Hurting on the Inside, Cutting on the Outside: Understanding and Helping Teens with Self-Harmful Behavior

It can be hard to understand why your child is cutting. You may think it is for attention, a possible suicide attempt, immature and they will grow out of it, or that stopping is as easy as making the choice not to do it anymore. Perhaps you really can’t imagine why anyone would cut his or herself or how it would help a person.

Actually, cutting is a type of coping skill that makes sense for many teens. It is a negative coping skill, yes, but still an effective one to meet the needs of some people. Cutting is just one type of self-harm- others are burning the skin, head-banging, ingesting dangerous objects, pulling out hair, etc. It can also be addictive- when something works to deal with our emotions, we will keep using that strategy. It is similar to substance abuse- the brain becomes conditioned to want a certain release of chemicals that banish negative emotions.

Here are common reasons for teens to self-harm and what they get out of the experience:

1. It transforms emotional pain to physical. Many teens have a difficult time communicating their feelings. This could be for several reasons: because they actually cannot identify what feelings they are having, don’t want to burden others, or think no one else will understand or care. Cutting is a flesh wound that can heal with time, whereas emotional pain is something that festers and may never heal; or at least this is the way a teen may think. For some the physical scars feel like an accomplishment, kind of like battle scars that show how much the person has been through.
2. It releases pent-up emotions. Many people who cut do it when they are feeling angry, sad, or anxious. Just when they feel they might erupt on someone, break apart in tears, or crawl out of their skin, they cut their skin in order to release these uncomfortable emotions. When they are experiencing deep emotional pain, cutting the skin can actually feel less painful and serve as a distraction from the even worse agony of negative emotions. If you think about it, it makes sense- nurses tell you to pinch yourself as you are getting a shot to distract from the pain, and cutting can do the same.
3. Cutting is a way to feel something instead of being numb. A common sign of depression is numbness, or just not feeling anything. Sufferers of depression lose interest in things they used to enjoy and may think they will never feel happy again. Even some antidepressants or anxiety medications can cause emotional numbness. Teens experiencing this symptom may want to cut themselves just to feel anything at all- like waking themselves up from a stupor.
4. It helps a person feel in control of his or her own body. Teens are in the midst of a big transition from being kids who depended on their parents for instruction to becoming young adults who are responsible for themselves. Sometimes this becomes a power struggle between the teen and parents, teachers, and other authority figures. Cutting oneself is a way of regaining power and control over the body, as well as a way to “punish” adults by whom the teen feels persecuted.

As you can see now, cutting can become a coping mechanism that can help a teen feel like they are healing, release emotions and pain, experience feelings, and gain control.

Here are steps to take to help your teen kick the habit of cutting:

1. Find new, positive coping skills. The only way a person who self-harms is going to want to stop is if there are other coping skills to take place of the negative ones. Sit down with your teen and make a list of things that make him or her feel happy, such as listening to music, talking to a friend, watching a funny TV show, or drawing. These are positive coping skills that may actually make the situation better in the long run. Cutting is a very temporary fix that often leads to feelings of shame and guilt soon after, which is not helpful and can actually make problems worse.
2. Use strategies to resist the urge to self-harm. To ease the transition out of using it as a coping skill, there are ways to simulate the feeling one gets from cutting. Have the teen try snapping a rubber band on their wrist when they feel the urge to cut, or squeeze an ice cube. These things cause pain but not actual physical damage. Another strategy is to busy the hands- many people who self-harm take up knitting or some type of craft on which they can focus their energy instead of cutting.
3. Express sincere concern without going overboard. Let your child know in a calm manner that their cutting behavior is concerning to you. Do not ignore it and hope it goes away- cutting can be a cry for help and a symptom of depression or anxiety. Equally as important, do not hyperbolize it and react with extreme anger, sadness or concern. Just because a teen is cutting does not necessarily mean they want to commit suicide- you should ask what the intent is before assuming this. Also, reacting this way may make your child feel even more that you are trying to control them, which can be a trigger for cutting.
4. Take your child to therapy. It is important for teens that cut to learn different coping mechanisms now, before they start down the road of using negative coping skills because they are a quick fix. Sometimes it is easier for a teen to talk to a neutral third party as opposed to a parent. If you offer your help and the person continues to cut or the situation becomes worse, therapy can help.

Author: Grace Norberg, AMFT