Teen self-harm was not top of mind for Dyan Aretakis when, ten years ago, she noticed cuts on the upper thighs of her teen patient. The girl offered what seemed like an adequate explanation — the cuts came from riding a horse through brush. Years later, Aretakis realized that what she’d seen was definitely not a sports accident.
Now that cutting in teens has begun to reach a “crescendo,” Aretakis knows exactly what to look for. And at the UVA Teen Health Center, she sees a lot of it during routine exams.
What is Cutting?
Technically, intentionally cutting yourself falls into the “non-suicidal self-injury.” Other behaviors in this category include banging, bruising, self-hitting and burning — any self-destructive, repetitive behavior outside the norm. Cutting involves knives or any sharp object. Girls choose cutting 70 percent of the time; boys more commonly bang their heads.
Usually cutting and other self-injury is not severe enough to warrant medical attention. And it doesn’t necessarily predict suicidal thoughts; it depends on the underlying causes.
Kids Who Cut
Aretakis says cutting is definitely a “young person’s thing.” About 15 percent of teens do it. Statistics show peak initiation occurring between the ages of 12-15 and 18-19.
“There’s no doubt we do see it associated with kids with serious mental health issues,” Aretakis says — 70-75 percent of teens diagnosed with borderline personality disorder do it, as do large percentages of teens with dissociative disorders, eating disorders and depression. But “we see it in kids with less serious health issues, too, as a response to bullying, abuse or out of curiosity. Boys and girls.”
What Causes Teen Self-Harm?
For those who don’t self-harm, the reasons teens cut may seem counter-intuitive.
“It really serves a function of stress reduction,” Aretakis says. “If you’re in emotional pain and want to relieve it, you might do something worse or more dramatic. Kids see cutting as an option” that actually proves less destructive than other ways they could react to stress, like hurting other people or property.
Cutting as Stress Relief
To understand how cutting might serve to release stress, Aretakis reminds us about the teenage brain. Teens do not have a developed prefrontal cortex — the part of the brain that makes rational decisions. This is why they tend to act more impulsively than adults. They also have less experience and ability in processing emotions.
Some theorize that the act of cutting releases serotonin, the hormone responsible for regulating anxiety and happiness. “If it provides relief, they’ll do it again,” she notes. The physical pain may draw attention away from the emotional pain.
Teens apparently report a number of reasons for cutting themselves, including to:
- Feel anything, even pain, rather than numb or empty feelings
- Stop bad feelings
- Take control of a situation
- Get a reaction or attention from someone
- Have something to do when alone
- Demonstrate anger
Aretakis sees teens in general as dealing with “so many underlying stressors and mental health issues, and there’s just not enough mental health services for kids. They’re really struggling because of sports and jobs and classes. Or struggling with a lifetime of trauma. They’re so vulnerable.”
Sometimes, though, the causes or reasons for a teen’s self-harming behavior can be more ambiguous.
“There’s so many different things going on for a kid who gravitates towards this,” she says. “There is sometimes the element of curiosity. Because it is so prevalent, kids get exposed to it and try it.”
Tips for Parents to Prevent, Intervene, Support
Pay Attention
Self-harm can become a mechanism for “self-soothing that’s harder to stop the longer it goes on,” Aretakis says. “A parent or professional needs to intervene early on.”
This can prove tricky. Especially if the youth in question hides the behavior.
“Some kids keep it very, very private,” she says. “They can hide it at the tops of their legs where parents may not be able to see it — and won’t see it, until we get into warm weather.”
So how do you know if your child is cutting, or at risk of self-harm?
Pay attention to your teen. Warning signs to watch:
- The makeup of your child’s friends or lack of friends
- Mood changes — increasing irritability or more withdrawn behavior
Try Therapy
Once discovered, “it’s really the role of the person involved in the teen or young adult’s life to tease out the underlying causes” and address them.
“If there’s a root or baseline of anxiety or depression, cognitive or dialectical behavioral therapy or medication can help,” Aretakis says. The goals of therapy are often to help a teen regulate emotions, problem solve and improve self-esteem.
Other than that: There are no known researched, evidence-based treatments.
Talk With Your Teen
When talking to your teen about self-injury, Aretakis advises adults to:
- Understand and avoid labeling, such as assuming the self-injury is suicidal
- Gather information about the frequency of self-injury
- Find out if the teen is thinking about suicide
- Express empathy
- Avoid arguing with the teen
Validate your child’s experience. Ask questions:
- How does it make you feel?
- What does it do for any pain you may feel?
- What kind of relief do you get from doing it?
- Does it relieve your emotional pain?
Listen with empathy and a lack of judgment. You can apply these strategies to any teen struggling with emotions and stress.
Concerned About Your Teen Cutting?
Get support: Visit the Teen and Young Adult Health Center.
Help Your Teen Cope
You can try to help your teen:
- Find a substitute coping strategy, like mindfulness
- Recognize and name triggers, then avoid them
Several resources (PDF) exist, either online or from a health provider. Aretakis shares “rules” from The Butterfly Project, which challenges teens to draw a butterfly on their arm instead of cutting. If your child wants to find alternative activities for self-soothing, some to try include:
- Taking a bath
- Hot yoga
- Writing a poem
- Playing with playdough
The bottom line for parents: Stay active and involved.
“As a parent, you do feel sad, and it is hard to understand,” Aretakis tells parents. “The sooner you can address it with a professional, the better. It is likely there will be a constellation of issues, so the focus is not only on the skin changes, but on the whole individual and what their life is like at this time.”