When Heather Caruso* received the message from her daughter’s high school counselor notifying her of a “concern,” and asking that she please call right away, she was baffled.

“Mia* is quiet and shy—a straight A student, with good friends. Her teachers love her. She makes good choices,” says Caruso. “I couldn’t imagine what kind of concern there could be. The only thing we ever worry about is her stress level—she’s an overachiever.”

As the story unfolded, it became clear that the teacher who had seen “scratches” on Mia’s arm and alerted the counselor had been right to be concerned. Mia’s story about the dog pulling her into a tree branch was not ringing true on any level. Especially when Caruso picked up Mia from school and saw slashes on her upper arm.

“I knew right away what I was looking at. My stomach just fell. I was devastated that she felt driven to that and especially that she felt like she had to hide it and lie about it,” says Caruso. “We probably should have, but we just didn’t see this coming. My husband was actually speechless—completely unaware that this is even a thing that people do.”

It’s no secret that teens are stressed. They are born into a culture that reveres overcommitment, overachievement, and unrealistic body images. They deal with shifting familial norms, rampant substance abuse, the incessant pressures of social media, and the ever-present threat of random violence. They are searching for ways to express their fears and regulate their anxieties.

Unfortunately, an increasing number of adolescents and teens, like Mia, are finding that expression and relief through self-harm, and specifically cutting—the practice of intentionally cutting one’s own skin repeatedly and deeply enough to draw blood.

The “Why” Behind Cutting

According to a 2008 publication by the U.S. National Library of Medicine, 55 percent of self-injurers said “I wanted to get my mind off my problems.” Forty-five percent said it helped them to release tension and relax.

Cutters typically report an immediate sense of control, well-being, and equilibrium following cutting. This is due in part to the release of mood-boosting endorphins triggered by injury. Somehow, the external pain one can’t control is counteracted by pain one does control.

Much of the current research on self-injury is being done by Dr. Janis Whitlock, research scientist and lecturer at Cornell University, at the Cornell Research Program on Self-Injury and Recovery. In her 2010 article, Speaking the soul: Why kids cut and what we can do about it, she writes that “self-injury often emerges from normal and healthy impulses to feel better, self-integrate, to feel connected to oneself and to others, and to manage overwhelming emotion.”

Bella Morgan* first cut when she was 14. She’d fought with her parents about music she wasn’t supposed to have. She knew a friend that self-injured to feel better.

“I was grounded from going anywhere, from my friends, and my music. All my normal sources for comfort were taken away so I tried cutting, and it freaked me out because it really worked and I liked it,” remembers Bella, now 25. “I knew right away I would do it again. There was also a degree of rebellion that first time. I wanted to upset my parents.”

The Cornell studies indicate that the rapid spread of cutting suggests a contagion or “trendiness” factor. Anecdotal reports from school settings describe a fad quality to the behavior, similar to that which occurs with eating disorders. Some teens may cut for attention, while others just want to try it. Like Mia and Bella, teens hear about it from friends or social media.

“I had heard that it was a good way to alleviate stress,” says Mia. “I was in the middle of rehearsals and finals and felt overwhelmed so I tried it. It kind of helped in the moment, but it backfired and caused even more stress.”

Some teens, like Mia, try it once and never repeat the experience. But many more, like Bella, get hooked.

Who Is Cutting?

The number of kids self-injuring is astounding. Although the secretive nature of cutting makes it challenging to get reliable numbers, an increasingly large number of studies in the past decade offer a reasonably good picture of the prevalence.

A recent meta-analysis (a study of other studies) pooled the worldwide self-harm estimates at 17.2 percent among adolescents and 13.4 percent among young adults. U.S. studies report ranges from 12 to 37.2 percent in secondary school populations and 12 to 20 percent in young adult populations.

Considering that, a 12 to 37 percent range puts the median at 25 percent. This means that an estimated one in four secondary school and college age youth intentionally cut, burn, bruise, or otherwise injure their bodies. Although onset of self-harm commonly occurs between ages 12 and 15, the Cornell studies report onset in children as young as seven years old.

There is no evidence for differences by socioeconomic status or ethnicity, although studies support that females are more likely to self-injure, to start younger, and to self-injure longer than males.

According to current trends, every second or third American girl between adolescence and adulthood is likely to experiment with, if not regularly practice, self-harming behavior. These numbers qualify this trend as an epidemic.

What Cutting Leads To

Contrary to assumptions and every parent’s worst fear, cutting is most commonly performed without suicidal intent, according to Whitlock’s article, Speaking the soul. Instead, it typically serves the opposite purpose of alleviating stress and regulating emotions.

“When my cutting was at its worst,” says Emily Leighton,* who started cutting at 14, “I told my parents not to try and stop me because my cutting was keeping me alive. It felt like the blade was the only one that was always there for me—my only way to cope.”

Adolescence can feel unsurvivable. Most often cutting is a way to live through it, rather than end it—but not always. It should never be minimized.

The fact that someone cuts suggests high levels of psychological distress. Self-injury is often a sign of, or can lead to, more serious concerns. For Emily, cutting signaled a depression that culminated in a suicide attempt. While self-injury does not cause or lead to suicidal thoughts and/or behaviors, habitually hurting one’s body may make suicide more conceivable if distress becomes acute.

Available evidence suggests that for individuals whose circumstances and mental health are otherwise stable, most stop cutting within five years of starting. However, for the majority, self-injury is cyclical—used for periods of time, stopped, and then resumed. This is the case for Bella.

