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Teen Cutting/Self Mutilation

What is Cutting?
Cutting is the practice of teens who purposely injure themselves by using a sharp object to scratch or cut their skin deep enough to draw blood. It's a type of self-injury behavior typically seen more often among younger teen girls, although older teens and boys can also engage in cutting.

Teens usually will cut themselves where they can most easily reach - on arms, legs, and torso. They often take care to cut themselves only in places where their injuries and scars can be concealed by clothing to hide the practice from parents, siblings, and teachers.

Although it's sometimes done in groups, cutting is typically a secretive behavior. Teens often keep their secret even from their closest friends because they're embarrassed and ashamed. If their injuries are noticed by a friend or family member, those who cut usually offer a rational explanation, like "I was playing with the dog and he got too rough," or "I fell and landed on some broken glass," to continue their deception. (1)

Why Teens Cut Themselves
It's usually hard for parents to understand why their teen would cut himself or herself on purpose. According to therapists, teens cut themselves for several reasons. Among them:

  • For release of pent up emotional stress.
  • To express anger or other negative emotions.
  • To exert an element of control when their lives seem out of control.
  • To feel something other than emptiness, even if what they feel is pain.
  • To punish themselves because they feel inadequate or worthless. (2)

Teens who cut themselves lack coping skills to deal with strong emotions, intense stress, or relationship problems. Without healthy ways to deal with what they feel inside, tension builds up to an unbearable level until the teen seeks physical relief through cutting himself/herself. Those who cut don't intend to injure themselves seriously or permanently. And while teens who cut do sometimes attempt suicide, cutting episodes are usually not suicide attempts, experts say.

Rather, those who cut are feeling emotional pain and resort to physical self-injury in an attempt to feel better. Cutting releases endorphins, the brain's feel-good chemical, providing a respite from the pain or helping the teen "feel more alive."

But not unlike a drug induced high, the endorphin rush from cutting is temporary. When it fades those who cut feel more guilty or depressed than before. To achieve that endorphin rush again, they have to cut themselves some more. (3)

This cycle often causes cutting to become a habit for teens. Kicking the cutting habit can be for some as difficult as ending a drug habit. Although cutting is not physically addictive, the behavior can have a compulsive element, causing a teen to feel that the more she cuts, the more she needs to cut.

Cutting can be, although is not necessarily, associated with a mental disorder like depression, bipolar disorder, anorexia or other eating disorders, obsessive-compulsive disorder and others. It may also be associated with substance abuse and with other impulse control and risk taking behaviors. (1)

Signs Your Teen May be Cutting

  • Wearing only long sleeved shirts, or refusing to wear shorts, even in hot weather.
  • A sudden increase in the number of skin injuries, even when your teen provides a good explanation.
  • Unexplained cuts or scratches.
  • Associating with friends who cut.
  • Discovery of a sharp object you wouldn't expect among your teen's possessions.
  • Withdrawing from family, friends, or favorite activities.
  • Increased irritability or impulsiveness.
  • Constantly covering arms, legs, hands, and wrists.
  • Low self esteem. (4)
  1. Teens Health [online]
  2. Bay Therapy [online]
  3. Elite Skills [online]
  4. The Step Family Life [online]

How Widespread is Cutting?
Statistics on teen cutting are hard to come by because so few studies have been done on the subject.

Broad estimates are that about one percent of the total U.S. population, or between 2 and 3 million people, exhibit some type of self-abusive behavior. But that number includes those with eating disorders like anorexia, as well as those who self injure. (1)

A 2002 study published in the British Medical Journal estimated that 13 percent of British 15- and 16-year-olds purposely injure themselves. (2)

In the U.S., it's estimated that one in every 200 girls between 13 and 19 years old, or one-half of one percent, cut themselves regularly. Those who cut comprise about 70 percent of teen girls who self injure.

Two of the most alarming facts about teen cutting are these:

  • the number of cases is on the rise, and
  • without treatment, many who begin cutting themselves as teens will continue the behavior well into their adult years.

Treatment visits for teens who self injure have doubled over the past three years. And those numbers are expected to grow as life becomes more complex for teenagers. Directors at self-injury treatment programs refer to this growth trend as an epidemic that reaches even into middle schools.

The profile of a typical self-injurer looks like this. She's female in her mid-20's to early 30s, and has been cutting herself since her teens. She's intelligent , middle or upper-middle class, and well educated. She also comes from a home where she was physically and/or sexually abused and has at least one alcoholic parent. (3)

What Should I Do if My Teen is Cutting?
Parents who discover their child is cutting typically are shocked and immediately blame themselves for failing as a parent. Therapists say that parental self-blame is NOT helpful.

Remember, cutting is a behavioral sign of a deeper underlying problem. The goal should not be to get your child to "stop cutting," but to treat the deeper problem so your teen develops more mature coping skills and no longer feels the need to self-injure.

