Written by: Michael Reed, MA LMHC Family Counseling Associates of Andover
Throughout the past ten years of working with adolescents and teenagers, the issues of suicide and self-harm have come up constantly. I work to address specific behaviors and to help young clients learn how to manage and regulate their emotions in a healthy way, but I also work with parents to better understand how to make sense of and engage with these topics. I plan on discussing both self-harming behaviors and suicidality in two separate posts. This will serve as a primer of sorts for parents and teachers, first providing a foundational understanding of what leads to these types of behaviors, and then how to discuss them openly and directly with your kids, while avoiding common pitfalls that will further alienate you from them.
I’d like to begin by discussing self-harming behaviors, most commonly seen in the form of cutting, but which can also involve burning or severe scratching. Cutting is by far the most prevalent and will often appear as a series of shallow, superficial cuts, often fairly small: around an inch in length and typically a long series of them, appearing most commonly on the inside forearms, but also on the upper thighs and the rib cage, where the cuts will be less visible to parents and teachers. A common tell-tale sign is when the adolescent consistently wears long-sleeve t-shirts or refuses to be seen in a bathing suit in hot weather as a way of hiding the cuts or scarring.
Why Kids Cut
Parents, when they see self-harm, are understandably very concerned, but the subsequent interactions they have with their children can often lead to them to feel further invalidated, embarrassed, or more reticent to open up. Let us first dispel a common myth: that cutting is attention-seeking or showy behavior, meant to be provocative or a shallow ploy to have the spotlight on them at school. The first thing to understand about cutting is that it is, first and foremost, a coping skill. A dangerous and unhealthy coping skill, but one which does, nonetheless, create some reprieve of emotional pain and allow the individual to feel in control of something and to be momentarily distracted from their negative emotions.
It is almost always passed along from one teenager to another as a sincere suggestion of something that was helpful to them and which may be of use to their friends. In working with teenagers, I often highlight that acknowledging that something is wrong and that they are in need of finding ways to cope with their feelings is a positive step. Acknowledging this both validates them emotionally and creates the means to a conversation about healthier and more appropriate options with which to replace self-harm. This is, after all, something that, despite the physical pain and embarrassment it causes, something that they likely feel is a useful tool for them and something upon which they may have come to depend. If that is immediately invalidated or met with accusations of attention-seeking, it may likely prevent the conversation from moving any further and ensure extra steps are taken to hide the behavior from the parents. To better understand the emotional value that cutting provides, I will break it down into the most commonly heard reasons from teenagers; these generally fall along a few common themes which could be helpful for parents to understand:
- Depression: One of the most common reasons for cutting is serious or chronic depression. This can create for many people a sense of feeling numb or emotionless, and the desire to feel something – to feel anything – is met with the sharp and acute pain of the cuts. I have heard many of them say that the pain of cutting serves to remind themselves that they are still capable of feeling anything at all. Others describe it as a means of replacing the heaviness and emotional pain of depression with physical pain: a pain that is at least different and one which they are in control of.
- Anxiety: Anxiety can be another significant factor that leads to cutting: when everything in life seems overwhelming and chaotic; when there are a myriad of pressures which someone feels as though they are being crushed by; or when their thoughts are racing and they cannot focus, the sharpness of the pain is, in a sense, grounding and sobering, arresting their attention and focus if even for a few minutes. A number of individuals have described it as taking back a sense of control: when they can’t control what’s going on with their friends, what’s going on in their home lives, etc., they can control what they are doing to their bodies. They can control the amount and intensity of the pain and use it to focus their attention and tune everything else out for that brief period of time.
- There are other reasons as well, which are commonly heard: low self-esteem and a sense of feeling the need to “punish” oneself. Punishment for not being good enough, smart enough, pretty or handsome enough – this becomes a way of inflicting pain on themselves out of disappointment or anger. I have also heard several teenagers talk about it as a form of journaling, of documenting their difficult experiences; their older scars remind them of previous hardships that they have survived, which only they know about. This reminds them that the newer cuts, those representing current pressures or difficulties, will eventually pass and fade into memory as well.
How to Talk to Kids That Cut
For so many adolescents and teens, cutting or other forms of self-harm are a way of affecting some degree of control over their body or their emotions, and in this, there is the possibility of starting an important conversation. It is an acknowledgement that they need help, that there is something in their lives which they cannot manage and with which they are trying to cope. However, this conversation needs to be had while bearing in mind some general parameters:talk about it directly, calmly and openly, without judgment.
It is of course entirely appropriate to let your children know that you are upset and frightened by this behavior, but it can be very overwhelming for them to see their parents become overly emotional, panicked, or overwhelmed. To see their parents panic makes them feel that they (the parents) would therefore be unable to hear or cope with further conversations down the road. If there are underlying suicidal thoughts, for example, the reasoning goes that if my parents can’t handle my cutting, they certainly couldn’t handle hearing about suicide. This can make them feel that they have nobody to talk to, that adults will only panic and that their peers will be the only ones who understand.
Another common pitfall to avoid is responding with anything that could be viewed as punishment: grounding, restricting access to friends, etc. While it is of course an unhealthy and unsafe coping skill, an attempt to cope is the driving force and to give them the impression that they are being punished for this or for having opened up to their parents about it, is only going to ensure that they will either be more secretive about it going forward and or refrain from discussing it with parents.
Self-harming such as cutting is incredibly common and a clear indication that something is wrong and that they are in need of help and therapy. The focus for parents must be to try and understand the emotions and reasons behind it, acknowledging and validating that they must be hurting very badly if they have found themselves here. They need to know that you are there for them to support them and get them the help they need. So be calm, direct, and as much as you are able, focus on the underlying reasons and emotions which have led to this, while working together so that they can feel heard and get the help that they need.
Part Two of Self-Harming and Cutting, A Primer for Parents will be available on June 15, 2018