My Teen is Cutting: What can I do?

Liz and Dan recently received a call from the school counsellor informing them their 14 year old daughter, Becky, has been cutting herself. Liz and Dan were in disbelief and confusion. Becky has always been an outstanding child who is friendly, outgoing, does well in school, is in cheer competitively and helps out around the house. When meeting with Becky, the therapist discovers she has been feeling extremely overwhelmed by pressures to be perfect and successful. Becky started self-harming last year and finds it helpful in calming her anxiety. Finding out your loved one is self-harming is often a surprising time for a parents that generates a mixture of emotions including anxiety, fear, hurt, anger, and much more.

According to the Canadian Mental Health Association (2010), self-harm occurs in 1-4% of the general population and in 14-39% of the adolescent population. According to the DSM V (2013) a person would meet criteria for non-suicidal self-injury (NSSI) if within the past year, on 5 or more days, s/he engaged in intentional self-inflicted damage to the surface of the body without a suicidal intention. Examples of self-injury are cutting, burning, hitting, stabbing, or excessive rubbing. Moreover, the individual is engaging in the behavior to meet one, or more, of three expectations: to induce a positive feeling state, to resolve an interpersonal difficulty, or to obtain relief from a negative feeling or cognitive state (APA, 2013). The self-injury must also be associated with one of three things: a period of preoccupation with the intended behavior that is difficult to control, thinking about self-injury that occurs frequently, or interpersonal difficulties or negative feelings or thoughts occurring in the period immediately prior to the self-injurious act (APA, 2013).

Self-injury can be a difficult thing to discover. Some warning signs that an individual may be self-harming include: having unexplainable cuts, burns or bruises, having unexplainable scars, stating s/he is accident prone, or covering his/her body regardless of the temperature (Canadian Mental Health Association, 2010). Some risk factors for self-injury include: adverse life events such as victimization or trauma, stressful life events, depression, anxiety, substance use, and a family history of self-harm. Levenkron (2006) describes those who self-harm as lonely and fearful individuals who have a perceived, whether real or imagined, concern of disappointing another. Often these clients report overwhelming emotion with few emotional regulation skills. A teen may appear to have her life together on the outside while experiencing an emotional storm on the inside. Levenkron (2006) also mentions the connection of self-harm to trauma and indicating the traumatic events may be subtle such as a parent with a mental or physical illness or having a divorced family to more unsubtle forms of trauma such as incest or abuse.

Parents are often at a loss on what they can do to help their teen. Three things parents can do to help their teen include:

1. Educating themselves. There are many myths about self-harm that could taint your perception and make matters worse. Reading resources such as Helping Teens Who Cut: Understanding and ending self-injury by Michael Hollander, accessing information through the Canadian Mental Health Association website (www.cmha.bc.ca), or talking to a professional such as a your family doctor or therapist.

2. Practicing your own self-care: without self-care, parents of self-harming teens are at risk for burnout. Burnout can effect your relationship with your children, spouse, your work, and your ability to effectively support your teen. Emphasizing basic self-needs such as balanced sleep, healthy eating, regular exercise, and avoiding excessive use of alcohol, drugs, or caffeine.

3. Validating your teen’s experience: approaching your teen with judgment about his or her actions and experience can generate greater family polarization, ultimately pushing your teen away from you. Being open, accepting, and curious about your teen’s experience will result in a stronger bond and foster collaboration. Some examples of validation include avoiding personal references, practicing attentive and active listening, and avoiding the word ‘but’.

At the end of the day, your teen is probably experiencing the same fear, confusion, and intense emotion that you are. Being kind, collaborative, and open will be more beneficial than being angry, passive, and accusatory.

References
Canadian Mental Health Association. (2010). Self harm. Retrieved from http://www.cmha.bc.ca/get-informed/mental-health-information/self-harm
DSM-V handbook of differential diagnosis. (2013). Arlington, VA. American Psychiatric Publishing, Inc.
Levenkron, S. (2006). Cutting: understanding and overcoming self-mutilation. New York: NY. Norton and Company.