Posted by: counselorcarmella | March 1, 2012

Info About Cutting and Self Injury

The subject of cutting or self injury comes up a lot in my office. Experimenting at least once with cutting, or self injury,  is quite common in young teens, particularly girls. They don’t all do it, of course,  but everyone at least knows someone who does.  There are a lot of myths about these behaviors. I guess that’s partly because the idea of cutting is so hard to understand. Why would someone intentionally do something that is painful?  And why would young women, so fixated on physical beauty due to media influences, do something that could scar them?  They truly don’t know what else to do.  Some of them like to  see actual blood.  Others just  need the scratching or surface abrasions. Using an object to  make oneself feel pain, to draw blood, or to scratch or burn the skin  is  an example of maladaptive coping. In other words, it is a way to manage feelings.
 
Cutting releases endorphens and other chemicals that actually do seem to provide a sense of emotional relief and release like crying or laughing or eating something good and so on. The behavior serves as  a distraction and  it can  give those who feel numb all the time a sense of feeling something.  For some, feeling physical pain is preferrable to not feeling anything emotionally because at least there is an actual  sensory sensation they can connect with. It can also help someone who is very upset to calm down. Some of these girls say they almost feel like they go into a trance when they do it. It also gives them a sense of control. Some girls  do it out of  a need to punish themselves  if they aren’t perfect at something. The problem is that  for many of them, it becomes like an addiction or an OCD sort of thing where they  feel such strong urges that they have to do it and can’t stop themselves.  Then, breaking this pattern is a problem and we have to help them  learn other skills. 
 
Most girls cut in private and don’t want people to  know.  Those who do it for attention are not the usual type.   As in, it is always a cry for help of some  sort, but those who cut specifically to get attention are  showing the cuts to people vs the  ones who do it just to try and cope with feelings.  Most girls who cut  feel ashamed and  may only tell a close friend or two and swear them to secrecy. These girls are wearing long sleeves and  don’t want people to see their cuts and scars.  Later in life, they  have scars they’re embarrassed about and  are
angry at themselves for marring their bodies that way.  They don’t want their parents to know because they’re afraid they’ll be punished or experience other negative consequences. A lot of parents do freak out about cutting.  Unfortunately many of them make their daughters promise they won’t do it again and  ground them or punish them in other ways for doing it.  Neither of these approaches tohandling this behavior are helpful.

When girls tell me they cut, I tell them  I’ve worked with other girls who have done it.  I  let them know I’m not going to fuss at them or judge them for it. I get curious. I  try to get a sense of what  is going on when they feel the urge to do it, how often they do it, and  what parts of their bodies they cut.  I want to know how long it has been going on and how it started.   I  start talking with them about other things they do that helpsthem feel better or other things they could try instead. I don’t tell them they can’t cut because I don’t have that kind of control. I let them know I want them to be  able to tell me about their cutting behaviors and that I don’t expect them to just be able to   stop and never do it again if they’ve started doing it a lot. I want them to  be honest with me about it and for them to know there is someone they can talk with about their cutting who isn’t going to freak out about it  and threaten or ask them for  promises about it. I  want to help them begin decreasing the frequency of cutting, resisting the urge to cut, and  replacing cutting with  healthier behaviors. Sometimes, this is just about distraction  and some of it is about finding constructive outlets such as writing, drawing,  physical activities,  or things like tearing up cardboard,  ripping up paper,  holding ice cubes, eating hot candy, etc.   There have to be  behaviors to substitute in place of the cutting and I don’t want  them feeling guilt or shame about it.

With parents, I do a lot to educate them about it. A lot of parents will freak out and just punish for the behavior or make a child promise they won’t do it.   Or, they’ll accuse their child of doing that to try and get attention or because of peer pressure. Friends will have them promise also. They’re actually more likely to honor their word to a close friend.  A lot of times they just try even harder to keep it a secret so they won’t  have to  deal with the  guilt of hurting someone else’s feelings or  to avoid punishment.  Its not  a behavior that is to be  punished, in my opinion, and based on what I understand of it clinically.  It is  a behavior to be understood and worked with so that it can   begin to decrease as we get them more socially plugged in and  doing healthier things to deal with feelings. This can also include helping them with thought patterns about  what they expect of self and others and teaching them communication and assertiveness skills. Helping them to  find  people they can have healthy relationships with is important if they are isolated.

 
There are a lot of things that can be done around the issue of cutting, but it isn’t  usually the primary issue or the thing I focus on  most.  I focus on the things that are causing the emotional pain.  Depression can be involved, but  not always.  Same for personality disorders, like borderline. They tend to  do  a good bit of cutting because their feelings are so intense and the DBT training so often used with that population is very helpful around the issue of cutting. A lot of girls cut because they’re upset about  peer relationships or parental conflict, or because they  are upset with themselves for not doing as well as they hoped  on a test or in a band concert or sports event. These are common stressors and there are all sorts of ways of  trying to  manage them.  The sooner  intervention happens, the better, but cutting is not the same as being suicidal or making a suicide attempt.  Inpatient or residential treatment isn’t always necessary either, but can be if other severe symptoms are involved.  Some people get used to having an external source of  emotion  regulation.  These would also  be the ones to use alcohol and substances, cling to other people  so that relationships are the addiction,  use food  to  soothe and distract, or other  things that come more from outside than from  within themselves. Our instant gratification society  makes all that even more common and tempting.
 
There is hope and help for cutters. They can learn different ways of dealing with their feelings and can  find caring  adults to support them as they work to  make changes.  If you cut, let someone  who cares about you know what’s going on. Let them know you’d like to talk with a counselor who can  help you.  If you know someone who cuts, the best thing you can do  is educate yourself about this problem and let them know you care and  don’t want them to feel like the only choice they have is to hurt themselves.  Encourage them to  let their parents, doctor, or guidance counselor know so they cann get the kinds of help they  need.    
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