Cutting in Teens as a Form of Self-Harm in Adolescence

There’s something inherently disturbing – at least for most people – at the thought of anyone intentionally cutting himself or herself.  And yet, a surprising number of young, vulnerable teens gravitate towards this behavior – and their parents are completely oblivious.

Teens who engage in cutting usually aren’t trying to commit suicide.  Death is rarely their end goal. Rather, this type of self-harm behavior is often referred to in clinical settings as “non-suicidal self-injury” (NSSI for short).  However, there are occasions when self-harm in the form of cutting accidentally leads to death, for example, if the cutting goes deep enough to sever an artery.

Regardless of the intention behind cutting, any form of self-harm isn’t normal or healthy in teens and it should always be taken very seriously.

This brief guide is designed to help you know what to look for and what to do if you suspect your teen is engaging in self-harm in the form of cutting.   

Cutting Behavior in Adolescents – Statistics and Facts  

• Approximately 50% of those who cut have a history of sexual abuse
• 90% of individuals who cut started in their teens or pre-teen years
• A 2012 survey found that nearly 8% of third graders and almost 13% of ninth graders had engaged in some form of self-harm
• Adolescent girls are more likely to engage in cutting than their male peers
• About half of those who cut continue the behavior into their early adult years
• An estimated 20% of 10- to 18-year-old girls are engaging in self-harm such as cutting or burning themselves
• Teen who engage in cutting and other forms of self-harm often learn it from their friends or websites that promote the behavior
• Cutters don’t fit a specific stereotype. A significant number of teen girls who cut are popular, pretty, and doing well in school

Types of Cutting

Adolescents who engage in cutting themselves can do so in a variety of ways, including:

• Cutting or piercing their skin with a sharp object
• Carving or branding the skin
• Scratching the with fingernails or other objects
• Inserting sharp objects into their body or under their skin
• Biting oneself

Why Teens Engage in Cutting

Teens cut for many different reasons.  They may use it to:

• Release “unacceptable” or “bad” emotions
• Alleviate stress
• Distract themselves from problems they’re facing
• Punish themselves (often because they hate themselves or perceive themselves as inherently bad)
• Experiment out of curiosity
• Experience a temporary “high” (cutting releases endorphins in some individuals)
• Cope with difficult parents, or a chaotic or painful home life
• Reduce feelings of anxiety / to self-soothe
• Stimulate themselves when they’re feeling emotionally numb or dead inside
• Alleviate negative emotions, such as sadness, loneliness, or anger
• Fit in with their peers
• Respond to a dare

Cutting can become habit-forming or even addictive for some individuals, which makes it particularly difficult for them to stop.  Others do it as a type of ritualistic or ceremonious behavior.

While cutting usually isn’t done with the intent to die, accidental deaths can and do sometimes occur.  That’s why it’s critical to have your teen evaluated by a professional to determine the underlying issues and address them accordingly.   

Mental Health Issues Associated with Cutting

While cutting and other forms of self-harm aren’t considered “normal” or healthy behaviors, they don’t automatically signal the presence of an underlying mental health disorder.  However, there are several psychiatric disorders with which self-harm may be associated, including:

• Borderline personality disorder (self-harm – particularly cutting – often occurs with this disorder)
• Eating disorders (e.g. anorexia or bulimia)
• PTSD (posttraumatic stress disorder)
• Bipolar disorder
• Depression
• OCD (obsessive-compulsive disorder)
• Anxiety disorders
• Substance use disorders
• Schizophrenia
• Conduct disorder
• Oppositional defiant disorder

Risk Factors for Cutting in Teens

There are several factors that increase the risk of cutting and other forms of self-harm in teens, including:

• Having friends or family members who engage in self-harm behavior
• High levels of stress
• Previous self-harm
• Being bullied
• Perfectionism
• Poor coping skills
• Current or past neglect or physical, sexual, or verbal abuse
• Experiencing one or more significant losses (significant in the eyes of your teen, even though it may seem “minor” to parents or others)
• Mental health issues

Looking for and Recognizing the Signs of Cutting

When it comes to cutting and other forms of self-harm, teens will frequently go to great lengths to hide it from parents, teachers, coaches, friends, and siblings.  They usually don’t want anyone noticing their wounds or scars because that will lead to questions or attempts to intervene.  It’s not uncommon for parents to be oblivious to this type of behavior, which is why it’s so important to know what to look for.  Warning signs may include:

