Question: My 14-year-old daughter always wants to wear long sleeve shirts and cover her wrists. The other day, I saw scars on her wrists and inner thighs. She talks about how other girls in school cut themselves when they are upset, and I think she is cutting too but doesn’t want us to find out. What should we do? How can we help her?
Answer: It sounds like you are in tune with your adolescent. While this article provides general information about self-harm behaviors, it is not medical advice. Please have your daughter see a trained mental health professional to assess her self-harm behavior and provide you with specific treatment recommendations. The sooner your adolescent gets help, the better.
What is Non-Suicidal self-injury?
Non-suicidal self-injury is a behavior when someone purposefully hurts oneself and inflicts pain on one’s body. This does not include socially acceptable behaviors – such as tattoos, piercings, and other forms of body art.
Unfortunately, you may hear someone who self-injures described as a “cutter.” This is not an accurate description of the behavior. First, self-injury involves other methods apart from cutting. Secondly, the term “cutter” describes a person and their character, when in reality, self-harm is a behavior and is not who someone is.
Is self-injury the same as a suicide attempt?
Not all self-injury behavior is a suicide attempt. One of the differences is the individual’s intention behind the self-injury. There is suicidal self-injury where the person’s intent is to end their life. And, there is non-suicidal self-injury where the individual’s purpose behind doing it is for different reasons, such as to emotionally regulate, end a feeling of pain and suffering.
In addition, suicidal self-injury are typically more severe and more lethal. Non suicidal self-injury involves less severe and extreme behaviors that result in self injury to the body.
Why do adolescents self-injure?
Some of the most common reasons are:
Affect regulation: adolescents can get easily overwhelmed, especially if they are dealing with depression, anxiety, and inter-sonar stressors. Self-injury helps them distract themselves from the emotional overwhelm, albeit short lived.
Self-Punishment: adolescents may self-injure to express anger and frustration with themselves.
What are Parents Reaction to adolescents who self-injure?
Families are an important part of recovery from self-injury. A study in adolescents found that a perceived level of family support was associated with starting, continuing, and stopping of self-injury. Having your adolescents disclose self-injury behavior is a first-step towards recovery and improving familiar and social support. However, it is complicated as parents are the gatekeepers to seeing a therapist and getting treatment. Often, family members want to help; however, gauging the reaction of family members can be challenging.
Your first step towards being able to help your adolescent is becoming aware of what your potential reactions are when your adolescent discloses that they self-harm or when you bring that concern up to them.
Common reactions include:
Denial: It is difficult for parents to understand why their child self-injures and as a result parents tend to deny that it happens.
Anger: Adolescents struggle with being open about self-injuring and as a result, the parent can become angry with their child.
Bewilderment and guilt: Parents often blame themselves for not noticing the self-injury behavior earlier and feel like they may have caused it.
Overwhelmed: Parents have to manage many different things for their household and children. Finding out about self-injury can be one more thing to be added to the already overwhelmed parent.
Anxiety/fear: Parents are often afraid to leave their child alone for fear that they may self-injure and their safety.
Minimization: Some parents think that self-injury is a phase that will pass and dismiss it. They may put their adolescent at risk for safety without addressing the underlying causes and mental health concerns.
Relief: Some parents feel a relief as they were already suspecting or fearing that their adolescent is self-injuring.
How to talk to your adolescent who self-injures?
Don’t be judgmental: approach the discussion with an open mind. Your adolescent is likely dealing with guilt and shame around self-injury. Providing a safe supportive space sends the message that it is ok to talk about self-injury so that your adolescent feels heard and seen, not judged.
Do focus on the behavior of self-injury, not the identity of self-injury: Self injury is a behavior used to cope with stressors. It is not the adolescent’s identity. You may have heard others refer to the adolescent who self-injures as a “cutter”. The term is inappropriate as it renders the self-injury behavior as a character defect and further increases the shame and the guilt and decreases the chances of being able to apply an intervention. Self-injury is a behavior that can be changed with learning different skills.
Don’t overreact, stay calm and collected as your adolescent talks to you about their self-injury behavior. Communicate that you are not concerned about them but that you are there for them and are there to help them get through it. Adolescents are often scared themselves from the emotions that come up and cope with them by self-injuring.
Do use code words: Sometimes, it can be hard for an adolescent to verbalize that they have thoughts about self-injury. Finding some code words that they communicate to the parent to let them know that they need support is crucial and focuses on changing the behavior without overwhelming the parent or adolescent.
Don’t think of self-injury as a way to get attention: You probably often heard others say that the adolescent is self-injuring as they are “just attention seeking”. That may seem like that on the outside. However, looking into it deeper, the adolescent is dealing with difficult emotions and feeling disconnected and looking for a way to cope. This is not to justify self-injury but to help you have more compassion and empathy towards your adolescent. They are trying to cope the best way they can and self-regulate, though it may not be the healthiest way. That is why they need your help and support.
Do use a functional model to understand self-injury: Spend time with your adolescent to understand the triggers and warning signs of the self-injury behavior. This would help the adolescent find healthier ways of coping with emotions, triggers, and emotionally self-regulate.
What organizations and resources are available for support of individuals who self-injure?
There are no general peer-support groups (such as AA) to support people who self-injure. However, there are some therapy practices that are evidence-based and help people cope with self-injury behavior.
Dialectical behavioral therapy (DBT) is an evidence-based therapy that can help individuals with impulses to self-injure. Find a therapist who is trained in dialectical behavioral therapy for your adolescent to see.
SAFE alternatives runs support groups their group and can be found at:
International Society for the Study of Self-injury
Cornell research program on self-injury and recovery
Self-injury: Alexian Brothers. Center for Self-injury Recovery.
By Nesrin AbuAta