Cutting, or self-harming, is intentional self-injurious behavior resulting in tissue damage, illness, and/or risk of death. Cutting is generally not done with suicidal intent, though teens who engage in self-harming behaviors are at a statistically a higher risk for suicide. Despite what your teen may report, these acts of self-mutilation do not represent typical or harmless adolescent behavior. Self-harming behavior is symptomatic of serious underlying emotional or mental health issues that should be addressed with the support of a mental-health professional.

TYPICAL FORMS OF SELF-HARM:

• Cuts or scrapes with a knife, razor blade, or any sharp object
• Scraping the skin with abrasive material, e.g. glass, fingernails, or metal
• Burning the skin with a lighter or cigarette
• Burning the skin with a chemical agent
• Breaking bones

Recent research indicates that up to 46% of teens report having engaged in self-injurious behavior. This high surge in cutting behaviors may be due in large part to recent high-profile cutting cases. The media has made much recently of cutting behaviors described by such celebrities as Princess Diana, Angelina Jolie, and Johnny Depp. Like other coping or anxiety-based behaviors, cutting can spread as a copycat phenomenon. Many teens even seek validation and encouragement for self-harming from popular blogs and websites devoted to self-mutilation.

WHY DOES MY TEEN SELF-HARM?

The paradox of pain:

For a person who has had no experience with intentional self-harm, it is a confusing and frightening phenomenon. Most of us avoid pain and seek pleasure, but the cutter seems to avoid pain by seeking pain. Self-harming typically acts as a form of emotional avoidance and escape from unwanted unpleasant emotions. It is often an attempt to drown out emotional pain by engaging in more manageable physical pain. Many teens report relaxation and emotional numbness after self-harming. Self-harming can also serve as a tool to express strong negative emotions towards others or as an attempt to elicit help or attention from others.

Warning signs:

With the exception of those individuals whose cutting has an attention-seeking dimension, most cutters attempt to hide their cutting behaviors. Parents, educators, friends, and healthcare providers can, however, be alert to signs of cutting that include:

• Wearing long sleeves or long pants or turtle necks when it is warm outside
• Cutting a thumb-loop at the end of long sleeved shirt to keep arms covered
• Suspicious scratches, burns, or bruises anywhere on body
• Band Aids or tape on extremities
• Leaving or stashing razor blades, glass shards, or other “sharps” in the bathroom, bedroom, drawers, backpack, etc.
• Attempting to hide scars, burns, or other injuries
• Dramatic or intense emotional outbursts
• Difficulty expressing emotion appropriately
• Self-directed anger

Cutting is a red flag for emotional distress:

In most cases, cutting itself is just a symptom of underlying emotional distress. It is easy for loved ones to become so distracted by the cutting itself that efforts go toward controlling the behavior instead of addressing the problems underneath. Because cutting represents both a physical danger and a deeper mental health issue, the involvement of a mental health professional is always an imperative. If cutting leads to infection or if cutting goes beyond superficial physical harm, medical attention should be sought immediately. Deep cutting may indicate that the young person dissociates during the act of self-harm; even if the intent is not suicide, this kind of cutting is extremely dangerous and can lead to permanent tissue damage or death.

Cutting can be an indicator of many mental health issues, including:

• Depression
• Anxiety
• Suicidal ideation
• Physical, sexual, or emotional abuse
• Substance abuse
• Related eating disorders
• Personality and/or relational difficulties

EFFECTIVE TREATMENT FOR SELF-HARM:

Mental-health professionals experienced with adolescent issues and self-harming behaviors favor a variety of approaches in the context of a safe therapeutic relationship and/or milieu. These approaches include:

• Cognitive Behavioral Therapies
• Dialectical Behavioral Therapy
• Pharmacotherapy

If you suspect your child of cutting or other self-harm it is vital to consult with a mental health professional. Your child’s self-harming behavior is a warning sign of an underlining mental-health problem that needs immediate professional attention.

Sources:

• Linehan, Marsha (1993) Cognitive Behavioral Treatment of Borderline Personality Disorder, The Guilford Press
• Miller, Alec (2007) Dialectical Behavioral Therapy with Suicidal Adolescents, The Guilford Press

Information compiled and edited by Jack Hinman, Psy.D.

Photo by Morgan Cain

Photo by beaniebg17

I heard about TWLOHA last year. I was alerted to it by a student of mine who struggles with self-harm.

On Facebook there are over 315,000 people who have committed to being a part of TWLOHA Day, which takes place tomorrow, Feb. 12.

Tomorrow, let’s all help raise awareness of those who choose to deal with intense emotional pain by harming themselves. Let’s all help raise awareness of the reality of depression.

