By Fernando Espi Forcen, MD, PhD

Posted in: Parenting Concerns

Topics: Behavioral Issues, LGBTQ+, Mental Illness + Psychiatric Disorders

Este artículo está disponible en español.

You can also listen to a more detailed conversation about self-harming behavior in teens. Tune in below, or search for “Shrinking It Down” wherever you stream.

What is Self-Mutilation?

Cutting and other forms of self-mutilation are common behaviors in children with mental health challenges. Other self-harm behaviors include burning with cigarettes or lighters, hitting oneself to the extent of causing bruises, piercing one’s skin, self-biting, or pulling one’s hair. The reasons that children cut themselves may vary. Harming oneself is not necessarily related to suicidal thinking or behaving. Children and adolescents who harm themselves frequently do so to reduce and cope with emotional distress. Thus, in some way, the sensation of physical pain may relieve emotional pain.

Why Do Young People Cut Themselves?

The reasons may vary. As noted, self-cutting can be a way to relieve emotional stress. Hurting oneself physically can help with feelings of anger, resentment, or sadness. Often these cuts are superficial and heal on their own. But in other cases, the cuts can be deep and require medical attention.

A child may feel overwhelming emotional distress and that their problems don’t have an easy solution, so they harm themselves to regain a sense of control. Other times, a child may feel confused and disconnected from reality, which poses an unconscious type of distress. Here, the child or adolescent does not understand very well why they are stressed out or what is worrying them. In these cases, cutting or self-mutilation can make them feel connected to reality again. Often, a child may pick up the idea of ​​cutting themselves from a friend, classmate, or family member who is self-harming.

There are also times when a child or adolescent cuts themself, feeling hopeless and helpless as a means of attempting suicide. Thus, it is critical to find out if the cutting is a means to relieve emotional pain or end one’s life.

Clinical Tip: It is always important to ask your child why they are cutting, and be sure to ask if their intention is to kill themselves. It is a myth that asking this question will actually cause suicide. In fact, it is a relief to the child to be asked. The key, and this may be a good reason to get a professional mental health evaluation, is to determine if there is a threat of suicide; to recommend treatment for an underlying condition such as a mood disorder; and to provide you some ways of helping to support your child at home.

What Are the Causes of Cutting?

As mentioned, both perceived and unconscious distress are the most immediate causes of self-cutting. Young people and adults who cut themselves generally have a hard time managing their emotions. But one may wonder, what are the underlying causes for a person to arrive to this situation? Scientific research has shown that many children and adolescents who cut themselves have psychiatric disorders such as mood disorders or substance use issues with alcohol or other drugs, and these biological conditions may be hereditary. At the same time, a history of physical, psychological, or sexual abuse is highly associated with the risk of a self-cutting to manage emotional distress, though this is not the only reason for cutting.

Do Those Who Cut Have a Psychiatric Disorder?

In general, most people who cut themselves suffer from some type of mental health disorder. Cutting or self-mutilation can be a symptom of borderline personality disorder, a disorder characterized by mood problems, distortions of one’s self-image, impulsiveness, and problems in relationships with other people. Other psychiatric disorders related to self-mutilation include depression, bipolar disorder, substance use disorders, and eating disorders.

What Are the Signs of Self-Cutting?

The symptoms that a person is self-cutting are scars, which are often in patterns on the arms, ankles, legs, or groin area. These frequently coexist with more recent and fresh cuts. Other times, the signs are scratches, rubs, burns, bites, or other types of wounds on the child or adolescent. It is not uncommon for young people who cut themselves to wear long sleeves, even in summer, to hide scars and to have a history of unstable relationships with partners, friends, or family. They often say that they are hopeless and that no one helps them with their problems.

What Can You Do If a Child or Adolescent is Cutting?

1. Contact a Parent or Teacher. Parents or teachers are often the first to notice that a child or adolescent is self-injuring. Other times a friend, or a classmate notices the behavior and tells their own parents who contact a school teacher or the child’s parents directly when they know them.
2. Get a Professional Evaluation. In all cases of self-cutting, it is important for a mental health professional to sort out the underlying reason. Schools have social workers who can evaluate the child at the school. When indicated, the social worker can contact you to receive approval for referral to a clinic where they can be evaluated by a psychologist and a psychiatrist . You can always call your primary care pediatrician for a professional mental health referral.
3. Using a Hospital Emergency Room or Urgent Care Clinic. If you are worried that the life of your child is at risk, it is wise to take your child to the nearest hospital psychiatric urgent care clinic or emergency room.  Self-injurious behaviors may require admission to a residential or inpatient psychiatric unit; and in other cases to an outpatient program.
4. Treatments That are Effective. The most recommended treatment, in general, is psychotherapy. There are three types of psychotherapies that have been shown effective in people who cut: cognitive and dialectical behavioral therapy as well as mentalization based treatment. Medications can help with depression, anxiety, and emotional problems associated with self-mutilation, particularly if there is an underlying psychiatric disorder. In addition, other therapies that may be helpful are group therapy with other kids that have challenges regulating their emotions. Finally, family therapy may be useful for support, guidance or to help resolve conflicts in the family that are emotionally distressing to your child.

The bottom line is that cutting is a sign of emotional distress and there is a wide range of conditions that may be the source of concern. The great news is that there are effective ways of managing the cutting, determining the causes, and treating underlying conditions.