Many young people scratch, cut, burn, or otherwise habitually harm themselves to seek relief from emotional pain or to express uncomfortable emotions that they have never learned to express in a healthy manner. Though there are many forms of self-harming behavior, we’ll lump them generally under the category of cutting, since cutting is the most commonly practiced form of self-harm among adolescents.
Many cutters are discreet and attempt to hide their scratches and wounds under long sleeves or pants. Some even cut thumb loops in long sleeved shirts so that their sleeves do not inadvertently creep up, exposing their wounds. Many compulsive cutters desperately want help addressing this addiction but don’t know where to turn. Like most addictions, talking to someone (both about the addiction itself and also about the feelings that drive the behavior) is the first step toward healing. If you know someone you suspect may be cutting, it can be helpful simply to ask, as long as your query is direct, compassionate and non-judgmental.
Others who cut or otherwise self-harm may do so, at least in part, as a manipulative or attention-seeking behavior. These young people may dramatize their cutting in order to act out anger toward parents or others by creating shock value; others may manipulate those around them by using the threat of cutting to get their way. Still others may find the attention and nurturance their cutting garners to be itself soothing, which reinforces the self-harming behavior. Even attention-seeking cutting, however, often has the escapist and addictive roots of more discreet cutting and should not be judged solely as a manipulation.
Most cutting is not suicidal or life threatening, but overly zealous or unsanitary cutting can cause serious injury and infection. When cutting co-occurs with a dissociative disorder, the cutter may be unaware of the depth of her cutting and can risk arterial injury and death. Cutting that accompanies suicidal ideation, psychosis or extreme attention-seeking can also be life threatening and should be taken very seriously. Hospitalization and residential care may be critical for the safe care of young people whose cutting is compounded by these issues. If your child or friend exhibits what seem to be life-threatening self-harming behaviors, call 911 immediately.
For typical chronic cutters, however, many therapies have proven effective. Helpguide, a non-profit that provides a wide range of valuable mental-health content (www.helpguide.org), suggests the following therapies, most of which can be pursued in either an outpatient or residential setting:
- Hypnosis or other self-relaxation techniques are helpful in reducing the stress and tension that often precede injuring incidents (see Helpguide’s article on Yoga, meditation and other relaxation techniques)
- Cognitive-behavioral therapy may be used to help the person learn to recognize and address triggering feelings in healthier ways
- Because a history of abuse or incest may be at the core of an individual’s self-injuring behavior, therapies that address post-traumatic stress disorder such as EMDR may be helpful (see Helpguide’s article on Eye Movement Desensitization and Reprocessing)
- Group therapy may be helpful in decreasing the shame associated with self-harm, and help to support healthy expressions of emotions
- Family therapy may be useful, both in addressing any history of family stress related to the behavior, and also in helping other family members learn how to communicate more directly and non-judgmentally with each other
- In severe cases an in-patient hospitalization program with a multi-disciplinary team approach may be required
- In cases of moderate to severe depression or anxiety an antidepressant or anti-anxiety medication may be used to reduce the impulsive urges to self-harm in response to stress, while other coping strategies are developed.