Self-Harm and Cutting

The incidence of self-harm, or “cutting” is on the rise among adolescents. Primary care physicians are in an ideal position to identify self- harming behaviors due to the presence of atypical wounds and scarring. Self-harm can occur anywhere on the body, but usually is expressed on the wrists, thighs, arms or chest. Self-harming behaviors may include burning with cigarettes or a lighter, scratching with any- thing sharp enough to pierce the skin, or cutting with a knife or razor.

Many adolescents will initially deny that they have engaged in self-harming behaviors because they do not want their parents to find out and because they are embarrassed. However, adolescents often communicate among them- selves about their cutting and there can be a contagion effect among communities and groups of adolescents. Adolescents who self- harm are typically in emotional distress and referral to a mental health professional is always warranted. Self-harming behaviors should not be ignored, and assurances from the adolescent that they will stop on their own are insufficient.

Self-harming behavior is not necessarily suicidal behavior. Adolescents who self-arm should be assured that they are not “crazy”, this is a common problem, and one that can be ad- dressed by a trained mental health provider. People who self-harm are not “looking for attention.” Often, they are introverted people who are trying to avoid drawing attention to them- selves. Frequently, they are experiencing in- tense emotional distress that is beyond their ability to express and cope with.

Parents often need immediate counseling and intervention when they learn their child is self- harming. They too need to be reassured that their child is not “crazy,” this is a common problem, and it is treatable. Advise parents to provide reassurance of love and support to their child. Parents should ensure that their child spends more time with, and receives supervision from, a trusted adult. They should avoid judging the child and assist them in finding resources. Encourage the parents to “vent” with someone other than their child. Parents should be encouraged to let their child express their emotions without passing judgment.

Individuals who self-harm often experience temporary relief fr0m their emotional pain, a sense of calmness, and a sense of control. Sometimes self-harm is self-punitive and relieves guilt. Some individuals experience a sense of control over their bodies when they cut or engage in other self-harming behaviors. Treatment involves acknowledging the problem and talking with a trusted adult. Over the course of therapy individuals who self- harm learn to identify their triggers, learn better ways to cope and self-soothe, and address underlying emotional issues. They replace self-harming behaviors with adaptive behaviors and appropriate expression of emotions.

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