Cutting As Pain Relief? Understanding and Helping Teens Who Self Harm
By Jennifer Jones, LCSW
Site Director, Palo Alto High School
This article is intended to educate parents and the general public about an increasingly common behavior among adolescents called self-harm. Although brief, I hope to shed some light on some of the emotional issues and neurophysiology behind the behavior and to help families be able to talk to their teens about it and get them the help they need.
“I feel relieved and less anxious after I cut.” “I feel like a wave of calmness.” “It makes me numb which is better than the pain I feel inside.” These are some of the reasons I’ve heard from the high school students we counsel for why they repeatedly hurt themselves. Sometimes called “deliberate self-harm,” “self-injury,” “self-mutilation,” “cutting,” or “non-suicidal self-injury,” self-harm typically refers to a variety of behaviors in which an individual intentionally inflicts harm to his or her body for purposes not socially recognized or sanctioned and without suicidal intent (Favazza, 1996). Burning oneself, pinching to point of bleeding, hitting, punching, bruising, ripping/pulling skin or hair, interfering with healing (picking at scabs), and embedding objects under the skin are all ways that people self- harm. But cutting, using any kind of sharp object to scratch or cut open the skin, is by far the most commonly seen and reported type. The cuts are usually on the arms and wrists or torso, hips and upper legs.
Maybe one of the most ironic features of self-harm is that most of those who do it say it’s to relieve pain, or to feel something rather than nothing: in other words, to control overwhelming/painful emotions. It’s really important to understand that hurting themselves does make those who do it repeatedly feel better. Attributing it to merely attention-seeking behavior or attempts at manipulating those around them may exacerbate the problem and increase the desire to cut. Most youth who cut carry around a lot of shame and have difficulty expressing emotions for whatever reasons. They need to learn alternative methods of coping with painful emotions and how to express those emotions to get their needs met in a healthy manner. There is also an addictive quality to self-harm behaviors. Endorphins are released that create a sense of well-being as in drug use. Over time a tolerance builds and the person needs more to get the same result. Identifying this behavior early and seeking help immediately is critical for successful treatment.
Things to look out for:
- Unexplained burns, scars, cuts, scratches on hands/wrists, arms, legs or torso
- Long sleeves in warm weather or lots of bracelets
- Avoiding activities that expose their bodies (such as swimming or PE)
- Frequent bandages, odd/unexplainable paraphernalia (e.g. razor blades or other implements which could be used to cut)
- Signs of depression or anxiety such as withdrawal, changes in sleep or appetite, loss of interest in pleasurable activities
- Concerned friends or reports of friends who are engaging in self harm behavior
Self-harm can be contagious in school settings. This behavior among groups of youth can be a means of bonding and belonging. They feel a lot of empathy for one another and therefore want to care for each other. However doing so then triggers the negative coping response to the stress of their friend in pain. It can create a domino effect. Parents may be tempted to blame their teen’s friends. Attempting to keep your teen from spending time with their friend typically will backfire. Instead it’s better to set healthy boundaries around when, where, and what time they spend together, and to teach the teen how to care for themselves by setting boundaries with those friends who trigger stress and unhealthy responses.
Parents may also blame themselves, which then tends to increase the shame the teen already feels. Kids feel bad when their parent feels bad which reinforces the self-harm behavior. Shock, pity, or reassurance may also reinforce the behavior. They usually already distrust and think parents don’t understand. It’s better to just listen and to validate the child’s experience and feelings before trying to problem solve. It’s equally important for parents to self-validate: acknowledge their own feelings in order to be able to move forward and learn how best to help their child.
Although suicide is not the intention of the person who self-harms, the relationship between self-harm and suicide is complex, and self-harming behavior can potentially be life-threatening, depending on the method and severity. There is an increased risk of suicide in individuals who self-harm. Recent studies show that individuals with a history of self-harm were over nine times more likely to report suicide attempts (www.crpsib.com, Cornell Research Program). Some sufferers have suicidal thoughts and hurt themselves, while some hurt themselves as a type of suicide prevention (it makes them feel better). If they didn’t do it and feel better, they might actually think of killing themselves. So it is critical that anyone who self-injures undergo a suicide assessment by a qualified mental health professional.
When seeking professional help, parents can start with their family doctor or child’s pediatrician. Guidance counselors at the school will also be able to refer families to the appropriate professional for help. One could also go directly to a therapist in the community, mental health clinic, or the local hospital adolescent psychiatry department. If a parent or anyone ever feels that a child is in immediate danger they can take them directly to the nearest emergency room or call 911.