We see a lot of kids who engage in cutting, and parents – quite understandably -- want to know how to make the problem go away. Kids usually cut their arms or legs, but sometimes they’ll cut other places as well. Sometimes the cutting is superficial like scratching themselves with their fingernails, sometimes it is deep enough to require stitches or to be life-threatening.
What, pray tell, could possibly possess a child to do such a thing? To many adults, it seems to be a more and more rampant problem in society today, and many parents (including me) don’t recall seeing anything like it when we were kids ourselves. And what can we do to help?
Well, it’s complicated.
Kids cut for a variety of reasons. It becomes tempting for many adults (including some treatment providers) to view cutting as being some kind of “disorder” in-and-of itself. This isn’t the case. Cutting is a behavior with many possible underlying causes. It’s the end result of psychological problems far upstream that may not be obvious, and sometimes not even knowable.
For purposes of illustration, here are some reasons that kids may cut themselves:
1. It can be a maladaptive way to deal with distress.
Many kids report that the physical pain of cutting distracts them from unpleasant emotions, such as sadness, anger, or anxiety.
2. It can be a maladaptive way to communicate distress to others.
Some kids will cut themselves and show it to others – either deliberately or “by accident” – to demonstrate to others that they are suffering in some way, and thus try to elicit their sympathy or care.
3. It can be a way to manipulate others, particularly family members or peers. =
For some kids, it’s a way to “get back” at someone who has angered or rejected them, or it can be a way to hold others hostage in a relationship.
4. It can be away for a child to punish him or herself.
Some kids, particularly those who have endured significant trauma in their lives, cut themselves because they think they deserve it.
5. “Everyone else is doing it.”
Part of being a teenager is doing things you aren’t supposed to do, particularly if other teens are doing the same thing (think smoking, drinking, shoplifting, etc.). The rise of social media has exacerbated the problem, and kids will sometimes even share images of their cutting with their peers.
6. It can represent a legitimate attempt at suicide or serious self-harm.
This is more common when there are significant biological factors (chemical imbalances) at play, such as bad clinical depression or PTSD. Cutting driven by bipolar disorder can be quite severe, and sometimes seems to happen “out of the blue.” Sometimes people with serious psychiatric disorders like schizophrenia cut in bizarre places, such as their genitalia.
Finally, no matter what the reason for cutting, it can become a habit, just like anything else done over and over. This is why when kids’ other problems improve, some will continue to cut themselves, at least for a while. In effect, cutting has become an addiction for them. Some psychiatrists will even prescribe medications normally used to reduce cravings for alcohol and other drugs of abuse.
So what is a parent supposed to do when confronted by a child’s cutting him or herself?
In the short term, the parent needs to determine whether or not it constitutes an emergency based on both the severity of the cutting, and the surrounding circumstances. Scratching with fingernails during a tantrum is one thing; cutting vertically up the forearm with a razor blade after a breakup with a boyfriend is another. When in doubt, bring your child to the emergency room.
In the longer term, the key is to focus on the behavior itself, but what is driving that behavior. If the problem is related to a serious psychiatric condition, medication may help. If the problem is related to adolescent development and maladaptive, immature ways of handling relationships, that’s where the focus should be.
Individual, group, or family therapy may be helpful for some kids, provided the therapist forms a good relationship doesn’t get too distracted by the behavior itself.
How you respond as a parent can be critical as well, and there are many pitfalls to avoid. It is easy to make the mistake of reinforcing the habit of cutting by engaging in a power struggle with the child around it, or by being manipulated by it. This is part of the reason we as a general rule do not recommend “locking up sharps.” As Wholeistic Education reminds us, “Neither enable nor punish imbalanced behavior.” Walking this tightrope, while still keeping in mind above else a child’s immediate safety, is hard. We describe how we approach the problem in more detail in our book, The Art of Direction.
Because there are so many causes, there is no one-size-fits-all solution for cutting. The main thing is to view cutting for what it really is: a symptom of an underlying problem, rather the entire problem itself.