Self-Injury, Black Youth, and the Perils of Cultural Stigma

Cultural stigma related to African-Americans and therapy attendance is well known. Seeing therapy attendance as a sign of weakness, believing that personal information should not be shared outside of the family, and preferring spiritual resources instead are among common reasons some African-Americans refrain from seeing mental health professionals. Additionally, a history of misdiagnosing African-Americans and a limited number of therapists of color are impediments to African-Americans entering therapy.

Discrimination, bias, and minority stress increase the mental health vulnerability for many African-Americans (USHHS Office of Minority Health, 2016), including African-American youth. As an attempt to cope with overwhelming stress or emotions, some African-American youth engage in self-injurious behavior, such as cutting. As defined by the International Society for the Study of Self-Injury (ISSS, 2016), self-injury is “the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned.” Parents often feel at a loss for understanding these behaviors or accessing appropriate services for them.

According to information from ISSS, 12% to 24% of young people engage in self-injury; however, much of the attention related to cutting focuses on the experiences of white youth, while only a small amount of research on self-injury explores the experiences of ethnic minority youth (Gratz, Latzman, Young, et al., 2012). Consequently, cutting may seem like something done only by white youth. In fact, many of the African-American parents I see in my practice express surprise at their child’s self-injurious behavior, believing cutting was not something in which black youth engaged.

Viewing cutting and other acts of self-injury (hitting, burning, scratching, biting) as a “white thing” is problematic for a number of reasons. First, African-American parents may be in denial of the seriousness of their child’s emotional well-being and thus delay seeking treatment for their child. Second, African-American parents may feel embarrassed about their child’s behavior, seeing their cutting as a reflection of their parenting, which can also promote delayed entry into mental health services. Third, African-American youth are faced with consolidating their identity, including integration of their racial/ethnic identity. A challenge faced by some African-American youth is being accused of “acting white” or “not being black enough.” Viewing cutting as a white issue adds unnecessary challenge to the already stressful process of ethnic identity development.

The idea of strength within the African-American community has been effective in persevering through historical and present-day hardships. However, the idea of perpetual strength provides little space for African-American youth to express the distress they feel; hence cutting becomes a viable option.

Unknowingly, African-American parents can also promote stereotypes that get in the way of getting effective help for their children. Comments such as, “You are better than this” and “You don’t have any reason to do this” are meant to motivate changed behavior in their child. However, such comments unintentionally communicate the expectations that African-American youth should be stronger and that negative internal or external stressors should not affect them. The idea of strength within the African-American community has been effective in persevering through historical and present-day hardships. However, the idea of perpetual strength provides little space for African-American youth to express the distress they feel; hence cutting becomes a viable option.

Punishing youth for their self-injurious behavior can also backfire. Again, well-intended parents may use punishment as a means for curbing cutting behavior. But punishment also runs the risk of their child becoming better skilled in hiding their self-injury. If parents are aware of cutting, they can talk with their child about it and seek solutions. However, if an adolescent or teen becomes skillful in hiding their cutting, precious time is lost in addressing the real needs of their child. Furthermore, the child is likely cutting because they feel bad; punishing them or inducing guilt or shame is likely to only make them feel worse.

Fortunately, there is a growing push to end cultural stigma associated with mental health services, making counseling services more accessible to African-American families. Research is better extending to the specific needs of African-American youth. In fact, one study in the United Kingdom found that young black females were more likely to engage in self-injurious behavior than other groups (Cooper, Murphy, Webb, et al., 2010).

To support African-American youth engaging in cutting:

• Accept that African-American youth engage in self-injurious behavior. Cutting is not a “white issue,” but rather a very real concern within the black community. Moving from denial and shock to a place of acceptance regarding cutting can aid in finding the best resources for your child.
• Look for warning signs. This includes marks on wrists, arms, legs, the abdomen, or other areas of the body. This also includes changes in behavior such as wearing long sleeves in warm weather, isolation, and poorer functioning at home, school, or with peers.
• Address the issue. Talk directly to your child about your observations and concerns. Talking will not encourage the behavior, and it is faulty to think your child will just “grow out of it.” Addressing the issue can help your child express stressors they are experiencing. Avoid shaming, yelling, blaming, or punishing the behavior, which can result in secrecy or continued self-injury.
• Seek treatment. African-American youth face numerous stressors that can lead to the development of self-injury. Among others, stressors include bullying, racial harassment, depression, anxiety, discrimination, and vicarious trauma. Mental health treatment can facilitate the development of safer strategies for handling emotions, as well as targeting systemic issues that impede on your child’s mental well-being.

References:

1. Cooper, J., Murphy, E., Webb, R., Hawton, K., Bergen, H., Waters, K., & Kapur, N. (2010). Ethnic differences in self-harm, rates, characteristics and service provision: three-city cohort study. British Journal of Psychiatry, 197, 212-218.
2. Gratz, K. L., Latzman, R. D., Young, J., Heiden, L. J., Damon, J., Hight, T., & Tull, M. T. (2012). Deliberate self-harm among underserved adolescents: The moderating roles of gender, race, and school-level and association with borderline personality features. Personality Disorders: Theory, Research, and Treatment, 3(1), 39-54. doi:10.1037/a0022107
3. International Society for the Study of Self-Injury (ISSS, 2016). Fast facts. Retrieved from http://itriples.org/redesadmin15/fast-facts/
4. U.S. Department of Health and Human Services Office of Minority Mental Health. (2016). Mental health and African Americans. Retrieved from http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=24

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