An increasingly common topic that I am asked about by parents and school counselors is self-harming behavior among teens. This issue puzzles counselors and frightens parents. It has been estimated that as many as one in five teens have tried self-harming. There isn’t a week that goes by that self-harm does not come up in my therapy office, so it seems to be a useful topic to discuss in this forum.
Self-harm (or self-injury) presents in different ways, but most often it’s cutting. While self-harming individuals do sometimes have suicidal ideation that may or may not accompany the acts of self-harm, most of the time self-injurious behavior such as cutting is not a suicide attempt. So that begs the question: why is this person cutting him or herself? There can be multiple answers to this question. At the most basic level, this is a means of coping with emotions that feel intense, painful, or overwhelming. Occasionally, a young person will try self-cutting out of curiosity. If they find it is not a pleasant or relieving experience, they probably won’t do it again. However, for some people, self-injury is an effective means of dealing with difficult emotional experiences. Self-harming behaviors may signify that an individual is going through a particularly difficult life experience or that he or she suffers from a chronic emotional problem such as depression, traumatic stress, or mood disturbance.
Often individuals who self-harm attempt to conceal the marks they have made. They may wear long-sleeved shirts or lots of bracelets to hide the cuts or scars. Also, they may cut or otherwise injure themselves in places that are typically concealed by clothing, such as the thighs or abdominal area. Sometimes individuals allow others to see the marks or appear to be putting them on display. I have frequently heard this described as “attention-seeking” or “manipulative” behavior. I don’t think it’s useful to construe this behavior in such pejorative terms. In my experience, this is most often the best way the individuals can come up with to communicate their difficulties so they will get help.
So what do you do if you find out your child is self-harming? First, don’t punish them for it and don’t shame them for it. Secondly, don’t make them show you all the marks. DO express concern and try to understand what the underlying feelings are. If your child doesn’t feel comfortable telling you what is going on, offer the opportunity for them to talk with someone else, such as a psychologist, about it.
It is important that teens who turn to self-harm learn more healthy ways of coping with their feelings. Therapy can be very helpful for both the teen and the parents in dealing with this problem. Treatment should focus on containing any actual life-threatening behaviors and helping the individual process and work through the underlying stressors that contribute to the self-harming behaviors. Additionally, family therapy may be needed to address contributing family dynamics. When self-harm is not life-threatening, it is not generally helpful to force the individual to stop self-injuring immediately or to hospitalize the individual for the behavior. A more effective method is to help the teen replace self-harm with other effective coping strategies and to address the actual underlying problems. The process of therapy in these cases can take considerable time, but can be very effective.
Melissa K. Hunt, Ph.D.
Licensed Clinical Psychologist
FamilyFirst Psychological Services