I spoke with a young woman yesterday who is beginning to find hope in the trusting, loving relationships she is building in her life. For the first time in three years, she sees the possibility of living a life without thoughts of suicide.

Another young woman slipped a notecard into my box at work a few weeks ago. Inside the card read, “Dustin, I haven’t cut for six months now. Thank you for talking to me and encouraging me to do hard things.”

Tomorrow, let’s go out of our way to reach out to those who are suffering silently. Healthy relationships are the best ways to begin healing self-loathing and depression.

Photo by Jaypeg21

We were huddled around a bonfire during a heat wave in July. Julie’s mother was holding an empty bottle of painkillers in her hand. She raised the bottle and held it over the flames. I had led scores of burning ceremonies for students over the years, but I’d never had a parent spontaneously participate before. Her eyes shone with tears but her voice was strong and clear. “I’m burning this because I finally have confidence that Julie will never attempt suicide again,” she said.

Julie wore only black clothing. She lied constantly about sexual abuse and cut on her forearms weekly. She had attempted suicide by overdosing on painkillers. That had been the final straw for her parents. They’d sent her to a wilderness program and then to New Haven. Julie was diagnosed with budding borderline personality disorder traits.

Psychologists do not agree upon what causes borderline traits in teens. I prefer a systemic view – both for its description of how personality disorder traits form and for the effective interventions it offers.

In therapy, Julie revealed that her father had been unfaithful to her mother and distant from the rest of the family during Julie’s formative years. Her father and mother had separated for a year when Julie was nine years old. Julie’s mother had contracted cancer during that same year. As a doctor, Dad was away from home for long periods of time. Yet even when he was home, he was emotionally distant and critical. Dealing with the fear of death caused by her cancer diagnosis, Mom would draw close to her children; bouts of depression, however, would make her emotionally unavailable. This family system was extremely difficult to navigate for an already overly sensitive, dramatic child like Julie.

One of the hallmarks of borderline personality traits is a fear of real or imagined abandonment. The result of living with this constant fear is a feeling of perpetual emptiness and what I call the “borderline drowning reflex”. Julie thrashed about emotionally, as if anchorless in a sea of abandonment. A string of poor relationships with boyfriends as she grew into adolescence further confirmed what she feared: everyone she loved would leave her eventually. She was unlovable and destined to be lonely her entire life. If that was the case, she reasoned, why not be done with it and end life now? If she left them before they left her, maybe it wouldn’t hurt so badly.

When Julie attempted suicide, she swallowed a large quantity of painkillers. Her mother found her and called the paramedics. When Julie’s father arrived, Julie was fighting with the paramedics who were attempting to strap her to a gurney so that they could remove the poison from her body. In an attempt to save his child, Julie’s dad removed the belt from his waist, looped it around one of her arms and tied her to the gurney. He would later tell me that the look in her eyes as he strapped her down with his own belt haunted him for months.

Throughout treatment, I attempted to create experiences for Julie and her family which would foster emotional communication and bond them to each other. It is very difficult for a young woman struggling with the fear of abandonment to feel connected. But when she participates in an emotionally powerful event – a shared experience with those most important to her – it is very difficult for her to deny that connection in the future. An experience is something that cannot easily be taken away or forgotten.

As an example, after months of treatment Julie, her parents, and I had gathered on a hot summer day in July to participate in a special ceremony designed to symbolize the cleansing of the past and to celebrate the beginning of a hopeful future. We lit a bonfire in the cherry orchard at the back of New Haven’s property and watched as Julie burned her black clothing, short skirts, CDs of depressing music, and the straight-edge razors with which she’d cut her skin. The symbols of her abandonment were consumed by the flames of the fire.

When Julie was finished, Julie’s mother unexpectedly held up an empty bottle of painkillers – the painkillers on which Julie had overdosed – and said she was burning it because she trusted that Julie would never again attempt to take her life.

When his wife had finished, Julie’s dad slowly removed the belt from around his waist, wound it around his fist then thrust it over the fire. He said that he was burning the “horror” of being forced to strap his oldest daughter to a gurney with his own belt. “I’m moving on,” he said, looking at Julie, “and I invite you to do the same.” Then he threw his belt into the burning cherry logs. Julie ran to embrace her father.

This was a hallmark event for Julie and her family. It was a powerful, positive bonding experience which could never be taken away from them because they had lived it – together. The burning ceremony and other therapeutic experiences like it addressed the issue of abandonment at the core of Julie’s borderline traits, and she completed her healing.

At a four year follow-up, Julie’s parents are happily married and Julie is successfully completing a bachelors degree.