Part II Identifying, treating self-injury: A professional’s perspective

By SARAH DOOLITTLE, Four Points News

Dr. Green is a licensed professional therapist working in the Four Points community. As part of her work she treats a number of patients who engage in cutting, known in the medical and psychological professions as non-suicidal self-injury or self-mutilation.

Very little data exists about the number of people engaging in self-injury. Due to the private nature of cutting and the injuries sustained, which are in most cases non-life threatening and therefore don’t require medical care, there are no medical records to study for statistical purposes. It is known that self-injury affects more females, but males also cut. And it is more common in adolescents. Anecdotal evidence among mental health professionals, parents and students also suggests that cutting is happening in Four Points.

What is non-suicidal self-injury?
Dr. Green explains that, as the name suggests, cutting is, “not to kill themselves. It’s not suicidal. But it’s an injury… It’s a way to relieve tension.” Objects used for self-injury are typically very sharp: for example, a razor blade, hair cutting scissors or a knife.

While hurting one’s self to relieve stress seems counterintuitive, the body’s biochemical response to an injury, even one that is self-inflicted, does provide relief. “The purpose of it is (to release) that cascade of neurotransmitters, which give the feeling of being in control again.”

By triggering the body’s defense response, “We’re using a natural mechanism to relieve tension and stress in an artificial way.”

Self-injury is usually ritualistic in nature and involves a well-hidden “kit” of tools. It’s performed, “in a private place, usually their bathrooms or bedrooms, a place where they feel they will not be found.”

The private nature of cutting can make it very challenging to identify. One outward sign may be the consistent covering of one part of the body that may not normally be covered.

Parents need to ask themselves, “What area haven’t we seen in awhile?… We see our children 24/7, so we sometimes stop looking at them. Look at the skin on their arms, legs, hips, anywhere that can be easily reached with a razor… Ask questions.”

While Dr. Green emphasizes the importance of respecting a child’s privacy, if parents suspect self-injury they can, “Look for hidden razor kits… Things that can cut that are kept out of sight.”

Trying to understand the origins of cutting
A world more connected through technology can be a healthy outlet to seek friendships and community. It can also be a gateway to what Dr. Green calls, “the copycat syndrome,” in which teens especially copy the behaviors of their internet peers, though copycatting can also happen between friends or schoolmates. Copycatting is, “a kind of a bonding. It’s a community bonding.”

That’s not to say cutting itself is social. Unlike drug or alcohol use, “It’s something that’s very private.”

For the child, if no one notices and the self-injury achieves the result of relieving tension, however temporarily, “It becomes more okay… It’s not noticed, I feel better and there’s no consequences. So it’s okay.”

“We need more research in this area,” noted Dr. Green. “The fifth edition of the ‘Diagnostic and Statistical Manual of Mental Disorder’ (DSM-5) refers to cutting as nonsuicidal self-injury and it is included under ‘Conditions for Further Study,’ which means it’s still under investigation. We are still learning about it because it is relatively new,” and in the 21st century, like marijuana or sleeve tattoos, far more common.

What may start as a response to emotional pain becomes something much harder to treat: a habit. “And habits have a life of their own… It becomes what we do, like brushing our teeth.”

Even without a clear understanding of its causes, parents should not ignore the very real danger cutting represents to a child’s physical and mental health. “We cannot deny the seriousness (of cutting)… Hopefully it’s not suicidal, not life-threatening. But accidents can happen. We need to assess the severity of the situation. What is important is to acknowledge that there is something going on with the child and that the child needs help. Cutting is often associated with high levels of anger, depression, anxiety and self-criticism. ”

How to talk about self-injury
For parents finding out about a child’s cutting for the first time, the biggest challenge will be to respond in a way that opens the door for the child to seek help rather than to be shamed or punished. Despite the natural urge to react with fear and anger, it is important for parents to analyze the situation and to seek immediate help.

“In front of them we have to be cool, calm and collected. Many children crave for their parents to accept them for who they are unconditionally and not depending on their behavior.”

Ask questions and engage with the child in a conversation to find a solution that works for them. “Ask questions, not to tell. Not to give them a lecture but to listen… They need to talk.”

Do not make demands that may incite your child to rebel. Rather than being ordered not to cut, the child must be empowered to do so with parents’ help and support.

Tell your child how you feel. Without invoking guilt, it is also okay for parents to express the concern they feel about their child’s self-injury.

Do not punish your child. Dr. Green reminds parents, too, that part of every cutter’s internal monologue is the fear that her parents will no longer love her, or will judge her. Or punish her.

Do ask for your child’s cutting tools. Go through your home and remove or secure items that could be used for cutting.

The first conversation about cutting will be one of many. “This is a process that takes effort, time (and) a tremendous amount of understanding and love.”

Getting professional help
Treatment of cutting is still developing because it touches on so many areas of mental health such as depression, anxiety and compulsive physical harm.

Still, “I would encourage professional help,” said Dr. Green.

Because cutting is so complex, involving emotional triggers, a biochemical response, rituals and habits, recovery can be difficult. “The person who wants to cut wants to do something… Stopping that action takes a lot of energy… Dialectical behaviour therapy is saying… Instead of cutting, what is something you can do that does not involve hurting yourself?”

The challenge of treatment is further complicated by the fact that the adolescent brain is not fully developed. “Our cortex is working on a level that is difficult to reason with, because the reasoning side is not fully developed.”

The good news is that the brain does eventually develop. “The shelf life of cutting is probably under (age) 26. Hopefully, once the brain fully develops, namely the frontal cortex, so can the understanding that cutting is not good.”

Even without having all the answers, discussing and processing self-injury with parents or with a mental health professional engages and develops higher-functioning parts of the brain. “Asking questions allows them to think, to use their frontal cortex. To analyze. To explore the factors. To ask themselves what’s going on.”

Because — and despite the intention to feel better — cutting is ultimately a solution doomed to failure. “When we choose to cut ourselves, the tension that we are relieving is at the expense of hurting our own (bodies).” And with scarring, it is a permanent solution to a temporary problem.

Dr. Green encourages parents not to see therapy as a cure but as part of a longer process. A true cure requires patience, time and collaboration between the child, parents and external support such as a therapist.

Parents can also help to relieve some of the pressure on their kids by enforcing the non-negotiable necessities of daily life: sleep, meals and exercise. This can be done by reducing extracurricular activities, re-negotiating academic schedules, or by adjusting expectations to fit a child’s needs and abilities, both in the short- and long-term.

Dr. Green’s name was change in this article protect the confidentially of her clients.