By Dan Florell, Ph.D, and Praveena Salins, M.D.
The mother is concerned when she notices scratches all up and down her teenage daughter’s arm. When asked about them, the daughter said she was wrestling with the cat and was scratched several times. Still, the mother thought the marks were more organized than random scratches. She started becoming concerned there might be more going on than her daughter was letting on.
In the situation above there is a strong likelihood that the daughter is engaging in the behavior of cutting. This behavior is also known as self-injury and involves intentionally injuring one’s body. In addition to cutting, other self-injurious behaviors include hair-pulling, picking at skin and excessive body piercing.
Cutting is a complex behavior and is quite frightening for parents whose teens engage in the behavior. Teens can cut as a way to deal with strong emotions and anxieties that they are feeling. Cutting can localize their psychological pain and serve as a temporary release while allowing them to control the pain they are experiencing.
Others will cut because they feel dead inside and need to feel something. Yet other teens who cut may be drawing people’s attention to their need for help. Though it is an extreme behavior, cutting typically is not a suicide attempt.
Cutting behaviors typically start during puberty and continue on through adolescence. Girls are more likely to cut though boys also engage in the behavior. Teens who engage in cutting can have low self-esteem, lack skills in expressing their emotions, have a history of abuse and lack adequate social support. Cutting can also be a symptom of psychological illnesses such as depression, anxiety and personality disorders.
Most teens who cut keep their cutting very secretive and attempt to hide their behaviors. However, there are others who cut to be part of a group or experiment with cutting if they have friends who are doing it.
Parents can look for signs of cutting. One sign is that teens who cut tend to wear pants and long sleeves in warm weather. Another is the appearance of lighters, razors or sharp objects that would be unexpected to find in teens’ belongings.
In addition, teens may have relationship problems and difficulty in dealing with their feelings. They may also exhibit poor functioning at work, school or home. Finally, small linear cuts carved into the forearm, upper arm or legs are strong signs of cutting behavior.
Once started, cutting behaviors can be very hard to stop. Each time a teenager cuts, it serves as a reinforcement for the behavior to the point that it will become a habit, and the teen will engage in the behavior more and more frequently.
If parents suspect cutting, it is best to be open with the teen about the parents’ concerns. Ignoring the problem or fighting about it won't help. This is not a behavior that a parent can simply order the teen to stop doing.
A preferred approach is to be direct and express concern for the teen. Once the teen decides she is not going to do the cutting anymore, parents should reach out to a mental health professional to get more assistance.
Dan Florell, Ph.D., is an assistant professor at Eastern Kentucky University and has a private practice, MindPsi (www.mindpsi.net). Praveena Salins, M.D., is a pediatrician at Madison Pediatric Associates (www.madisonpeds.com).