Risky Business
Why kids cut and what to do about this dangerous
behavior.
by Sony Khemlani-Patel, Ph.D., Merry McVey-Noble,
Ph.D., Fugen Neziroglu, Ph.D., and Steve Weissman,
Ph.D.
TWEENS & TEENS News September
2007
Some of the friends Erin had counted on during
adolescence seemed to disappear in high school,
dumping her for “cooler” teens.
Erin became quite irritable at home, spurring
frequent fights with her parents. Though she
realized her parents’ good intentions,
Erin felt infuriated by their unhelpful suggestions,
like: “Don’t worry, we’re
sure you’ll make new friends soon. Just
be patient.”
A few months into her freshman year, Erin
met Paul, her first boyfriend. She wanted
to spend every minute with him. Suddenly,
not having many friends didn’t seem
to matter anymore. But Paul, a great boyfriend
in many ways, didn’t need Erin the way
she needed him. While Erin spent hours planning
to spend Saturdays night with him, Paul often
let her know at the last minute that he had
plans with his friends. When this happened,
Erin became outraged and miserable, but never
really told Paul how she felt— she didn’t
want to drive him away. During these times,
Erin truly felt isolated.
Erin recalled reading about a girl who cut
herself when she became upset. The behavior
initially seemed ridiculous. Yet one Saturday
night, overwhelmed by intense emotions, Erin
thought about what she had read and tried
cutting herself with a razor blade. At first,
she couldn’t believe she was cutting.
Afterward, she felt relieved, relaxed and
satisfied, considering herself brave. Within
a few weeks, Erin found herself cutting whenever
she felt overwhelmed by intense negative emotions.
One Monday, after another weekend cancellation
by Paul, Erin heard a rumor in school that
her boyfriend had been seen with another girl.
All day, Erin thought about cutting at home.
But when she actually did the deed, Erin was
so overcome with emotion that she injured
herself more than she had intended. Though
she wasn’t suicidal, Erin realized that
she might have injured herself badly enough
to end her own life. Fortunately, Erin’s
mother was home when Erin came to her severely
bleeding and distressed. Erin’s mother
recognized the danger and took Erin to the
hospital immediately.
With Erin’s self-injury out in the open,
Erin’s entire family was terrified.
At least Erin’s treatment team at the
hospital had informed the family that cutting
is treatable. Erin and her parents were able
to get into a treatment program called Dialectical
Behavioral Therapy or DBT. This program stresses
that it’s fine to be upset, feelings
and thoughts are neither wrong nor dangerous,
and there are better ways to handle intense
emotions than by cutting. Erin’s DBT
focused on teaching her how to handle intense
feelings without hurting herself, and provided
her with healthy strategies to regulate her
feelings.
Erin’s parents insisted she stick with
the program and they supported her through
it. A small part of Erin was glad her parents
wouldn’t let her quit the treatment.
One year later, Erin remained emotionally
intense and had difficulty tolerating disappointment,
loneliness, rejection and abandonment. She
still occasionally thought about cutting,
however, she had learned effective ways to
handle her feelings. It had been six months
since Erin last cut herself; she doubted she
would ever do it again.
Why Do Some Teens Cut?
•People who cut themselves often describe
self-injury as a way of relieving stress or
calming down when they get highly upset.
•Some people experience emotions more
strongly and intensely than other people.
For these people, good emotions are great,
but negative emotions— sadness, anger
and loneliness— can feel almost unbearable
and persistent. Teens who experience such
drastic emotions are more likely to take drastic
steps to “regulate” their emotions.
•Teens who cut, like many teens, often
feel as if their parents and friends don’t
understand them. Thinking this way can lead
to increased frustration and loneliness, further
motivating dangerous behavior like cutting.
•Some people think cutting is just a
way of getting attention. Remember this: There
are lots of ways to get attention. If people
choose to cut holes in their bodies, they
must be in an extraordinary amount of emotional
pain.
What Makes Cutting Dangerous?
•Teens who cut tend to justify the behavior
by thinking, “it’s only a few
scratches” or “I’m in control
of my cutting.”
•Because teens who cut themselves are
usually not thinking clearly during the dangerous
act, they may cut themselves much more seriously
than they had intended. Even small incisions
can spur life-threatening behavior.
•Cutting can also become an addictive
behavior. The more a person cuts, the more
frequently he or she may rely on cutting,
and the more that person may need to cut in
order to calm down.
•Cuts can get infected. But because
many teens who cut keep the behavior a secret,
they are not likely to seek medical attention
for their infections.
•Cuts leave scars. These scars can frighten
friends and family members and serve as a
constant reminder of the problematic behavior—
both of which can lead to more negative emotions
and induce more cutting.
Warning Signs That Someone You Know
May Be Cutting.
If you notice at least two of these signs
in a friend, you may have cause for concern,
particularly if that friend’s behavior
has recently changed, like the person seems
more depressed, argumentative or secretive.
Warning signs include:
•Multiple unexplained scars, especially
on the arms, legs and stomach.
•Vague or unreasonable explanations
for the injuries. For example, “I scratched
myself on a rusty nail” isn’t
a likely explanation for three, neat and even
cuts on the inside of someone’s arm.
•Doing things that suggest a friend
is hiding scars, such as wearing long sleeves
and pants even in hot weather or avoiding
activities such as pool parties, sleepovers
and sports.
•Talking about cutting, even if the
person seem to be joking. A teen who cuts
may be trying to gauge your reaction to the
topic.
•Regularly carrying things that can
be used to cut, like razor blades, paper clips
and pins.
•Having friends who cut. People who
have friends who cut may be at a greater risk
to start cutting themselves.
What Can I Do If I Suspect Someone
Of Cutting?
•Talk to your friend about it. Try to
stay calm and avoid accusations. Stick to
the facts— what you’ve noticed
that worries you— and remind your friend
how much you care and how you don’t
want to see him or her hurt.
•Validate your friend. Reveal your willingness
to listen and that you’ll do your best
to understand what’s so upsetting. Don’t
tell the person that his or her problems aren’t
so bad.
•There is no “good” time
to talk to a friend about cutting, but it
is best to avoid discussing the behavior during
a fight, in front of other people or during
any stressful or potentially embarrassing
situation.
•Consider telling a parent or another
trusted adult in your friend’s life
about the potential problem. Ultimately, only
a parent can get your friend into the type
of treatment program that he or she needs.
Speaking to a parent can be an extremely difficult
decision to make. Yet, it may save your friend’s
life.
Sony Khemlani-Patel, Ph.D., is a cognitive
behavioral psychologist and executive director
of the Bio-Behavioral Institute. Merry McVey-Noble,
Ph.D., formerly at the Bio-Behavioral Institute,
is currently a supervisor at the Counseling
Center of Hofstra University. Fugen Neziroglu,
Ph.D., ABBP, is a board-certified cognitive
behavioral psychologist, clinical director
of the Bio-Behavioral Institute in Great Neck,
New York, and professor of psychology at Hofstra
University. Khemlani-Patel, McVey-Noble and
Neziroglu are also the authors of When Your
Child Is Cutting: A Parents Guide to Helping
Children Overcome Self-Injury (New Harbinger
Publications). Steven Weissman, Ph.D., is
a staff psychologist at the Bio-Behavioral
Institute and is specially trained in dialectical
behavior therapy, marital and family counseling,
and the treatment of anxiety and mood disorders.
