Emma's mom first noticed the cuts when Emma was doing the dishes one night. Emma told her mom that their cat had scratched her. Her mom seemed surprised that the cat had been so rough, but she didn't think much more about it.
Emma's friends had noticed something strange as well. Even when the weather was hot, Emma wore long-sleeved shirts. She had become secretive, too, like something was bothering her. But Emma couldn't seem to find the words to tell her mom or her friends that the marks on her arms were from something that she had done. She was cutting herself with a razor when she felt sad or upset.
What Is Cutting?
Injuring yourself on purpose by making scratches or cuts on your body with a sharp object - enough to break the skin and make it bleed - is called cutting. Cutting is a type of self-injury, or SI. Cutting is more common among girls, but guys sometimes self-injure, too. People may cut themselves on their wrists, arms, legs, or bellies. Some people self-injure by burning their skin with the end of a cigarette or lighted match.
When cuts or burns heal, they often leave scars or marks. People who injure themselves usually hide the cuts and marks and sometimes no one else knows.
Self-injury is not new. It's also not a very common behavior. But lately people are talking about it more. As guys and girls hear about cutting, they may feel curious about it and why people do it. Because it seems a little bit forbidden, some younger teens may think that cutting might make them seem daring, grown up, or popular.
Anna was wearing long sleeves under her soccer jersey again. She told Monica she was worried about getting too much sun. But when Anna raised her arm, Monica noticed fresh cuts on her forearm. When she saw Monica looking at them, Anna said something about losing a fight with her mother's rose bushes.
You're aware that some people — both guys and girls — cut themselves on purpose. Could your friend be one of them? If so, what should you do?
Be an Informed Friend
It can be hard to understand why a friend might injure himself or herself on purpose. Cutting — using a sharp object to cut your own skin on purpose until it bleeds — is a form of self-injury. Guys sometimes self-injure by burning their skin with the lit end of a cigarette, a lighter, or a match. Their skin won’t show cut marks, but it might show the small, round scars of a burn.
Some people turn to this behavior when they have problems or painful feelings and haven’t found another way to cope or get relief.
Most of the time, people who cut themselves don’t talk about it or let others know they’re doing it. But sometimes they confide in a friend. Sometimes a friend might find out in another way.
It can be upsetting to learn that a friend has been cutting. You might feel confused or scared. You may feel sad or sorry that your friend is hurting herself in this way. You might even be mad — or feel like your friend has been hiding something from you. You might wonder what to say, whether to say anything at all, or if there is anything you can do to help a friend who cuts.
It can help you to know more about cutting, why some people do it, and how they can stop. Sharing this information with your friend can be a caring act, and it might help her or him take the first step toward healing.
Ways to Help
Understanding why a friend may be cutting can help you be supportive. But what can you actually do to help your friend stop?
The first thing is to be realistic about what you can achieve: As with any damaging behavior (such as alcoholism, drugs, or eating disorders), some people just may not be ready to acknowledge the problem and stop. So don't put too much pressure on yourself — your friend's problem could be a long-standing one that requires help from a professional therapist or counselor. Therapists who specialize in treating adolescents are often experienced in working with people who self-injure, and can also help with other issues or emotional pain they might have.
Here are some things that you can try to help a friend who cuts:
* Talk about it. You've asked your friend about the cuts and scratches — and maybe he or she changed the subject. Try again. Let your friend know that you won't judge, and that you want to help if you can. If your friend still won't talk about it, just let him or her know the offer stands and you are open to talking whenever he or she wants. Sometimes it helps to let a friend know that you care. Still, even though you do your best, your friend may not want to talk.
* Tell someone. If your friend asks you to keep the cutting a secret, say that you aren't sure you can because you care. Tell your friend that he or she deserves to feel better. Then tell an adult in a position to help, like your parents, a school psychologist or counselor, or a teacher or coach your friend is close to. Getting treatment may help your friend overcome the problem. Your friend may be mad at you at first. But studies show that 90% of those who self-injure are able to stop within a year of beginning treatment.
* Help your friend find resources. Try to help your friend find someone to talk to and a place to get treatment. There are also some good books and online support groups for teens who self-injure. Be careful, though: Although some websites offer useful suggestions about how to resist the urge to cut, the stories or pictures some people send in may actually trigger the urge to cut in those who read or see them. And some sites promote a sense of sisterhood or solidarity that might interfere with a person's getting help. There's nothing cool about cutting — beware of people or websites that suggest there is!
* Help your friend find alternatives to cutting. Some people find that the urge to self-injure passes if they squeeze an ice cube in their hand really hard, draw with a red marker on the body part they feel like cutting, take a walk with a friend (you!), rip up old newspapers, stroke their cat or dog, play loud music and dance, or find another distraction or outlet for their feelings. These strategies don't take the place of getting professional counseling, but they can help in the short run. For more ideas, click here.
* Acknowledge your friend's pain. Let friends who cut know that you get what they’re going through by saying things like, "Your feelings must just overwhelm you sometimes. You've been through a lot — no wonder you hurt. I want to help you find a way to cope that won't hurt you any more." Try to avoid statements that send the message you don't take your friend’s pain seriously (statements like "But you've got such a great life" or "Things aren't that bad" can feel dismissive to a person who cuts).