Here are some tips for dealing with this serious issue.

Don't

  • React with anger.
  • Go into denial about the problem.
  • Assume this is a "phase" your teen will outgrow.
  • Say "What did I do wrong as a mother (father) for you to do this to yourself."
  • Ask "Why are you doing this to yourself?"
  • Try to hide sharp objects. It's an ineffective deterrent. If your child wants to self-injure, she'll find a way.

Do

  • Admit you and your child need help.
  • Take the problem very seriously. This is not just attention-seeking behavior.
  • Be completely supportive.
  • Immediately seek treatment for your child.

Treatment
If you suspect your teen is cutting, talk to your family physician or your local public health department to find a mental health treatment program that can help.

Parents are cautioned to understand that treatment probably won't simply be a matter of medication and/or a few visits with a therapist. Treatment often includes medication combined with individual and family therapy over a sustained period of time.

Don't assume that your child is "okay" once he's in treatment and making progress. As with treatment for any habitual behavior, setbacks are not uncommon. Some teens report cutting episodes even after a year of therapy, although episodes typically become less and less frequent the longer a teen is in treatment.

If You're a Teen Cutter

  • Tell somebody - a sibling, a friend, a parent or relative, anyone you can talk to. Overcoming your shame and admitting your problem is often the hardest part of getting help.
  • Identify what triggers your cutting behavior. This can be difficult to do on your own. You'll probably need a mental health counselor to help you.
  • Ask for help. Go to your parents, a medical professional, a school counselor, or any adult you trust and tell them you want to stop cutting. If the person you approach downplays your cutting, go ask another adult for help.
  • Stay with it. Breaking your cutting habit will not be easy. But with treatment, teens who cut themselves can and do successfully learn more healthy way to deal with stress ands negative emotions. (4)

What is Self-Mutilation?
Self-mutilation, sometimes called self-injury, self-harm, self-abuse, or self-inflicted violence, is the deliberate harming of one's own body without the intent to commit suicide. Researchers have identified five elements common to all self-injury behaviors.

  1. The injury is done to the self.
  2. It is done by the self.
  3. It involves physical violence.
  4. The injury is intentional.
  5. There is no conscious intent to kill oneself. (1)

Self inflicted violence, or SIV, takes many forms, including:

  • ripping or picking the skin
  • hair pulling
  • punching
  • head banging
  • bruising
  • burning
  • branding
  • scratching
  • bone breaking (2)

Among teens, the most common, and perhaps the least noticeable, self-mutilation behaviors are skin picking and hair pulling.

Why Do Teens Self-Mutilate?
To those who have no inclination to purposely injure themselves, the concept of self-mutilation can seem bizarre and frightening. But teens engage in self-harm for many reasons. Among them, to:

  • release tension
  • express anger, or other unacceptable feelings
  • punish themselves
  • "numb out"
  • feel "alive"
  • have control
  • relieve feelings of emptiness
  • stop "bad" thoughts
  • to calm down
  • feel euphoric

Self-injury works as a coping mechanism to help teens release tension, relieve stress, and overcome feeling of depression. This kind of behavior can be used almost like a drug - to provide temporary relief from pain or other overwhelming feelings the teen can't otherwise deal with. And like some drugs, SIV can even be habit forming. (3)

Teens who lack the skills or maturity to verbally express their feelings may demonstrate their emotions through self-mutilation. Typically, these adolescents also lack other more healthy physical outlets, like involvement in sports or engaging in exercise, to release tension or deal with strong emotions. (4)

Who is at Risk for Self-Mutilation?
More teen girls than boys self-injure, although recent studies suggest the numbers may be about equal. Many who engage in SIV have been victims of physical or sexual abuse, have an alcoholic parent, a substance abuse problem, an eating disorder, or suffer from another mental condition like bipolar or obsessive-compulsive disorder. (5)

Teens who self-mutilate often display these characteristics.

  • low self-esteem
  • difficulty controlling impulses
  • high anxiety levels
  • difficulty coping with stressful situations
  • tendency to hide away in their own space for hours on end
  • hyper-sensitivity feeling unaccepted by parents or peers.

What are Some Signs of Self-Mutilation?
Self-injury often goes undetected because teenagers are ashamed of the behavior and often go to extreme lengths to prevent parents, family members, and even close friends from discovering their secret.

Here are some common signs of self-harm. If you observe any of these, you'll likely want to do some further investigation.

  • Family members telling you that they are finding sharp objects in strange locations.
  • Evidence that your teenager's friends are self-mutilating.
  • Teen regularly locking himself/herself away for long periods in their room or the bathroom.
  • Loss of interest in usual friends or social activities.
  • Finding sharp objects hidden in your child's room.
  • A reluctance to wear clothes such as short-sleeved shirts or shorts, even in hot weather.
  • The appearance of an abnormal number of injuries or scars.