If you haven’t heard the term “cutting” out of your child’s mouth, count yourself lucky (or buckle up because it may be coming). Increasingly, I’m hearing this term from kids in my practice commenting on a disturbing trend at their schools, which we’ll call “cutting culture:” kids showing each other their scars and talking about cutting themselves over frustrations with parents, academic work, relationships, etc. “Cutting” is one form of what is referred to clinically as “Non-Suicidal Self-Injury” (or NSSI for short).
NSSI is any self-inflicted wound (e.g., scratch, cut, burn, bruise, etc.) that is made, not as a suicide attempt, but as a way of coping with strong feelings and difficult situations. Unfortunately, there are indications that this behavior is on the rise or, at least, that more kids are trying it, even if they don’t engage in it long term. It’s certainly being talked about in middle and high schools more than in the past. If your child has mentioned that a friend or acquaintance has talked about “cutting” or if you’re suspicious that your child is purposely harming herself in some way, try not to freak out. The more calm your reaction, the more likely she’ll be to share information honestly with you in the future. Here’s some info that will help you handle this often difficult to understand behavior.
Prevalence estimates for NSSI in adolescence are usually between 12-14%. Keep in mind that includes all adolescents who admitted to any self-injury, even if it only happened once or twice. Girls are much more likely to self-injure than boys. Very often, NSSI that isn’t addressed in adolescence continues on into adulthood, and may escalate.
Causes of NSSI are very, very difficult to explain. If you’ve never experienced it yourself, it may seem inexplicable why a kid who, two years ago was howling in the pediatrician’s office because she had to get a shot, would be purposely and frequently causing herself pain. Here are some reported reasons an adolescent might engage in NSSI:
1) To escape from emotional pain (e.g., anger, anxiety);
2) To release tension;
3) To punish herself for perceived mistakes, failings, etc.;
4) For attention;
5) To feel good – the pain releases endorphins;
6) To gain control over a seemingly out-of-control situation; and
7) To physically express pain. Notice that, although seeking attention is one reason, it isn’t the only reason.
When talking to an adolescent about NSSI, it’s really important not to assume they’re just doing it for attention. The vast majority of people who engage in NSSI regularly do so very privately and go to great lengths to hide the evidence (e.g., keeping the injured body parts covered up, lying about how injuries were sustained, etc.).
NSSI can indicate more serious underlying mood, anxiety, or personality disorders. Most often, we see this behavior in kids who are also dealing with depression or severe anxiety. Many are current or past victims of physical or sexual abuse and NSSI is often associated with Borderline Personality Disorder in later adolescence/early adulthood. When talking to your child about NSSI, it’s important to check on other things that might be going on in their lives that we know can co-occur.
If your child talks about a “cutting culture” at school – people admitting to NSSI and, perhaps, even bragging about it – ask her what she thinks about it. Try to remain neutral and non-judgmental. Maybe your daughter thinks the whole thing is weird but maybe she’s bringing it up to test your reaction because she herself has done it (or at least thought about it). Discuss together the reasons peers might tell others they’re cutting. Are they really looking for help? Just seeking attention? Are they trying to “fit in?”
Likely, there are different motives for different people so the appropriate response isn’t one-size-fits-all. Explain the reasons it will be important for you to talk to the principal or school counselor about what your daughter is telling you. See if she wants to be involved in that conversation or stay out completely. If your child tells you in private about a close friend who is cutting, it will be important to let that friend’s parents know. Try doing so in person and armed with some information to give the other parent – this may help relieve some of the shock and worry he or she might feel.
If it turns out that your child has engaged in NSSI or that it is currently ongoing, thank her for trusting you enough to tell you. Ask her to try and explain why she does it and do your best to listen rather than judge or argue. Tell her your concerns about what she’s doing: self-injury can be dangerous, wounds might become infected, she could get negative feedback from peers, her skin may be scarred. Also, talk about the fact that NSSI doesn’t really do anything to “fix” the underlying problems and that thoseare most concerning of all. Offer her hope that there are other ways of coping with strong feelings and that you know she would feel better about learning and using those versus what she’s doing now.
Immediately seek out a referral for a psychologist or counselor – talk to your pediatrician and close friends for names. When you meet your child’s therapist, express your interest in remaining involved to whatever extent possible so that you and your spouse can learn how to help your child cope. Remove items your child might use to hurt himself (e.g., scissors, knives, razors, matches, etc.) and store them in a locked cabinet for the time being. Check in frequently on how your child’s day was and how he is feeling. Try questions like, “Who sat at your lunch table today?” “Was your history teacher grumpy or in a good mood?” Encourage positive coping like getting outside, talking about feelings, and relaxation exercises. Show your child that you, your child, her therapist, and other important adults in her life will work together to help her through and that she doesn’t have to handle this alone.
About this column: Send your parenting- and kid-related questions my way and I’ll tell you what I can: parentingwithaphd@gmail.com Please be aware that email is not a secure method of transmitting personal information so it’s best to keep your questions general. If your question is featured, your name and email will not be published. Submitting a question does not constitute a professional relationship in any way and this column is not meant to substitute for face-to-face therapy. If you feel you’re doing the best you can and still need help, it may be time to bring in a professional. Start by talking with your child’s pediatrician to get a referral.
Kristen Berthiaume, Ph.D. is a clinical psychologist with Grayson and Associates. She obtained her doctorate in clinical psychology from the University of Kentucky. She completed a predoctoral internship in clinical psychology at the University of North Carolina at Chapel Hill and a post- doctoral fellowship in the Attention Deficit Hyperactivity Disorders (ADHD) Program at Duke University Medical Center. She specializes in providing assessment and treatment of children, adolescents, and families dealing with the following issues: ADHD, learning disorders, social skill deficits, organizational problems, behavioral difficulties, anxiety, and depression. She generally focuses on behavioral and cognitive- behavioral techniques, but maintains a flexible approach to therapy. Her other day job is as mom to her daughters, ages seven and one, and four-year-old son.
