When teens cut themselves

Rima Himelstein, M.D. talks about why teens cut themselves and how parents can talk to their teen about it.

by Rima Himelstein, M.D.

Published Apr. 29, 2013, 10:37 a.m. ET

It's difficult to hide: multiple slash marks on the forearm. Many try to cover-up the painful reminders of a very bad day while some tell me openly all of the details. Either way these are the patients that are amongst the most distressing to me as a doctor and as a mother. And at the same time they are the most intriguing. They almost all say the same thing: they were not trying to kill themselves…but they cut themselves for other reasons.

Cutting is one type of "non-suicidal self-injury" (NSSI). In teens, NSSI most often involves cutting, but also can be burning themselves or banging their heads. Cutting is usually done on the arms, stomach, or thighs with a sharp object like a razor blade, knife, or scissors. To parents it may be out of the expected, but it's usually not out of the blue.

NSSI is an outward sign of an inward pain. Teens often cut themselves in response to emotional pain or distress. When they cut, they feel a rapid physical release of emotional pain that is otherwise too difficult to tolerate. Surprisingly, studies have shown that people who self-injure have little or no physical pain even when tissue damage is severe. After cutting, they still feel badly, but they feel calmer and better able to manage their feelings. It often begins as an impulse, but cutting can quickly become a habit that is difficult to stop.

NSSI is more common than you may think. It has been estimated that 15 to 20 percent of adolescents have injured themselves in the past. In a recent study of 665 youth in third, sixth, and ninth grades:

Ninth graders had higher rates of self-injury than children in lower grades.
Ninth grade girls were more five times more likely to say they had hurt themselves than ninth grade boys.
Girls most often reported cutting while boys most often reported hitting themselves.

Why do they cut? There are many theories, from Freudian to folklore...

To control sexual urges.
As a result of child abuse.
As part of a psychiatric disorder like depression, bipolar, anxiety, or an eating disorder.
To manipulate other people.
Due to impulsivity or low self-esteem.

It may sound confusing, but NSSI and suicide are related. In spite of the name—"non-suicidal self-injury"— many kids who hurt themselves in this way also think about killing themselves. Between 40 to 80 percent say they think about suicide, and about 30% have also tried suicide. So it is important for parents and professionals to take NSSI seriously. Psychiatrists are taking it seriously; in fact, NSSI may receive its own diagnostic category in the new edition of the Diagnostic and Statistical Manual of Mental Disorders the manual used by mental health professionals throughout the United States.

What can parents do? Here's my advice ...

Ask this question: "It's 10 p.m.; do you know how your children are feeling?"
It may be difficult as a parent to bring up this sensitive topic, but ask them if they have ever heard of teens who cut. Asking them about it won't make them do it. Chances are they have heard about it or read about it.
Your child's primary care provider can suggest mental health professionals to help. Therapy can help teens learn healthier ways to deal with life's stresses. Therapy can also help identify underlying mental health conditions that need evaluation and treatment.