By Diana Swift
From the print edition, October 2011
Paige first stapled her thumb at age eight just to see what it felt like. By her late teens she had started cutting herself. “It’s a form of control, controlling emotion,” says Paige, now in her 20s. She calls it a “recalibration,” a visible way of dealing with her invisible but very real pain. “I get to watch it heal,” she says.
The behaviour of self-mutilation is defined as non-suicidal self-injury (NSSI) that involves immediate visible damage to a person’s surface tissues. Most often beginning in early to mid-adolescence, self-cutting is estimated to affect 14 to 24 percent of youth and young adults. “About 17 percent of high school students are thought to self-injure,” says Dr. Shawna Atkins, a counselling psychologist at Montreal’s Westmount Psychological Services. Experts used to think that NSSI was more common in girls, but Atkins sees as many males as females who self-injure.
Teens may inflict injuries by self-cutting (the most common form) with knives or razor blades, by hitting or pinching themselves or by burning themselves with matches or cigarettes. Typical sites are the upper and inner arms, the thighs and the wrists. Most injuries are superficial and are not life threatening.
“The specific purpose of self-injury is to make the teen feel better immediately,” says Dr. Nancy Heath, a professor in McGill University’s department of educational and counselling psychology. When one study asked teens about their first episode of injuring, those who were more likely to continue tended to report feeling a great sense of calm following the self-injury. “All those intolerable negative emotions were gone,” notes Heath.
Teens who self-injure seek release from the burden of intense and overwhelming negative emotions—feelings they can’t regulate. Many share common characteristics, such as high expectations of themselves, difficulty regulating and expressing their emotions, and internalizing their feelings. “They are often strong, multi-talented, very together students, but they are very hard on themselves,” says Heath. Adds Atkins: “They perform well outwardly but they internalize their distress.” And, she says, most teens actually have very mixed feelings about self-injury. “They know it’s wrong and they tell themselves they are not going to do it again, but in distress they turn to it since they lack other means to soothe themselves.”
First look for a significant change in your teen’s mood or behaviour. “Of course, most teens can be moody and want to withdraw from others, but if this behaviour becomes prolonged, it can indicate something is going on,” says Dr. Stephen P. Lewis, an assistant professor of clinical psychology at Ontario’s University of Guelph. More obvious signs are cuts, burns, bruises or scratches and dubious explanations (“My friend’s cat did it!”). Finding a stash of sharp objects or noticing a teen wearing unseasonable clothing (such as long sleeves in hot weather) are also clues.
Above all, says Heath, parents must not minimize or ignore this behaviour because teens who self-injure are at an increased risk of attempting suicide. “In one study, we found some 48 percent of high school aged self-injurers admit to having made a suicide attempt, so dismissing this as the actions of a drama queen or a way to force the family to focus on the teen is the wrong approach,” she says. “Just telling her to stop is not going to work.”
If you suspect your teen is self-injuring, start by expressing your concerns and mentioning the behaviour you have noticed. “From here it is important to actively listen and attend to your teen’s emotions. Asking open-ended questions and using a supportive and calm tone can be quite helpful,” notes Lewis. Atkins also encourages self-injurers to get involved in activities they love such as sports or arts to increase physical and creative outlets. “But this is only and always an adjunct to identifying the feelings in their bodies, labelling them accurately and learning to verbalize them and use them to identify what they need, and acting on these needs,” says Atkins. “This is the kind of psychoeducation we do in counselling and parents can sometimes do some of this—but they often need guidance. If the self injury is severe and parents are unable to help, then expert help is recommended.”