‘Cutting’ to cope

For some teenagers, self-mutilation is a way to relieve tension and feel...something.

By DR. MIKE GROPPER
Teen depression (photo credit: INGIMAGE)
Teen depression
(photo credit: INGIMAGE)
Dina is a 14-year-old girl. She lives at home with her parents and brother, aged 18.
Her brother recently enlisted in the army and comes home only every other weekend.
Dina’s mother called me and asked me see her daughter. She was concerned about how withdrawn Dina was and how much time she spent alone in her room.
In our first meeting, Dina told me how difficult it was to be the only child in the house with parents who argue every day. She said she was certain that one day they would divorce. I asked Dina if her situation made her feel depressed. She stated that she had learned not to expect much from her home environment. I asked her again how the home situation made her feel. She went on to describe how numb she felt, although when I asked, she denied that she would ever try to take her own life. I asked her if she used drugs. She said that she did not, nor did she smoke cigarettes or drink alcohol.
In our second meeting, I asked Dina if she ever cut herself with a sharp object of any kind. This question may seem counterintuitive to many, but it immediately struck home with Dina. She said that one of her friends started cutting shortly after her parents divorced.
Dina told me that she got the idea from this friend and started to do it. At first, Dina used her nails to dig into her skin, and then she began to use sharp objects, even a razor blade, to penetrate her skin. She stated that the cuts were mostly on her upper and lower arms. She said that she was careful not to go too deeply, only deep enough to make herself bleed.
In spite of the rather warm weather, she wore longsleeved shirts to cover up the marks.
Over the years, I have seen many teenagers like Dina who exhibit this behavior. Dina knew exactly what I was referring to when I asked her if she ever cut herself.
What may surprise readers, including parents, teachers and school guidance counselors, is that self-harm behaviors are, in fact, quite widespread. Researchers in the United States estimate that around 17 to 18% of teens (three times as many girls as boys) try this behavior. The rate soars as high as 40% for teenagers in clinical treatment. In 2013, the American Psychiatric Association textbook of psychiatric diagnoses gave this self-harm behavior its own diagnostic term, “non-suicidal self-injury disorder,” referred to as NSSI.
The behavior is non-suicidal because the cutting is not an attempt to take one’s own life but rather a way to self-mutilate one’s body.
What leads to self-cutting behavior?
Teenagers face many pressures, which include changes in their body image, intensified sexual feelings, attraction to the opposite sex and/or the same sex, worries about academic demands, pressures to make friends and fit in, and the struggle to become more independent. While some teenagers have the emotional maturity to deal with these pressures and/ or have someone to talk to when the going gets tough, many others lag behind in their emotional abilities to cope. Some may not know how to process or deal with anger or depression. When a teenager is overwhelmed or has an emotional crisis, this is clearly a high-risk time for getting into emotional trouble. Some youths turn to drugs or alcohol, while others become anxious and/or depressed. Others act out and become rebellious.
Still other teens, predominantly girls, discover the behavior of cutting themselves. They do so in secret and try to pretend that everything is okay. They may continue to do well in school, as was the case with Dina. Overwhelmed with emotional pain and stress, she discovered a way to relieve herself of the tension and to get herself to feel again. For Dina and many other teens, the cutting behavior provides a maladaptive way to cope with their emotions.
Many girls share that they are sickened but also fascinated when they first hear of cutting. From there, the information is stored on a shelf in their easily accessible memory. It becomes an option for them. Depending on factors such as stress levels, sensitivity, vulnerability, emotional development, availability of emotional support and overall lifestyle health and balance, a teenage girl either will or would not explore cutting herself.
Cutting is a coping mechanism, which means it is a way to regulate feelings. Unfortunately, it “works” in that teens who cut report that it makes them feel better.
They like the fact that the cutting behavior gives them a sense of control. They are able to keep the behavior a secret, and see and feel results.
Most experts agree that cutting is a symptom that is secondary to some core psychological and/or interpersonal problem. In fact, researchers have found that cutting may also be associated with depression, bipolar disorder, drug and alcohol use, and eating disorders. It is also quite an addictive behavior, as the emotionally distressed teen learns to associate cutting with feeling relieved, in control and/or calm.
In Part II, I will describe the role that parents, teachers and counselors can play in preventing this behavior, and I will talk about the treatment for cutting and other self-harm behaviors.
The writer is a marital, child and adult cognitive-behavioral psychotherapist with offices in Jerusalem and Ra’anana.
www.drmikegropper.weebly.com; drmikegropper@gmail.com