* Be a good role model. Everyone experiences painful emotions like hurt, anger, loss, disappointment, guilt, or sadness. These emotions are part of being human. Coping with strong emotions — instead of dwelling on them and continuing to feel bad — involves a few key skills, like knowing how to calm yourself down when you’re upset, putting feelings into words, and working out solutions to everyday problems. Be the kind of person who can do this and your friend will learn from you.
And here are things you should avoid doing with people who cut:
* Don't deliver an ultimatum. The best thing friends can do is to be there for each other, accepting and supporting one another without judgment. Try to avoid issuing deadlines or ultimatums to people who self-injure (for example, don't tell them you'll stop being a friend if they don't stop cutting). This strategy doesn't work and it just puts pressure on everyone. Let your friend know that you’ll always be there to talk to.
* Don't accidentally reinforce the behavior. Among some people, cutting can have a certain mystique. If you're concerned about a friend who cuts, don't let your friend buy into the notion that the behavior is a sign of strength, rebellion, punk chic, or simply a part of his or her personal identity. Don’t reward drama with too much attention.
* Don’t join in. A few people may try to get others to cut as a way to be part of the group or to seem cool. They might dare you, or try to convince you to cut to see how it feels. Don’t let peer pressure pull you into doing something you know isn’t right for you. Someone who tries to pressure you probably isn’t a true friend after all.
How Important Is It to Help?
People who cut usually don’t intend to injure themselves severely, and cutting isn’t usually a suicide attempt. Most of the people who cut themselves say they don't mean to die and that they know when to stop. But even when suicide is not the goal, cutting can still cause severe injury or death. People who self-injure risk infections, scarring, shock (from blood loss), and they can die as a result of extreme injury or bad cuts that don't get treated promptly.
Without help, people who cut may also continue to feel socially isolated and depressed. People who self-injure may have other problems (such as eating disorders, obsessive-compulsive disorder, bipolar disorder, borderline personality disorder, or severe depression) that require long-term professional care. By helping a friend address cutting problems, you may open the door for him or her to resolve other issues, too. The first step to getting help is usually the hardest.
It's often difficult to help a friend who cuts and you may not see changes overnight, if at all. Remember, some people aren't ready to face what they're going through — and you can't blame yourself for that. You may need to be patient. But don't take on the burden as your own or feel responsible for your friend's behavior.
Sometimes even the truest friend may need to take a break from an intense situation. Be sure to care for yourself, and don’t allow yourself to be drained or pulled down by your friend's situation.
Reviewed by: D'Arcy Lyness, PhD
Date reviewed: March 2006
http://kidshealth.org/teen/your_mind/feeling_sad/cutting.html
http://kidshealth.org/teen/your_mind/problems/friend_cuts.html
With all the talk about it, cutting can almost seem like the latest fad. But cutting is a serious problem.
Why Do People Cut Themselves?
It can be hard to understand why people cut themselves on purpose. Cutting is what experts call an unhealthy coping mechanism. This means that the people who do it have not developed healthy ways of dealing with strong emotions, intense pressure, or upsetting relationship problems.
There are lots of good, healthy ways to cope with difficulties, such as talking problems over with parents, other adults, or friends; putting problems in perspective; and getting plenty of exercise. But people who cut haven't developed these skills. When emotions don't get expressed in a healthy way, tension can build up - sometimes to a point where it seems almost unbearable. Cutting may be an attempt to relieve that extreme tension. It's a confused way of feeling in control. That's one of the reasons why younger teens are more likely to cut.
The urge to cut might be triggered by strong feelings the person can't express - such as anger, hurt, shame, frustration, or depression. People who cut sometimes say they feel they don't fit in or that no one understands them. A person might cut because of losing someone close or to escape a sense of emptiness. Cutting might seem like the only way to find relief, or the only way to express personal pain over relationships or rejection.
People who cut or self-injure sometimes have other mental health problems that contribute to their emotional tension. Cutting is sometimes (but not always) associated with depression, bipolar disorder, eating disorders, obsessive thinking, or compulsive behaviors. It can also be a sign of mental health problems that cause people to have trouble controlling their impulses or to take unnecessary risks. Some people who cut themselves have problems with drug or alcohol abuse.
Some people who cut have had a traumatic experience, such as living through abuse, violence, or a disaster. Self-injury may feel like a way of "waking up" from a sense of numbness after a traumatic experience. Or it may be a way of reinflicting the pain they went through, expressing anger over it, or trying to get control of it.
What Can Happen to People Who Cut?
Although cutting may provide some temporary relief from a terrible feeling, even people who cut agree that cutting isn't a good way to get that relief. For one thing, the relief doesn't last - the troubles that triggered the cutting remain, they're just masked over.
People don't usually intend to hurt themselves permanently when they cut. And they don't usually mean to keep cutting once they start. But both can happen. It's possible to misjudge the depth of a cut, making it so deep that it requires stitches (or, in extreme cases, hospitalization). Cuts can become infected if a person uses nonsterile or dirty cutting instruments - razors, scissors, pins, or even the sharp edge of the tab on a can of soda.
