooms hosted on a TOR network, or The Onion Router. It's a programme that allows anonymous communication using encrypted relays located all over the world. This makes it extremely hard to trace the communication. One can locate these chat rooms using a TOR browser, which people with borderline psychopathic fetish frequent and spread the news about the challenge through "word of mouth". The knowledge about such chat-rooms and getting entry into one is difficult. One needs to know someone, an insider, who has to vouch for you. Once your credibility is established, it becomes easier to navigate through the deep web world, and partake in its activities.

Self-harm behaviour

  • Wearing trousers and long-sleeved shirts, even when it's hot
  • Brushing off injuries as a result of being clumsy
  • Needing to spend a lot of time alone
  • Challenges with friendships and romantic relationships
  • Keeping sharp objects close at hand
  • Withdrawing from once-enjoyed activities

Different ways in which kids self-harm

  • Cutting, scratching or pinching skin such that marks remain or bleeding occurs
  • Burning the skin with objects such as cigarette butts, hot water
  • Self-medicating or overdosing
  • Carving on the skin
  • Tearing the skin
  • Not letting wounds heal
  • Pulling put hair

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