Cutting As Pain Relief-Adolescent Counseling Services

Cutting As Pain Relief? Understanding and Helping Teens Who Self Harm

By Jennifer Jones, LCSW Site Director, Palo Alto High School

This article is intended to educate parents and the general public about an increasingly common behavior among adolescents called self-harm. Although brief, I hope to shed some light on some of the emotional issues and neurophysiology behind the behavior and to help families be able to talk to their teens about it and get them the help they need. 

“I feel relieved and less anxious after I cut.” “I feel like a wave of calmness.” “It makes me numb which is better than the pain I feel inside.” These are some of the reasons I’ve heard from the high school students we counsel for why they repeatedly hurt themselves.  Sometimes called "deliberate self-harm," "self-injury," "self-mutilation," "cutting," or "non-suicidal self-injury," self-harm typically refers to a variety of behaviors in which an individual intentionally inflicts harm to his or her body for purposes not socially recognized or sanctioned and without suicidal intent (Favazza, 1996).  Burning oneself, pinching to point of bleeding, hitting, punching, bruising, ripping/pulling skin or hair, interfering with healing (picking at scabs), and embedding objects under the skin are all ways that people self- harm.  But cutting, using any kind of sharp object to scratch or cut open the skin, is by far the most commonly seen and reported type.  The cuts are usually on the arms and wrists or torso, hips and upper legs.

Maybe one of the most ironic features of self-harm is that most of those who do it say it’s to relieve pain, or to feel something rather than nothing:  in other words, to control overwhelming/painful emotions.  It’s really important to understand that hurting themselves does make those who do it repeatedly feel better.  Attributing it to merely attention-seeking behavior or attempts at manipulating those around them may exacerbate the problem and increase the desire to cut.  Most youth who cut carry around a lot of shame and have difficulty expressing emotions for whatever reasons.  They need to learn alternative methods of coping with painful emotions and how to express those emotions to get their needs met in a healthy manner. There is also an addictive quality to self-harm behaviors.  Endorphins are released that create a sense of well-being as in drug use.  Over time a tolerance builds and the person needs more to get the same result.  Identifying this behavior early and seeking help immediately is critical for successful treatment.

Things to look out for:

·       Unexplained burns, scars, cuts, scratches on hands/wrists, arms, legs or torso

·       Long sleeves in warm weather or lots of bracelets

·       Avoiding activities that expose their bodies (such as swimming or PE)

·       Frequent bandages, odd/unexplainable paraphernalia (e.g. razor blades or other implements which could be used to cut)

·       Signs of depression or anxiety such as withdrawal, changes in sleep or appetite, loss of interest in pleasurable activities

·       Concerned friends or reports of friends who are engaging in self harm behavior

Self-harm can be contagious in school settings.  This behavior among groups of youth can be a means of bonding and belonging.  They feel a lot of empathy for one another and therefore want to care for each other.  However doing so then triggers the negative coping response to the stress of their friend in pain.  It can create a domino effect. Parents may be tempted to blame their teen’s friends.  Attempting to keep your teen from spending time with their friend typically will backfire.  Instead it’s better to set healthy boundaries around when, where, and what time they spend together, and to teach the teen how to care for themselves by setting boundaries with those friends who trigger stress and unhealthy responses.

Parents may also blame themselves, which then tends to increase the shame the teen already feels.   Kids feel bad when their parent feels bad which reinforces the self-harm behavior.  Shock, pity, or reassurance may also reinforce the behavior.  They usually already distrust and think parents don’t understand.  It’s better to just listen and to validate the child’s experience and feelings before trying to problem solve. It’s equally important for parents to self-validate: acknowledge their own feelings in order to be able to move forward and learn how best to help their child. 

Although suicide is not the intention of the person who self-harms, the relationship between self-harm and suicide is complex, and self-harming behavior can potentially be life-threatening, depending on the method and severity. There is an increased risk of suicide in individuals who self-harm.  Recent studies show that individuals with a history of self-harm were over nine times more likely to report suicide attempts (www.crpsib.com, Cornell Research Program).  Some sufferers have suicidal thoughts and hurt themselves, while some hurt themselves as a type of suicide prevention (it makes them feel better). If they didn’t do it and feel better, they might actually think of killing themselves.  So it is critical that anyone who self-injures undergo a suicide assessment by a qualified mental health professional.

