Self-Injury

When I worked at a college counseling center we had a "suicide policy" which kicked-in whenever a student made a suicide attempt or "gesture."  If a student cut themselves intentionally it was assumed that this was part of suicidal thinking, and it was treated this way.  While it is certainly important to take such behavior very seriously, it does not always reflect suicidal thinking.  We are beginning to understand more about self-cutting and self-mutilation, and enlightened therapists can often help.

Susan Stiger wrote an article about adolescent self-mutilation in the Albuquerque Journal which quotes several New Mexico teens who cut themselves.  Some of the quotes shed light on the value that these behaviors have.  One 16 year old is quoted as saying  "I always cut deep enough to bleed, that was mandatory.  I'm afraid of people getting close to me, then rejecting me." (Stiger, 1998a)   It seems that seeing blood is calming for some.

Others report that the pain is what calms them down.  One theory is that such pain results in the release of endorphins, natural opium-like substances.  The resulting "high" may feel good, and reinforce the behavior.  This is sometimes thought of as "self-soothing."  The fact that it sometimes occurs in abuse survivors has led some to speculate that self-mutilation may involve a re-enactment of the abuse, or self-punishment related to self-esteem problems.

Stiger wrote a companion piece which includes the following advice from professionals in her community:

• Remember that teen-agers react strongly to slights and disappointments. "Things we would consider slight injuries are huge to teens," said [Eden] Brenner [a clinical social worker]. "And they don't have a future perception -- that this will pass."
• "The time to worry is when you first see a self-inflicted wound," said Marli Vogel, a therapist at Memorial Hospital. Have your child evaluated. "Kids need to know they're not alone in this."
• "If it's hot and they're wearing long sleeves, long pants, take things slowly. Don't strip-search them," said Vogel. "If they try to hide something, they have a reason."
• Cutting is a common symptom of borderline personality disorder, Vogel said. What might seem like normal teen-age behavior gets magnified with that disorder: "They're inconsistent in relationships, they love you to death or hate you, they have mood swings, explosive anger, poor attachments, huge feelings of emptiness. But they can't handle being filled up, either."
• Recognize that cutting is a plea for help. "Very often kids (who cut) felt there was no one adult in their lives they could talk to, who accepted them for who they were and could share back and forth with them," said West Mesa High School counselor Kathy Scott. "That's what it takes for kids -- at least one person to take an interest."
• "When people persist in times of stress to add a tattoo or pierce something, that's a problem," said Dr. Carol Hamilton, a psychologist in private practice. "Or if it gets chronically infected and they can't give it up, that's a danger sign.
• Listen for suicide talk; watch for regular drug use -- "Their friends would know, ask them," said Hamilton. Listen for signs that they're being abused or feeling abused emotionally or physically by a girlfriend or boyfriend. Are they not coming home, crying a lot, not getting up, pulling away from friends, saying they have no future? Can they function within the family limits? "Some parents give up," said Hamilton. "It's more painful for a kid to have a parent give up than to have parents be a pain."
• If you think your child might be cutting, approach carefully. "Intense shame can be involved with that kind of behavior," said Brenner. "Don't ask a whole lot of questions off the bat. It can be overwhelming. A lot of times teens feel they have no control over anything -- but cutting is something they have control over. You don't want to take that control away right away." (Stiger, 1998b)