“The thing is, when I want to cut it’s very difficult to find a replacement behavior that gives me the same reward, so even 10 years in, I still go through cycles of cutting,” she says. Bella finds that she’ll often feel drawn to a specific spot on her body and her compulsion grows until she cuts there.

Similarly, Emily found herself unable to stop cutting, even when her dad and stepmom bribed her with concert tickets for her favorite band. At that time, she was cutting every day both before and after school, and sometimes before bed, just to regulate her emotions. She declined the tickets, telling her parents that if she could choose to stop, she would. She eventually asked instead to be hospitalized, saying she didn’t feel safe.

Most researchers agree that there are strong indications of a biochemical addiction in addition to the psychological component. The addictive cycle kicks in when the endogenous opioid system in the body is routinely activated by injury, causing a tolerance effect: Over time, cutters may feel less pain, and need to injure more frequently and more severely for the same relief, much like drug addiction.

Is Your Child Cutting?

The most common expert advice for concerned parents looking for signs of cutting runs along the lines of, “be aware of mood shifts and a tendency to isolate.” However, these typical characteristics of teens may make that hard to distinguish. Realistically, if you notice a tendency to stay covered—wearing long sleeves and trousers even in hot weather—or a sudden increased sense of privacy, cutting could be the reason.

If you have suspicions, you won’t have to look very hard or very far for confirmation. Intentional cutting doesn’t look like anything other than what it is.
According to WebMD, typical cuts are very linear, straight lines often carved into the forearm or upper arm, and sometimes the legs. Some people may even cut words into themselves.

If explanations seem fabricated or if questioning makes kids edgy, more evidence is usually close at hand. A teen has to be extremely conscientious to consistently conceal bloody tissues, blades, and bandages. Many teens also document or discuss their cutting on social media or in their journals.

What To Do (And What Not To Do)

It’s a myth that if you’re parenting well kids won’t struggle; truthfully, you can be crushing it as a parent and a child might still be falling apart. On the flipside, kids will inevitably be the victim of parents own bad choices and human failings. A teen may very well resort to cutting because he’s not being heard or because of other trauma.

How can parents sort through their own tangle of confusion, fear, and guilt in order to stay in the game when kids need them most?

The first essential is to stay calm. While alarming, cutting is usually no more dire than some other teen coping mechanisms, so releasing the distaste and stigma is a first step toward a supportive response.

Second, if your child is cutting, reach out to someone. Talk to your family physician, school counselor, and any friends who may have experienced this with their own children.

“I called two of my friends whose daughters also self-injured, before talking with Mia,” Caruso remembers. “I had no idea how to navigate it. Their support and advice equipped me to make the conversation about Mia and what she needed, not about me freaking out.”

One of Caruso’s friends was Gwen Morgan, whose wisdom was hard won. “I know now that our responses with Bella were violating and uninformed. They only served to strain our relationship, but they were motivated by terror,” says Morgan. “At the time I just wanted it to stop. I believed it was a matter of discipline. But telling a cutter to stop cutting is like saying to an alcoholic, ‘just stop drinking.’ It’s not helpful.”

Morgan and her husband Rob told Bella that if she cut again she would be grounded for three weeks and after that they would take her out of speech and debate, which was her passion and her community. These ultimatums forced Bella back into hiding.

The Morgans discussed forced body checks, loss of privileges, and even taking the door off of Bella’s bedroom. These approaches almost always exacerbate the problem because they remove the child’s sources of comfort and community, take away the control the child is striving for, and increase negative emotions.
Restricting access is equally ineffective. When the Morgans confiscated Bella’s razors, she cut with jewelry, a pen, or even fingernail clippings. Emily typically unscrewed the blade from her pencil sharpener at school. You can draw blood with a lot of things, and since cutting is largely about control, any kind of mandate or restriction only increases the desire.

So, what does help? Self-injury treatment veteran Barent Walsh recommends “respectful curiosity.” Don’t show emotional displays of shock or horror. Instead, ask questions such as “what do you notice is happening for you when you self injure?” and “what kinds of things happen that make you want to injure yourself?”

“Emily’s self-injury initiated and accelerated because she didn’t have healthy ways of dealing with her distress,” says Emily’s mom, Cassandra Leighton. “The primary form of therapy has focused on teaching her forms of distress tolerance that don’t involve taking it out on herself. I just keep trying to steer her toward the tools she’s learning. That said, there are times when she just needs me to listen and let her be sad. Validation is huge.”

While studies show that some chronic self-injurers tend to get better without therapy, most need professional help focused on emotional regulation and stress tolerance. Dialectical Behavioral Therapy, a form of talk therapy, has proven highly effective for Emily and others like her. Treatment is not a quick fix and often includes medication combined with individual and family therapy over a sustained period of time. As with any habitual behavior, setbacks are common.

“Of course I wanted to stop cutting,” says Emily, “but it’s not about that. It’s about becoming OK so I don’t need to cut anymore. It makes me feel worse about myself and my life in the long run. When I’m happy I don’t want to cut. I want to live a fun, happy life. I know that cutting can’t be a part of that.”

*Name has been changed

Resources

• Cornell Research Program on Self-Injurious Behavior offers a wide selection of research, resources, and recommendations.
• The Self-Injury and Recovery Research and Resources (SIRRR) program based at Cornell University, offers psychoeducational web-based trainings in non-suicidal self-injury for youth-serving adults.
• SAFE: Self Abuse Finally Ends provides resources, referrals, and a full network of support.