When seeking professional help, parents can start with their family doctor or child’s pediatrician.  Guidance counselors at the school will also be able to refer families to the appropriate professional for help.  One could also go directly to a therapist in the community, mental health clinic, or the local hospital adolescent psychiatry department.  If a parent or anyone ever feels that a child is in immediate danger they can take them directly to the nearest emergency room or call 911.

Janis Whitlock, Ph.D., MPH, Amanda Purington, MPS, B.S., John Eckenrode, Ph.D., and Jane Powers, Ph.D. wrote the information below from the Cornell Research Program.  It has some really helpful tips for parents about how to talk to their teens about self-harm.

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Excerpt from The Cornell Research Program on Self-Injurious Behavior in Adolescents and Young Adults, www.crpsib.com, Copyright 2012.

How should I talk to my child about his/her self-injury?

Address the issue as soon as possible. Don’t presume that your- child will simply ''outgrow'' the behavior and that it will go away on its own. (Though keep in mind this can and does happen for some young people – some do mention "outgrowing" their self-injury.   This typically occurs because they learn more adaptive ways of coping).

Try to use your concern in a constructive way by helping your child realize the impact of his/her self-injury on themselves and others.

It is most important to validate your child’s feelings. Remember that this is different from validating the behavior:

·      Parents must first make eye contact and be respectful listeners before offering their opinion

·      Speak in calm and comforting tones

·      Offer reassurance

·             Consider what was helpful to you as an adolescent when experiencing emotional distress.

If your Child does not want to talk, do not pressure him/her. Self-injury is a very emotional subject and the behavior itself is often an indication that your child has difficulty verbalizing his/her emotions.

What  are  some  helpful  questions  I   can  ask  my  child  to  better  understand  his/her  self-injury?

Recognize that direct questions may feel invasive and frightening at first-particularly when coming from someone known and cared for, like you. It is most productive to focus first on helping your child to acknowledge the problem and the need for help. Here are some examples of what you might say:

·      "How do you feel before you self-injure? How do you feel after you self-injure?"

Retrace the steps leading up to an incident of self-injury - the events, thoughts, and feelings, which led to it.

·      "How does self-injury help you feel better?”

·      ''What is it like for you to talk with me about hurting yourself?"

·      “Is there anything that is really stressing you out right now that I can help you with?”

·      "Is there anything missing in our relationship, that if it were present, would make a difference?"

·      "If you don't wish to talk to me about this now, I understand. I just want you to know that I am here for you when you decide you are ready to talk. Is it okay if I check in with you about this or would you prefer to come to me?"

What are some things I should AVOID saying or doing?

The following behaviors can actually increase your child's self-injurious behaviors:

·      Yelling

·      Lecturing

·      Put downs

·      Harsh and lengthy punishments

·      Invasions of privacy (i.e., going through your child's bedroom without his/her presence)

·      Ultimatums

·      Threats

Avoid power struggles. You cannot control another person's behavior and demanding that your loved one stop the self­-injurious behavior is generally unproductive. 

The following are examples of unhelpful things to say:

·      "I know how you feel." This can make your child feel as if "their problems are trivialized.

·      "How can you be so crazy to do this to yourself?"

·      "You are doing this to make me feel guilty."

·      Take your child seriously. One individual who struggles with self-injury described her disclosure to her parents in the following way: “they freaked and made me promise not to do it again. I said yes just to make them feel better though. That settled everything for them. I felt hurt that they did not take me seriously and get me help.

Adolescent Counseling Services is a community non-profit, which provides vital counseling services on eight secondary campuses at no charge to students and their families. To learn more about our services please visit the ACS website at www.acs-teens.org or call Sabrina Geshay, LMFT Site Director at Gunn (650) 849-7919.  ACS relies on the generosity of community members to continue offering individual, family, and group counseling to over 1,500 individuals annually.  ACS provides critical interventions and mental health services, building a better future for tomorrow. If you are interested in helping to support our efforts, do not hesitate to call to make a donation. It goes a long way in helping teenagers find their way!