Everything old is new again. A few decades ago, kids who wanted to hurt themselves used lit cigarettes, pulled out their hair, punched their fists through glass doors, or beat their heads against a wall. Nowadays, the most common method of self-injury is cutting. Parents don’t understand it; sometimes they don’t even see it. I have had parents tell me it didn’t make sense, that their children were only doing it to get attention, or that they were just doing it because it’s a fad. Parents are afraid and confused, and they react with anger and denial. As always in parenting, knowledge is essential. If we want to help our children, we need to start with understanding them.

What is Cutting? 

Cutting is one aspect of self-injury. “Cutters” slice shallowly through their skin with a sharp object, like a razor. They generally cut in areas that can be hidden and are easily reached, most often their inner forearms. We also see it on chests, abdomens, and the inside of legs. They usually slice a series of 2 or 3 inch parallel lines into their skin in the chosen area.

People who self-injure also sometimes burn themselves, punch themselves, bang their heads, break their bones, or carve designs into their skin. They will pull out their hair, bite themselves, or pick at wounds so that they don’t heal. They look in mirrors and  yell obscenities at themselves to make sure they know that they are not worth the air that they breathe. We absolutely have to take this seriously.

Why do they cut?

It is a way of focusing and externalizing emotional pain. Physical pain is much easier to handle than the anger, frustration and depression they carry inside. Self injury is usually impulsive, prompted by an event that causes emotional devastation. Afterwards, they feel relief: they made a decision, took action and punished themselves for the crime of existing. There is a sort of pride in the fact that they were strong enough to see the punishment through. They are balanced on an edge: if they chose, they could cut a little deeper and not have to exist any more. They transiently feel in control, at least of their own bodies; the power is theirs. Later, they are overtaken with shame and guilt. The belief that they are worthless is reinforced, because what kind of an idiot would do this to themselves? The cycle starts over.

Who cuts?

Girls self-injure more frequently than boys; teens more often than young adults. Peer pressure has a huge effect: supportive friends can protect your child from him or herself, and allow a healthier outlet for the pain. Friends who also self-injure will pull them in the wrong direction. If a child is alone and lonely, the anger and self hatred can circle in their heads and build.

Kids are also more likely to break out razors if they have been neglected or abused, and after they experience a trauma; conflicts at home or in school can intensify the behavior. Self-injury is also more common in kids who have questions about their identity or sexuality. It is more common when kids are under the influence of alcohol or drugs. Last, it is more common in kids with eating disorders, depression, and psychiatric disorders.

As these children get older, their methods of self-injury change. Young adults develop eating disorders, become sexually promiscuous, drink to excess, take drugs, and put themselves in harm’s way. They might walk in front of a moving car to see if the car can stop in time, irritate people to start fights, or engage in damaging relationships. It is the motive that matters, not the method.

How do we know?

The first step in helping these kids is to notice that they are doing it, and to care. A child who self-injures will have scars from prior cuts, or burns. They will have fresh injuries: broken bones, bruises, cuts, or burns, with poor explanations. They will cover the area of their bodies with these injuries; usually children are quick to show their injuries and tell you the story of how it happened. If you never see your child’s forearms, look. These kids will keep sharp objects handy. In the same way a lighter should make you wonder if your child smokes, a razor blade should inspire you to start a conversation about cutting.

A child who cuts tends to be a loner who has problems maintaining relationships. They tend to have emotional labiality, moving from happy to angry in a split second. There are frequently other behavioral issues, such as trouble in school or with the police. They do sometimes tell their parents, but are not always heard. If your child tells you that there is no point, nothing will ever work out, or they wish they were dead, listen. It is human nature to try to communicate, but we do not always do it in a way that others understand. Self injury is not only a symptom and self therapy. It is also communication, if you will only look, see, and care.

How do we help?

What do we do about it, after we stop crying and shaking?

• We treat it seriously. Open a conversation, and listen. It is a small step from “I deserve to bleed” to “I deserve to die.” Bring your child to the doctor, even if he or she doesn’t want to, even if you promised you wouldn’t.  He or she will need to see a therapist.
• Provide emotional support: accept your child exactly as he or she is, love them, and let them know that you will love them no matter what. Don’t yell, punish, threaten, or judge. Issue no ultimatums.
• Lower their daily stress level. Sometimes this is as easy as letting them know that they do not have to be perfect; sometimes cutting back their work load of academics, job, and extracurricular activities will help. Keep their home stable and safe, and be a good example.
• Work to repair their self esteem. Part of this will be work with a psychologist. Encourage them to find friends with like interests (perhaps sign them up for classes or activities that they find interesting?), and engage them in activities at which they excel. Nothing repairs self esteem like achievement. Do things together that they enjoy.
• Their therapist should teach them to distract themselves from circular negative thinking. This is a learned skill; it is much easier to repeat the same old ugly “truths” over and over in your head, until it seems impossible to change.
• That psychiatrist should also work on teaching them to stand up for themselves. Girls especially are not good at saying “no.” Self respect is essential to prevent self-injury.
• Monitor the media they interact with, because there are sites that glorify and reinforce self injury. Also monitor them for signs that they are relapsing.
• Take an interest in who their friends are, and how those relationships are going. Are they able to maintain a friendship, or do they run through friends frequently?

Self injury is astoundingly common, very real, and serious. We need to see our children, listen to them, and believe them. The history in their heads is the true one to them, and the one that matters. Denying it’s validity only reinforces their belief that they themselves are stupid, or wrong, or worthless. Empower them to deal with their truth. Support them with your love, acceptance, and respect. Give them a better measuring stick with which to judge themselves: one that puts their own personality, talents and abilities at the top.