• Finding sharp objects hidden in your teen’s clothes pockets, bedroom, car, purse, or backpack
• Cuts, carvings, or scratches (fresh or scabbed over) anywhere on their skin, but most commonly on their arms, legs (often their thighs), or torso
• A doctor, teacher, or coach notices wounds or scars
• Someone (often a sibling or close friend) reports seeing your teen engaging in cutting
• Insisting on wearing long sleeves or pants, even during hot weather
• Spending a lot of time alone in his or her bedroom with the door locked, particularly after a stressful event (e.g. a fight with a friend or family members, a break-up or rejection, or a major disappointment)
• Discovering fresh or dried blood on a sharp object in your teen’s bedroom or the bathroom, such as a razor blade, scissors, knife, or box cutter

The Difference Between Teen Cutting & Suicide

Teens cutting is not a suicide attempt in and of itself. Teenage cutters engage in this form of self-harm as a way to get relief from big emotions that they don’t have the tools to handle. While cutting is usually a suicide attempt, cutting in teens is a symptom of underlying mental health issues. In fact, rehab for cutting often focuses on finding out if the teen is experiencing  depression, anxiety, or some other trauma that they need an outlet for. 

It’s important to seek out help for teenage cutters, because cutting is very dangerous behavior and can lead to escalation later on to actual suicide attempts. Some teens are hospitalized for self harm because there are times when it is unclear if their behaviors were a suicide attempt or not. 

What Can I Do to Keep MY Child Safe in Our Home

Teens cutting themselves can be scary for parents. You want to keep your child safe at home but it feels nearly impossible. When there is cutting in adolescents it’s important to be aware of sharp objects in the bathrooms and in the bedrooms, as this is where most teens will engage in this behavior. This includes shaving razors and paperclips. More importantly than that though is getting professional help for your teens to learn healthy ways to cope with emotions and get help when there are additional underlying mental health needs. 

How Can Parents Help If Their Teen is Cutting 

Discovering that your teen is cutting can be both alarming and confusing.  While it’s crucial to take any form of self-harm behavior seriously, it’s equally important to take action without over-reacting.  That being said, don’t chalk it up to just a “phase” your child’s going through.  Cutting can leave lasting physical and emotional scars.  It can also potentially result in life-threatening injuries.  The sooner you intervene and get help for your teen, the better.  Following are the first steps to take:

1 – Talk to your teen. 

Be open regarding your concerns about his or her.  Do your best to remain patient and calm.  Avoid nagging or scolding your teen, as doing either often backfires.  It can also add to your teen’s stress and possibly trigger more cutting in an attempt to cope.  Understand that your teen will likely try to downplay the behavior and try to convince you that it’s nothing.  Remind yourself that your child is likely pushing you away out of embarrassment, shame, and fear of consequences.

2 – Schedule an evaluation. 

With any form of self-harm it’s crucial to have your teen evaluated by a mental health professional – preferably a psychologist or psychiatrist who specializes in working with children and adolescents.  An evaluation will help determine if your child has an underlying psychiatric disorder that’s fueling the behavior.  Even if a mental health disorder is ruled out, the evaluation can help to identify and address the root issue, such as defiance, curiosity, peer pressure, or family conflict with the appropriate course of action (e.g. individual or family therapy).

3 – Get your teen into treatment. 

Treatment recommendations will be offered by the professional who evaluates your teen. With cutting, the treatment approach and methods will depend at least partly on whether there’s an underlying mental health issue, such as borderline personality disorder, anxiety, or oppositional defiant disorder.

Treatment may include the following:

Psychotherapy – There are several types of psychotherapy or “talk therapy” that can help reduce self-harm behavior, including:

• Cognitive behavioral therapy (CBT) – CBT is a relatively short term talk therapy approach. It focuses on identifying and changing negative thought patterns, self-talk, beliefs, and behaviors that are contributing to and reinforcing cutting and other forms of self-harm. CBT is also very beneficial in the treatment of many psychiatric disorders.
• Dialectical behavior therapy (DBT) – DBT is a variation of CBT. It was originally designed to treat borderline personality disorder, a disorder that often includes cutting and / or other types of self-harm behavior.  It helps individuals learn effective coping skills, have more satisfying relationships, and handle intense negative emotions. 
• Psychodynamic psychotherapy – This type of therapy helps individuals explore issues lurking at the subconscious or unconscious level that often stem from negative childhood experiences and other painful memories.
• Mindfulness-based therapy – Mindfulness helps individuals live in the present moment (rather than dwelling on the past or future) and increase their level of self-awareness. Individuals can learn to manage unhealthy behaviors and negative feelings by practicing mindfulness. 
• Family therapy – Family therapy focuses on addressing and changing unhealthy family dynamics, resolving conflicts, and helping family members learn how to interact in healthier and more appropriate ways.

