Understanding Teen Cutting and Self Harm

Few images evoke the degree of shock and disgust that accompanies those of self harm. When you think about cutting – one form of self harm – what likely comes to your mind is an emotionally unstable teenage girl who cuts her forearms with razor blades. However, self-injurious behavior can be much more subtle, and in turn, much more difficult to detect and address. That’s why it’s so important to know how and why it happens and where you can find help.

What is cutting and self harm?  

Self harm is intentionally harming oneself, oftentimes with the objective of  alleviating suffering. Examples of self harm include cutting the skin with objects, scratching the skin, picking wounds so they can’t heal, biting or burning oneself, and more harmful instances that include hitting one’s head or breaking bones. Of the many types of self harm, cutting is the most common. It damages the skin or other tissues, it is rarely associated with suicide attempts, and it is socially unacceptable. People who cut themselves may attempt to hide the marks or scars, and they may give false explanations for how they occurred (e.g., being scratched by a pet). Teens use many different items to cut (e.g., razor blades, scissors, pens, bottle tops, etc.), and it occurs in a variety of body locations (e.g., arms, legs, genital area, abdomen, etc.).

Who is most likely to cut? 
Young people of all ethnicities, ages, and income levels intentionally harm themselves. Cutting is most common among adolescent, Caucasian females who come from intact, middle- to upper-class families. Self-injurious behavior oftentimes begins during middle school, and young people are often introduced to it through peer groups and media outlets (e.g., music, television, internet, etc.).   

How common is it? 
Approximately one out of every eight people engages in some form of self harm, and currently, it’s more widespread than it has been in prior decades. Among people who have mental illnesses, it is more common, affecting approximately one out of every four people.

Why do people intentionally injure themselves? 
It is unclear why people cut themselves; some explanations include impulsivity, a way to distract from personal pain, feelings of control and peer pressure. If a person is cutting or engaging in any other form of self harm, a mental health professional should be consulted. Professionals will use interview techniques to identify reasons why it may be occurring and to provide interventions for effective treatment.

What are the risk factors and signs to watch for?
It is important to remember that each adolescent who cuts is different and not all start or continue for the same reason. In addition, some individuals who cut may not show any of the warning signs. If you believe or know that your child is cutting, it is important to seek professional assistance to assess the reasons why the cutting is occurring and to begin appropriate treatment. Here are some risk factors and signs that have been associated with cutting among adolescents:

Risk Factors

  • Knowledge that friends or acquaintances are cutting
  • Difficulty expressing feelings
  • Extreme emotional reactions to minor occurrences (anger or sorrow)
  • Stressful family events (divorce, death, conflict)
  • Loss of a friend, boyfriend/girlfriend, or social status
  • Negative body image
  • Lack of coping skills
  • Depression

Signs

  • Wearing long sleeves during warm weather
  • Wearing thick wristbands that are never removed
  • Unexplained marks on body
  • Secretive or elusive behavior
  • Spending lengthy periods of time alone
  • Items that could be used for cutting (knives, scissors, safety pins, razors) are missing

What should you do?
If you become aware that your child is engaging in self-injurious acts, remember that it is fairly common. Though it is often frightening for parents, the majority of teens who cut themselves do not intend to inflict serious injury or to cause death. If the injury appears to pose potential medical risks, contact emergency medical services immediately. If the injury doesn’t appear to pose immediate medical risks, remain calm and nonjudgmental, contact your child’s pediatrician to discuss the concerns, and ask for a referral to a trained mental health professional who has experience in this area.

Do you know someone who has self harms?  Call the Boys Town National Hotline at 1.800.448.3000 and talk to highly-trained crisis counselors.

By: Kimberly DeRuyck, Ph.D. and Jennifer Resetar, Ph.D.
Boys Town Behavioral Pediatrics & Family Services Clinic