When I meet a parent and family whose teen is engaging in self harming behaviors the revelation is almost always met with high anxiety, sadness, and a whole lot of fear. It makes sense that finding out your child has been harming themselves would lead to a great deal of confusion and concern for most parents. However, learning how to talk about this painful subject is one of the most effective strategies adults can use to reduce shame, end stigma, and help their adolescents to find a healthier way to cope with negative emotions. But the question remains: How do we talk about self-harm?
What is self-harm? Self-harm is any behavior that results in an injury and is self-inflicted. The most common form of self harm I see in my office is cutting. Cutting the skin superficially with any type of sharp object is generally not the same as a suicide attempt. Many teens who engage in self harm have experienced suicidal impulses but are not trying to kill themselves during the act of cutting. It almost always happens in private and is most common on arms or legs and is then hidden and covered with clothing until the secret is revealed.
Why do teens self-harm? There is no single explanation for why teens self harm. Many report that they are experiencing emotional and physical numbness and the pain of cutting allows them to “feel” something. Many others report that their emotional pain is so all encompassing that a moment of physical pain creates a welcome relief from mental distress. From my experience, what these adolescents all have in common is extreme emotional anguish coupled with an inability to cope in a healthy manner. Self harm becomes an unhealthy habit which brings momentary relief but long term shame and isolation.
What are the signs that a teen or pre-teen is cutting: While it is true that some teens will briefly experiment with some form of self harm as a way of exploring and trying on different identities, any healthy individual will not continue to self-harm. All teens who are using self harm as a coping mechanism will also be suffering from some form of depression, anxiety, or mental distress. The first signs are usually small, linear, cuts on the arms or legs which are excused or explained away and happening repeatedly (strike). If your child is frequently covering up in long sleeves and pants even in hot weather, take note. Most teens tend to spend increasing time alone and in their bedroom or bathroom, but a teen who is chronically cutting will need to engage in the behavior more to achieve the same effect.
How to bring up the topic: If you suspect that your child is engaging in self-injurious behavior, it is important to initiate a conversation about your concerns. Many adults fear that by bringing up the topic of cutting they are inadvertently putting the idea of this behavior into the mind of a suggestible teen. The truth is that open, honest communication is the best route to healing the wounds that contributed to the cutting behavior in the first place. Ideally, adults who find out that their child is cutting will keep as calm as possible. The goal is to be as clear, straightforward and clear spoken. Since cutting is not the same as a suicide attempt be careful not to assume the behavior is connected to suicidality. However, check for suicidality by asking your teen if they have thoughts of suicide, have attempted suicide, or have a plan of action as to how they would complete a suicide attempt. If your teen has thoughts of suicide along with a plan of how they would commit suicide contact a professional or take them to the nearest emergency room immediately.
How to Continue the Conversation: Many adolescents will react negatively to a parent bringing up the topic of cutting because they feel as if a shameful secret has been brought to light. Some will feel relief that the secret is out in the open. Whatever the reaction it’s common for teens to be hesitant to open up about the topic of cutting. Like any destructive coping mechanism or habit that one develops, cutting can become temporarily effective in soothing intolerable emotions. Because the behavior might work in the short term it becomes reinforced, sometimes making it very difficult to change. Do not expect this to be a one time conversation, but rather a continuous dialogue. Aim to have a conversation that is free of judgment, lectures, and harsh reprimands. Criticism will only intensify a teen’s shame and decrease the likelihood that they will open up about the topic of cutting. If teens do not open up to the adults in their life, then it becomes harder for us to help them find healthier ways to manage the powerful emotions with which they are struggling.
Get Help: It’s important to contact a mental health professional if your child is displaying self injurious behavior. A skilled clinician will help your adolescent develop new ways of coping and teach them how to use these healthy behaviors to replace cutting as a coping mechanism. Be patient and communicative. Habits do not change overnight but with time, compassion, and skill building your teen can learn to live a new life with freedom from the bondage of self harming.
Resources: Hollander, M. (2008). Helping teens who cut. New York, NY: Guilford.