Medication –  Medication isn’t used to treat cutting per se, but may help alleviate symptoms of depression or another disorder that’s present.  Once the distressing symptoms start to subside, teens who use cutting as a coping mechanism often feel less inclined to continue the behavior.

Hospitalization – Short-term psychiatric hospitalization is often warranted in more severe cases of cutting, for example if your teen’s cutting is extreme or potentially life-threatening.  Inpatient treatment can help ensure your teen’s safety while underlying issues are addressed and stabilized.

Supporting and Encouraging Your Teen

You may be experiencing a range of negative emotions – anger, fear, or confusion – since learning that your teen has been cutting herself or himself.  It’s important to keep those emotions in check as much as possible.  Over-reacting won’t help and may even backfire.  Staying calm is one of the best things you can do to help your teen.

Following are several ways to encourage and support your teen as he or she learns healthy, new ways to manage life’s challenges, negative emotions, and / or a mental health issue:

• Educate yourself about cutting behavior in teens
• If your teen is diagnosed with a psychiatric disorder, learn everything you can about that as well
• Encourage your teen to try out and practice new coping skills at home
• Make yourself available (and willing) to listen; let your teen know you’re there for him or her and want to help
• Listen with compassion; don’t judge or scold
• Understand that teens who cut often harbor deep feelings of shame and don’t want anyone to know about it. Be compassionate and don’t assume your teen is doing this to get attention.
• Actively participate in your teen’s treatment
• Show your teen unconditional love and acceptance
• Take your teen’s cutting very seriously, but don’t automatically assume he or she is trying to commit suicide
• Avoid using punishment or threats to keep your teen from cutting
• Find healthy ways to manage your own negative emotions about the situation
• Be patient with your teen as he or she heals and learns new ways of coping; overcoming any form of self-harm is a process that takes time.
• Be willing to address and work on any issues of your own that may be negatively impacting your teen
• Be respectful of your teen’s privacy. Don’t tell neighbors, friends, and relatives about the self-harm behavior (unless there’s a genuine need to know).  Your teen probably already feels embarrassed and ashamed
• Find ways to create a happy, peaceful, and low-stress home environment
• Respect your teen’s experience even if you don’t understand it
• Don’t blame yourself; this won’t help you or your child

What to Do When Things Escalate

There’s always the risk of cutting and other forms of self-harm escalating at some point.  This is most likely to occur after a significant loss or period of heightened stress, although other factors can trigger an escalation as well.  Also, some teens will get worse over time, even with treatment – particularly if the primary issue hasn’t been identified or addressed.

With cutting, the greatest risk is a life-threatening injury, suicidal thoughts and behavior, or complications due to an underlying psychiatric disorder.  If things escalate you

• Contact your child’s treatment provider or primary physician
• Enlist the help of a close family member or friend
• Take your child to the nearest hospital emergency room (if you can do so safely)
• Call 911

When Individual Therapy isn’t Enough

Individual therapy is often quite effective in treating teens who cut. Unfortunately, though, sometimes more treatment is needed.  If your teen doesn’t have a good support system, is battling a serious psychiatric disorder, or experiences something that escalates the cutting or triggers suicidal thoughts or behaviors, more intensive treatment will be necessary.  More intensive levels of treatment include:

• Intensive outpatient treatment (IOP) / Psychiatric day treatment
• Residential treatment
• Inpatient psychiatric treatment

Intensive outpatient treatment or psychiatric day treatment is the next step up from weekly therapy.  Programs vary in terms of the amount of time spent per session and how many times per week (e.g. 2 to 5 days a week).

Residential treatment involves having your child stay 24/7 at a non-hospital treatment facility that specializes in treating teens with various types of mental health issues.  It usually lasts between 30 to 180 days.

Inpatient psychiatric treatment is the highest and most intensive level of treatment, and can last for a few days to a few weeks.  It involves admitting your child to an adolescent psychiatric hospital unit where patients are monitored by medical personnel 24/7. It’s particularly helpful for teens who are actively suicidal or an imminent danger to themselves or others.

Each of these intensive levels of treatment typically provides daily or bi-weekly visits with a psychiatrist and various types of daily therapy.

Taking Care of Yourself

To effectively support and help your teen through the healing process it’s imperative that you take care of yourself as well.  Following are a few things that will help:

• Surrounding yourself with supportive individuals (e.g. a therapist, your church family, positive friends and family members, or support groups)
• Get plenty of rest so you feel refreshed and energized
• Exercise regularly, practice yoga, and / or meditate – each of these will help you relax, stay grounded, and reduce stress
• Set aside a little time each day for yourself

Your teen will be looking to you for encouragement, guidance, hope, and support.  By taking care of yourself you’ll be more equipped to be the loving, patient, and supportive parent he or she needs to get through this.