Cutting-In: Understanding Self-Injury - Cincinnati Family Magazine

Connecting with adults and having clear, consistent lines of communication is the antidote to the very worrisome behavior currently impacting as many as 5 million American kids today.

Forget the hot weather, Jenny wears long-sleeved shirts. Those marks on her arms? Oh, a cat scratched her, she briskly tells her mom one night as she bounds up the stairs. But Jenny is quieter than she used to be, and her mom’s instincts have kicked-in to alert her that something is not right.

The daughter who used to be so open around her family has become secretive and different. Even Jenny’s friends have noticed a change. But Jenny can’t find the words to tell her mother or friends what the “cat scratches” on her arms really are; that the “cat scratches” on her arms were actually self-inflicted. By a razor.

Injuring yourself on purpose by making scratches or cuts on your body with a sharp object – enough to break the skin and make it bleed – is called cutting. According to experts, cutting is an unhealthy coping mechanism. This means that the people who do it have not developed healthy ways of dealing with strong emotions, intense pressure or upsetting relationship problems.

Talking with a good friend, taking a walk, reading a book or petting your dog are some of the healthier options most of us turn to in order to manage stress and gain control of difficult emotions. Thankfully, a majority of children and adults have developed the necessary mixed bag of coping tools to help sort through the variety of life’s circumstances.

But imagine feeling that you only have one option to relieve your stress or to release your emotions. Regardless of whether that option was harmful, addictive or risky, you’d still turn to that source of comfort out of desperation, frustration and despair.

It is difficult to imagine a world where repetitively taking a knife to your own arm or plunging a lit cigarette into your leg is a source of comfort or relief. But poking palms with lead pencils or fashioning cutting implements out of typical school supplies occurs every day in an estimated 4 to 5 million households in North America.

Seeing self-inflicted pain as a chance to exert control over their body, emotions or a situation, children as young as 9 years old are relying on self-mutilation or “cutting” as a tool to cope with their emotions.

Who, What, Why, When?

Often classified as an impulsive disorder, self-mutilation, “cutting” or self-injury began surfacing in the 1990s. Those thought to be leading “perfect” lives began cutting as a form of emotional pain relief. Now, growing at an alarming rate, self-injury is a risky behavior that parents, educators and health experts continue to worry about. Linked to depression – and in 50 to 60 percent of the cases a history of physical or sexual abuse – self-injurious behavior is very complex and is something that is as unique as each individual who partakes in the activity.

Cutting tends to be the favored method of self-injuring among teenagers, and the onset of self-injury tends to accompany puberty. A surprising 80 percent of middle school-aged children who hurt themselves are female.

With limited exposure to knives, younger children resort to poking themselves, repetitively banging their head and scratching themselves. For some children, peer pressure factors into engaging in self-injury. For others, self-injury is a very personal, secretive and shameful act. Risky and self-injuring behavior has become the drug of choice for many thrill-seeking adolescents and those feeling unstable or insecure. Looking for an alternative to a substance induced “high,” â€˜tweens and teens look forward to the rushing release of endorphins experienced from self-inflicted pain.

The compulsion to be part of a group was the catalyst that sent one California fourth grade class to the school nurse with mysterious but similar injuries to the children’s forearms. “After talking with the students individually, we learned that they all used an eraser to burn themselves,” explains Richard Lieberman, school psychologist and coordinator of the Los Angeles Unified School District Suicide Prevention Unit. “This type of behavior is contagious because it creates a â€˜rite of togetherness.’â€

Asking to be excused from class to go to the washroom (only to subsequently hurt herself) creates the chance to redirect or control a situation for a teen who thinks she’s being made fun of. A teen who was once abused and finds herself in a threatening situation will cut herself to simulate control over her abuser or to punish herself for being abused.

Cutting oneself is something adolescents do alone and, as in the case of the California class, in groups. It takes just seconds to accomplish, but has effects that can last a lifetime. Perhaps one of the most interesting facts that parents should understand about self-injury is that the majority of children who cut themselves are not “cutting” as a means to attempt suicide. “Kids who are depressed and who can’t deal with strong emotions use cutting as a primitive coping mechanism,” says Tania Soja Case, manager at a residential treatment facility. “Self-injury is a very significant issue for children with depression.â€

It is important to understand the difference between self-injury and cultural or rebellious choices. Although many parents cringe at the thought of their child poking a hole in their eyebrow, lip, nose or ear cartilage, piercings and tattoos are not related to cutting or self-mutilation. “These are things that go in and out of fashion and indicate nothing about a person’s psychological makeup,” agree Lieberman and Soja.

Easing the Pain

It is understandably instinctual to punish a child for injuring herself or to forbid her from spending time with friends. Although motivated with the best of intentions, these actions actually encourage the risky behavior. “Ironically, many try to prevent or discourage the behavior without realizing the child feels this is all she has,” cautions Lieberman. Forbidding a child to wear long sleeves, yelling at her to stop hurting herself or threatening her with punishment usually results in the child finding a sneakier alternative to achieve the much needed release.

Productive intervention and consistent support is crucial to breaking the destructive pattern, because 90 percent of adults who self-injure started in adolescence. Working in conjunction with a school counselor, therapist or pediatrician, parents can offer some initial suggestions such as replacing the urge to cut into an arm with placing ice on the arm. “You can’t break the behavior cold turkey and without teaching healthier skills,” says Lieberman, who has worked tirelessly with thousands of children demonstrating risky behavior.

Connecting with adults and establishing clear, consistent and productive lines of communication can be powerful in the recovery process. Because many children who hurt themselves feel disconnected or fear abandonment, establishing and nurturing healthy relationships with role models and extended family members offers a much less harmful outlet for the powerful emotions experienced by children. “A stable, safe environment is equally essential,” adds Lieberman. In some situations, cognitive and dialectical behavior therapies alone or in conjunction with medication are necessary to develop less harmful coping skills.

“The good news is the majority of children will not repetitively self injure, and they learn better ways to cope as they get older,” adds an encouraging Lieberman.

Gina Roberts-Grey is a freelance writer and frequent contributor to this publication

For â€˜Tweens and Teens

kidshealth.org/teens offers in-depth coverage on important health topics pertaining to youths including cutting.

Who, What, Why, When?

Easing the Pain

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For â€˜Tweens and Teens

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