Cutting and Self-Harm

Most of us know about teens and cutting — how some use a sharp object like a razorblade, knife, or scissors to make marks, cuts, or scratches on their own body. But cutting is just one form of self-injury. Teens who self-injure also might burn, scratch, or hit themselves; bang their head; pull their hair; pinch their skin; pierce their skin with needles or sharp objects; or insert objects under their skin.

Self-harming is a serious issue that affects many teens. Like other risky behaviors, it can be dangerous and habit-forming. In most cases, it is also a sign of deeper emotional distress. In some cases, peers can influence teens to experiment with it.

The topic of self-injury can be troubling for parents. It can be hard to understand why teens (or even preteens) would hurt themselves on purpose, and worrisome to think your teen — or one of their friends — could be at risk.

But parents who are aware of this important issue and understand the emotional pain it can signal are in a position to help.

About Self-Injury

People who self-injure usually start doing it during their teen years. Some continue into adulthood. In some cases, there's a family history of cutting or other self-harm.

A sense of shame and secrecy often goes along with it. Most teens who cut hide the marks and, if they're noticed, make excuses about them. Some teens, though, don't try to hide cuts and might even call attention to them.

Cutting often begins as an impulse. But many teens discover that once they start, they do it more and more, and can have trouble stopping. Many teens who self-injure report that it provides a sense of relief from deep painful emotions. Because of this, it's a behavior that tends to reinforce itself.

Cutting and other self-harm can become a teen's habitual way to respond to pressures and unbearable feelings. Many say they feel "addicted" to the behavior. Some would like to stop but don't know how or feel they can't. Other teens don't want to stop.

Most of the time, self-harm is not a suicide attempt. But it can be easy to underestimate the potential to get seriously sick or hurt through bleeding, infections, or other problems.

Why Do Teens Self-Injure?

Teens self-injure for many different reasons:

Powerful overwhelming emotions. Most teens who do it struggle with powerful emotions. To them, it might seem like the only way to express or interrupt feelings that seem too intense to endure. Emotional pain over rejection, lost or broken relationships, or deep grief can be overwhelming for some teens.

And many are dealing with emotional pain or difficult situations that no one knows about. Pressure to be perfect or to live up to impossible standards — their own or someone else's — can cause some teens unbearable pain. Some have been deeply hurt by harsh treatment or by situations that have left them feeling unsupported, powerless, unworthy, or unloved.

Some teens have experienced trauma, which can cause waves of emotional numbness called dissociation. For them, cutting and other types of self-harm can be a way to test whether they can still "feel" pain. Others describe it as a way of "waking up" from that emotional numbness.

Self-inflicted physical pain is specific and visible. For some, the physical pain can seem preferable to emotional pain. Emotional pain can feel vague and hard to pinpoint, talk about, or soothe.

When they cut or self-injure, teens say there is a sense of control and relief to see and know where the specific pain is coming from and a sense of soothing when it stops. It can symbolize inner pain that might not have been verbalized, confided, acknowledged, or healed. And because it's self-inflicted, it is pain they control.

A sense of relief. Many teens describe the sense of relief they feel as they're cut or self-harm, which is common with compulsive behaviors. Some people believe that endorphins might add to the relief teens describe when they self-injure. Endorphins are the "feel-good" hormones released during intense physical exertion. And they can be released during an injury.

Others believe the relief is simply a result of being distracted from painful emotions by intense physical pain and the dramatic sight of blood. Some teens say they don't feel the pain when they cut, but feel relieved because the visible results "show" emotional pain they feel.

Feeling "addicted." Cutting, especially, can be habit forming. Though it only provides temporary relief from emotional distress, the more a person cuts, the more they feel the need to do it. As with other compulsive behaviors, the brain starts to connect the injury to the momentary sense of relief from bad feelings.

Whenever the tension builds, the brain craves that relief and drives the teen to seek relief again by self-injuring. So it can become a habit someone feels powerless to stop. The urge to cut — to get relief — can seem too hard to resist when emotional pressure is high.

Other mental health conditions. Self-harm is often linked to — or part of — another mental health condition. Some teens are also struggling with other urges, obsessions, or compulsive behaviors. For some, depression or bipolar disorder can contribute to overwhelming moods that might be hard for them to regulate. For others, mental health conditions that affect personality can cause relationships to feel intense and consuming, but unsteady. For these teens, intense positive attachments can suddenly become terribly disappointing and leave them feeling hurt, anger, or despair too strong to cope with.

Other teens struggle with personality traits that attract them to the dangerous excitement of risky behavior or self-destructive acts. Some are prone to dramatic ways of getting reassurance that they are loved and cared about. For others, posttraumatic stress has had an effect on their ability to cope. Or they're struggling with alcohol or substance problems.

Peer pressure. Some teens are influenced to start self-injuring by another person who does it. Group peer pressure can play a role too. Some teens cut in groups and might pressure others to cut. A teen might give in to group pressure to try it as a way to seem cool or bold, to belong, or to avoid social bullying.

Any of these things may help to explain why a particular teen cuts or self-harms. But each teen also has unique feelings and experiences that play a role. Some might not be able to explain why they do it.

Regardless of what may lead a teen to self-injure, it's not a healthy way to deal with even the most extreme emotions or pressures.

Confronting Self-Injury

Some teens call attention to their self-injury. Or an injury might need medical attention, so others find out about it that way. But many teens cut for a long time before anyone else knows. Some eventually tell someone about their self-injury — because they want help and want to stop, or because they just want someone to understand what they're going through.

It can take courage and trust to reach out. Many teens hesitate to tell others because they fear being misunderstood or worry that someone might be angry, upset, disappointed, shocked, or judgmental. Some teens confide in friends, but ask them not to tell. This can create burden and worry for a friend who knows.

If confronted about the cutting, teens can respond in different ways, depending partly on the teen and partly on how they were approached about it. Some might deny the cutting, while others might admit to it, but deny that it's a problem. Some might get angry and upset or reject efforts to help. Some teens are relieved that someone knows, cares, and wants to help.

Stopping Cutting and Self-Injury

Whether or not anyone else knows or has tried to help, some teens cut for a long time before they try to stop. Teens whose self-harm is part of another mental health condition usually need professional help. Sometimes cutting or another symptom leads to a teen's admission to a mental health hospital or clinic. Some teens have more than one hospital stay for self-injury before they feel ready to accept help for it or other problems.

Some teens find a way to stop self-injuring on their own. This might happen if they find a powerful reason to stop, get needed support, or find ways to resist the powerful urge to self-injure. To stop, they also need to find new ways to deal with problem situations and regulate emotions that feel overwhelming. This can take time and often requires the help of a mental health professional.

It can be hard for teens to stop cutting or other self-injury behaviors. They might not succeed at first. Some stop for a while and then start cutting again. It takes determination, courage, strength — as well as support from others who understand and care — to break this powerful habit.