Originally published in 2007

There’s a disturbing trend which parents of adolescents need to know about: many of our children are intentionally harming themselves.

I remember the first time I heard about it: a 16 year old told me he intentionally cut himself with a knife whenever he felt “down”.  The cuts were not deep, and he spoke about enjoying the feel of his blood as it dripped from each arm.  A year later, I heard another teen speak about harming himself, this time with a razor.  As the years progressed, I heard it more often until now, at any given time, I have a number of adolescents in my care who engage in Non-Suicidal Self Injury (NSSI).

Non-Suicidal Self Injury is simply that: people who purposely harm themselves without suicidal intent.  They may cut themselves, burn themselves, or hurt themselves in any number of ways, such as picking at their skin or punching walls.  Therapists have known about it for years and it crosses age, gender and cultural boundaries.  Disturbingly however, the prevalence of NSSI has been on the rise over the past decade in the adolescent population.

A recent study published in the August, 2007 journal Psychological Medicine (1) states that:

“46% of (more than 600) high school students surveyed said they had purposely injured themselves more than once in the past year. Among those who said they had injured themselves, more than half said they had cut or burned their skin or given themselves a tattoo or engaged in other acts the researchers labeled as “serious”.  Others engaged in comparatively minor acts such as pulling out hair, biting themselves or picking at areas of the body until they bled.”.  (2)

So why are adolescents doing this?  NSSI is often a way of trying to manage strong, painful and undesirable feelings; cutters sometimes claim they “control” their pain by this action, particularly in regards to how much pain they feel and when they feel it.  Working with teens, I have heard other reasons as well.  Here are a few:

1.  Cutters dealing with guilt claim this action helps them feel they are “paying” for their actions; cutters dealing with anxiety claim self-harming helps them feel “in control” of their stress-level.

2.  NSSI can also be a way to punish and/or scare someone.  I’ve seen parents get completely shocked (and rightly so!) when they realize their son/daughter is intentionally hurting themself.  I’ve also seen Self-Harm used to manipulate another, such as a girlfriend/boyfriend.  (For example, “If you leave me, I will cut myself”.)  Clearly, relationships based on this foundation will incur other problems as well.

3.  Because there is an endorphin-release when people are injured, one theory is that people cut to experience this endorphin “high”.

4.  NSSI can also be the sign of a significant and serious mental illness, and for this reason alone, should be taken VERY seriously.

5.  Finally, due to the popularity of cutting both by peers and in pop culture, cutting may be yet another behavior for some teens to experiment with as they travel through the complexities of adolescence.

This article is NOT meant to take the place of getting sound, clinical help for anyone dealing with these issues.  That being said, if you are aware that your son/daughter may be or is intentionally harming themself, the first thing to do is to make sure they are safe!  Consider speaking to them about it and if you believe they may be in danger, immediately speak to their doctor and/or to a therapist who deals with these issues. The important thing is to evaluate their level of risk and to get a sense of WHY they are doing it.  At that point they can hopefully learn other tools for coping with whatever is triggering this action.

A word of caution: don’t subscribe to the theory that your child is simply going through a stage and will stop on their own; while that may ultimately be the case, it is also possible that one of a number of other things may happen:

1.  By Self-Harming, your child may not develop the necessary tools for dealing with difficult emotional situations; development of these tools is important for all teens to master.

2.  There are reports (1) of people having difficulty breaking this sometimes habitual pattern; responding quickly to it is a way of stopping a potentially chronic pattern from developing.

3.  Kids who cut can have good friends, but young friends may not know how to respond to this behavior and relationships often become strained.  The loss of a close friend is a particularly difficult challenge for someone who is already self-harming.

4.  A darker potential exists as well:  kids may accidentally REALLY hurts themselves (physically) in their attempt to relieve emotional pain:  for many, the deeper the emotional pain experienced, the deeper the cuts (or self injury) needed to be to relieve that pain.  I have heard a few stories of children needing emergency care as well as accidentally killing themselves through self-harming behavior.

In conclusion, if your child is engaging in some intentional form of self harm, awareness and work on this issue are important.  With some help, this may become yet another chapter in the life of your child and your family, one that may help all members learn and grow.  It is important however, to evaluate and seize this opportunity before it becomes a potentially larger problem.

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David Franklin is a Marriage and Family Therapist in Lafayette specializing in Adolescent and Men’s issues.  He is married and the father of two sons.  His adventures include being a professional musician and walking across the country.  He can be reached at (925) 935-4000.

(1) Lloyd-Richardson, E., Perrine, N., Dierker, L., and Kelley, M. L., (2007).  Characteristics and Functions of Non-Suicidal Self-Injury in a Community Sample of Adolescents.  Psychological Medicine, 37, 1183-1192.
(2)  http://www.livescience.com/health/070719_self_hurt.html