A concerned parent commented to one of my blogs “Could My Teen Commit Suicide?” by describing his 14 year old daughter who had begun cutting herself.

He asked “Could this be a warning sign?”

Recently two colleagues raised concerns about young people engaged in cutting – one a female college student and one a 15 year old male.

Whether parent or professional, this is a topic that concerns and confuses us. It is one that we cannot ignore. It is one worth asking- Why Do They Do This?

What is Self-Injury?

  • Self-injury refers to a variety of behaviors which might include cutting, burning, scratching, self-mutilating etc. in which an individual intentionally inflicts harm to his or her body for purposes not socially recognized or approved and without suicidal intent.
  • Whereas people of any age or gender use self-injury, it is most common in the adolescent years. Studies find that 6%-8% of adolescents and young adults report current, chronic self-injury.  About a quarter of all adolescents and young adults with a history of self-injury have tried it only once. For some, however, even a single episode can reflect intolerable emotional pain and willingness to engage in risk behavior to escape it.

Is Self-Injury a Warning Sign of Suicide?

It depends. While the behavior may look similar, there is actually a difference between self-injury, which is sometimes termed “Non-Suicidal Self-Injury” (NSSI) and Suicidal Behavior. Self-injury is actually a maladaptive coping mechanism. Most describe it as a way to deal with overwhelming negative feelings to avoid suicide. Instead of feeling angry, sad, numb or anxious, the person cuts or mutilates self. Instead of screaming they create visible and noticeable wounds. Sometimes they are re-enacting a trauma. Sometimes they are protecting someone else from their anger.

The ritual for one beautiful and bright college student I worked with was to literally take out the rage she felt toward her family on herself by going into the bathroom, locking the door and cutting designs on her stomach. It was never a solution – only a short and painful fix that relieved the tension and distracted her into another place and feeling – never offering her a viable alternative for anger.

The Dangerous Connection to Suicide

Because those who use self-injury are clearly in emotional pain without a viable alternative, the connection between self-injury and suicidal despair can be a cloudy one. While the majority of young people with a self-injury history are reported to never consider suicide, there are others who become desperate in the face of a “fix” that doesn’t work to stop the emotional pain.  The fact is that those youngsters who report the use of self-injury without suicidal intent are still more likely than other young people to report having considered or attempted suicide.

What Keeps This Behavior Going?

Some have suggested that the even short term relief of tension or emotional pain in conjunction with the body’s physical response to injury, (the Endogenous Opioid System (EOS) that regulates pain perception and endogenous endorphins) offers a sense of comfort for a short time that adds to the addictive aspects of self-injury. For many, there is a misplaced sense of control of emotions. It is a solution, although self-destructive, of caring for self without depending upon or being hurt or disappointed by anyone.

Do Young People Want Others to Know?

While some young people want to communicate through self-injury, seek attention or manipulate care – most keep it private. Their self-injury is a dangerous self-soothing that they keep hidden from parents. That said, there is increasing evidence that the place it may be shared and may in fact cause some copy-cat and contagion is in the middle and high school settings. Given media, on-line sites and the treatment of self-injury in movies and news reports – there is some concern that the sensationalism about it may escalate self-injury in some youngsters.

What Can a Parent or Concerned Professional Do?

  • If a parent becomes aware through a youngster’s direct disclosure or after noticing covered sleeves, bandages, etc. that there has been self-injury, it is suggested that they take a position of respectful concern and curiosity.  “Are you OK?”  “Are you cutting yourself?”  If the young person indicates that they are – it is likely time to speak about helping them. “What resources can we find together?” “I want to understand this with you.”  “Let’s find a way to support you.”
  • If a youngster won’t respond or denies self-injury – stay emotionally close in other ways.  If the youngster is depressed, anxious or agitated or has a history or other emotional difficulties seek help together with your child. “I don’t want you to be alone with this pain – Let’s find a way together.”
  • If you are a concerned adult or professional, find a way to connect the youngster and the parents in your outreach to help.
  • If you are dealing with your own child,learn all that you can, try to be understanding and use whatever resources you find to support yourself and your youngster.

Making the decision to have a child is momentous. It is to decide forever to have your heart go walking around outside your body. (Elizabeth Stone)

Listen in to Survivor and Mental Health Professional Savannah Sanders discusses -Sexual Trafficking: A Trauma-Informed Approach to Prevention and Healing