Self Injury

We have recently been getting lots of questions about “cutting”.

What is it? Self-Injury (also called self-harm) is an unhealthy way to cope with uncomfortable emotions by deliberately harming one’s body and can take a variety of forms, including cutting, hitting, or pinching. It is important to understand that self-injury is not a suicide attempt. Although teenagers who engage in self-injurious behaviors are more at risk and may have thoughts of suicide, suicide attempts are different than self injury.

So, if not suicide, WHY do they do it? This is a frequent question we hear from parents.

While we have found that each situation is unique and self-injury behaviors surface for a variety of reasons, for the purposes of this article we will attempt to over simplify this behavior and break it down into a few predominant reasons for self-injury:

1) In some cases, a child who self-injures believes they deserve to be punished because of something they have done, something they haven't done, or simply because of whom they are. In our experience these children are extremely hard on themselves and beat themselves up with their own words far beyond their parents can fathom.  Clients who fit in this category typically struggle with anxiety on some level and have perfectionist tendencies. These children struggle to define realistic expectations for not only themselves, but others as well. It should be noted that their expectations for themselves are far greater than that for others. As a result of their unrealistic expectations they often feel as if they are worthless or a failure. Self-injury seems to be their attempt to cope with their feelings of shame and worthlessness resulting from their negative thoughts. These children often overly personalize their experiences and the world around them. For instance, when seeing someone else succeed they will assume that accomplishment came easy to the other child and further beat themselves up for struggling at a similar task.

2) Self-injurious behaviors can also be prevalent with children who struggle with depression. These children often struggle to feel anything other than sadness or numbness. As an attempt to feel something, anything, they inflict pain. The pain is a new feeling and it also releases endorphins that send a false 'positive' feeling or a feeling of relief to the brain. Cutting can be a means to feel something and to cope with the overwhelming negative feelings that dominate their thinking.

3) Because self-injury is often done impulsively, it can also be the result of an impulse-control problem. When children struggle to regulate their emotions such as frustration, they may impulsively injure themselves in an attempt to cope with their overwhelming emotions because they lack appropriate coping skills.

If, as a parent, you worry your child is struggling with similar symptoms approach your child thoughtfully without intensifying the shame they already feel.  Also, please don't over personalize the situation if they haven't come to you directly for help. Often these feelings are so intense that they feel too ashamed or worthless to reach out to the loved ones in their lives. As someone not emotionally involved, a therapist can offer an outside perspective.  In our practice we with work with the whole family to assist in facilitating difficult conversations, such as conversations about self-injury. Don’t try to deal with this alone; self-injurious behaviors are serious behaviors that require professional help.