Cutting & Self-Harm in Teenagers
At the first instance, Cutting and self-harm may not necessarily mean the person is suicidal, though of course, it cannot be ruled out off-hand. Current thinking reflects that cutting behaviour, might be a way of expressing deep emotional pain that they don't have the full capacity to express, explore and process.
Usually, cutting is a secretive, and often obsessive behaviour that is in private. To know if a child might be cutting, look out for changes:: changes in clothing with a preference for full-sleeved shirts, increase in bathroom breaks, avoiding preferred activities and usual social groups or adopting small cliques that stay aloof from others.
When as an adult you come across a teenage person cutting herself, the first thing is to know that this could be serious, and to alert the immediate family for possible counselling and mental health intervention. You can let the teenager know that you have become aware of this behaviour, your concern and your availability to discuss things if they want to, but please do not insist that they disclose. You can help by remaining calm and patient, much more than becoming anxious or panicking.
What you may not want to do:
1. Don't make a hue and cry about it. Don't publicize it or make it a public knowledge. Certainly keep it confidential from other students and peers.
2. Don't demand that the child stop the practice, or threaten with adverse consequences
3. Don't probe, and don't assume highly traumatic events. Don't ask for any details on possible family issues, especially if you know of any dysfunction
4. Don't lecture them on how they should cope with life challenges, what is good for them or how they need to grow up
5. Don't make them feel guilty or shamed. Do not tell them they are hurting you, their family or school by this behaviour
At the same time, this is difficult for an adult to witness and feel helpless. Please don't make it your mission to change things, and if the child is not willing to discuss with you, please don't take it as a personal disappointment or get frustrated.
Even if the child doesn't want to discuss with you, you can still help by:
1. Keeping a watchful eye over the child, reducing alone time of the child
2. Helping the child engage with other activities (without making a project of it)
3. Staying open and available when the child chooses to try and express
4. Keeping the environment as predictable and friendly as possible
What to do when the child starts to talk about it:
When the child does begin to express, you can help by asking simple questions to try and understand. Gently look to help them find other resources for themselves, and to identify positive qualities about life and themselves. Try and maintain a non-judgmental attitude, and try to take an attitude that nothing is too shocking for you.
You need not agree with them or feel the same way, but you can express that you understand how difficult it might be for them. A key benchmark is to see that the child is speaking much more than you. Even if the child is not talking, just being with them in comfortable silence can be great for the child.
Please do not try and please the child so that she doesn't cut herself, as that might lead to manipulative behaviour.
Is this the 'in' thing?
Many children do pick up such behaviour from each other, popular fiction and the internet. Sometimes, they tend to form small groups which sustain each other, and that can have adverse effects on recovery as the support they got from each other when they needed it might be hard to give up.
Look out if small cliques are getting formed with other similar people, and gently reduce grouping possibilities - not by policing them, but by increasing attractive options outside such group.
Be discrete and take help when needed:
Above all, your discretion, watchfulness, patience and availability matter. Please do consult a mental health consultant, or a psychiatrist when needed. They will work with the children and as the children learn more effective communication and coping tools, self-harming behaviour does tend to go away.
Ajanta, Mahesh and other InnerSight counsellors and guest contributors are happy to share their thoughts here.