Self-harming teenagers

We have noticed cuts on our 14-year-old daughter's wrists and arms at different times. When we ask her what happened she tells us the neighbour's cat scratched her or she avoids answering our question altogether. She used to be a happy and outgoing girl. Lately, she's been very moody, spending a lot of time in her room. We have also noticed that she is wearing long-sleeve clothing quite often even when it is warm. We are worried, but she always denies that there is a problem.

Your daughter is probably engaging in a form of self-injury called cutting, and needs additional help. Teenagers who cut generally use a sharp object such as a razor blade, knife, scissors or even paper clips or pens to make marks, cuts and scratches or carve words onto their body. Some self-injure by burning their skin with a cigarette end or lit match. Cutting may occur on wrists, arms, legs or the belly.
 

Why would kids intentionally cut themselves?

Some cut because of peer pressure, others because of the need to be perfect and the struggle to accept failures or mistakes. Some do it through feelings of anger, sadness or despair. Cutting is sometimes the result of trauma and difficult experiences such as a failed personal relationship, bullying or poor grades at school. According to Wendy Lader, co-author of Bodily Harm, cutting is a way to control emotion. For teens experiencing intense emotions, cutting may be used to lessen the intensity, whereas for teens feeling a sense of numbness, it may help them to feel something.
 

Who cuts?

Even though you may not have heard of it, cutting is an increasingly common behaviour among teens, particularly in cities. Approximately 15 to 20 per cent of adolescents in the US and UK have reported trying cutting. Although rates are not well-documented, cutting is becoming a growing phenomenon in Hong Kong. Studies indicate a more authoritative style of parenting and teaching and poor communication or conflict resolution skills may be some of the reasons. Most of the patients I've seen who cut are girls aged 12 to 24, but boys and children as young as five to seven years old have been known to self-injure as well.

Teens who engage in cutting may suffer from other mental health issues such as depression, substance abuse, obsessive thinking or eating disorders. Some may have had a traumatic experience, such as physical abuse or living through a natural disaster. However, cutting is generally not the result of suicidal thoughts.
 

What happens to kids who cut?

Although cutting may provide some temporary relief from tension, the relief doesn't usually last. Cutting can become compulsive behaviour. The more a young person engages in it, the more he or she develops a false sense of relief from cutting and craves this release the next time stress builds. When cutting becomes compulsive, it can be very difficult to stop.
 

What are the warning signs?

Warning signs among teens include unexplained cuts, withdrawal from family and friends and changes in communication, eating or sleeping patterns. Kids may wear long sleeves or trousers (even when it is quite hot) as well as wristbands and bracelets to hide marks. They may avoid going to the pool or gym/sports practice where cuts may be revealed. Most of my teen patients told me that they kept their cutting a secret and would not have discussed the behaviour on their own unless they had been directly asked and felt comfortable with the person they were discussing it with.
 

What is the treatment?

During adolescence, teens should be able to think about problems, describe their feelings and talk about issues. Cutting is a sign that some of these abilities have not fully developed. Treatment by mental health professionals involves an evaluation of underlying triggers and mental health concerns. It may also include individual or group therapy, raising awareness and developing distraction techniques such as writing a journal, exercising, yoga or even snapping a rubber band on the wrist.
 

What can you do?

Find out all you can about cutting, why teens do it, and what can help them stop. Start the discussion with your child, by saying you know about the cutting and that you want to help him or her to stop. Let your child know that cutting is often related to painful experiences or intense pressures, and ask what difficult issues he or she is facing. Teens may deny the cutting, feel embarrassed or get angry. Try not to place blame and if need be find another time to communicate.

• Communicate with your child.

Therapists can help kids identify underlying mental health conditions and, even more importantly, discover their strengths. These can be used to cope with problems. For many teens, cutting is a sign of depression or a struggle with perfectionism. Try to find a therapist your teen feels open and comfortable with. If you need help finding someone, your doctor or a school counsellor might be helpful.

• Get professional help.

While your teen is getting professional help, stay involved in the process. Encourage your child to talk about everyday experiences and put his or her thoughts, needs and frustrations into words. Spend time together doing fun or relaxing activities. Positive attention is an important part of the healing process.

• Offer support.

Notice how you manage your own emotions and deal with stress and be aware that you can shape how your child responds to pressure. Consider making changes in any patterns you don't want your child to imitate. With guidance, know that your child can stop cutting and learn ways to cope.

Anisha Abraham is an associate professor of paediatrics at Georgetown University in Washington and a visiting scholar at the Chinese University of Hong Kong