Most people who cut aren't attempting suicide. Cutting is usually a person's attempt at feeling better, not ending it all. Although some people who cut do attempt suicide, it's usually because of the emotional problems and pain that lie behind their desire to self-harm, not the cutting itself.
Cutting can be habit forming. It can become a compulsive behavior - meaning the more a person does it, the more he or she feels the need to do it. The brain starts to connect the false sense of relief from bad feelings to the act of cutting, and it craves this relief the next time tension builds. When cutting becomes a compulsive behavior, it can seem impossible to stop. So cutting can seem almost like an addiction. A behavior that starts as an attempt to feel more in control can end up controlling you.
How Does Cutting Start?
Cutting often begins on an impulse. It's not something the person thinks about ahead of time. Shauna says, "It starts when something's really upsetting and you don't know how to talk about it or what to do. But you can't get your mind off feeling upset, and your body has this knot of emotional pain. Before you know it, you're cutting yourself. And then somehow, you're in another place. Then, the next time you feel awful about something, you try it again - and slowly it becomes a habit."
Natalie, an eleventh grader who started cutting in middle school, explains that it was a way to distract herself from feelings of rejection and helplessness she felt she couldn't bear. "I never looked at it as anything that bad at first - just my way of getting my mind off something I felt really awful about. I guess part of me must have known it was a bad thing to do, though, because I always hid it. Once a friend asked me if I was cutting myself and I even lied and said 'no.' I was embarrassed."
Sometimes self-injury affects a person's body image. Jen says, "I actually liked how the cuts looked. I felt kind of bad when they started to heal - and so I would 'freshen them up' by cutting again. Now I can see how crazy that sounds, but at the time, it seemed perfectly reasonable to me. I was all about those cuts - like they were something about me that only I knew. They were like my own way of controlling things. I don't cut myself any more, but now I have to deal with the scars."
You can't force someone who self-injures to stop. It doesn't help to get mad at a friend who cuts, reject that person, lecture her, or beg him to stop. Instead, let your friend know that you care, that he or she deserves to be healthy and happy, and that no one needs to bear their troubles alone.
Cutting - The New Cool?
Girls and guys who self-injure are often dealing with some heavy troubles. Many work hard to overcome difficult problems. So they find it hard to believe that there are some teens who cut just because they think it's a way to seem tough and rebellious.
Tia tried cutting because a couple of the girls at her school were doing it. They pressured her. "It seemed like if I didn't do it, they would think I was afraid or something. So I did it once. But when I walked away, I thought about how lame it was to do something like that to myself for no good reason. Next time they asked I just said, 'no thanks, it's not for me.' "
If you have a friend who suggests you try cutting, say what you think. Why get pulled into something you know isn't good for you? There are plenty of other ways to express who you are. (Not giving in to peer pressure is one of them!)
Lindsay had been cutting herself for 3 years because of abuse she suffered as a child. She's 16 now and hasn't cut herself in more than a year. "I feel proud of that," Lindsay says. "So when I hear girls talk about it like it's a fad, it really gets to me."
Getting Help
There are better ways to deal with troubles than cutting - healthier, long-lasting ways that don't leave a person with emotional and physical scars. The first step is to get help with the troubles that led to the cutting in the first place. Here are some ideas for doing that:
1. Tell someone. People who have stopped cutting often say the first step is the hardest - admitting to or talking about cutting. But they also say that after they open up about it, they often feel a great sense of relief. Choose someone you trust to talk to at first (a parent, school counselor, teacher, coach, doctor, or nurse). If it's too difficult to bring up the topic in person, write a note.
2. Identify the trouble that's triggering the cutting. Cutting is a way of reacting to emotional tension or pain. Try to figure out what feelings or situations are causing you to cut. Is it anger? Pressure to be perfect? Relationship trouble? A painful loss or trauma? Mean criticism or mistreatment? Identify the trouble you're having, then tell someone about it. Many people have trouble figuring this part out on their own. This is where a mental health professional can be helpful.
3. Ask for help. Tell someone that you want help dealing with your troubles and the cutting. If the person you ask doesn't help you get the assistance you need, ask someone else. Sometimes adults try to downplay the problems teens have or think they're just a phase. If you get the feeling this is happening to you, find another adult (such as a school counselor or nurse) who can make your case for you.
4. Work on it. Most people with deep emotional pain or distress need to work with a counselor or mental health professional to sort through strong feelings, heal past hurts, and to learn better ways to cope with life's stresses. One way to find a therapist or counselor is to ask at your doctor's office, at school, or at a mental health clinic in your community.
Although cutting can be a difficult pattern to break, it is possible. Getting professional help to overcome the problem doesn't mean that a person is weak or crazy. Therapists and counselors are trained to help people discover inner strengths that help them heal. These inner strengths can then be used to cope with life's other problems in a healthy way.
Reviewed by: D'Arcy Lyness, PhD
Date reviewed: March 2005
2006-10-26 06:43:52
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