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Cutting and Self-Harm: Warning Signs and Treatment

Parents should watch for symptoms and encourage kids to get help.

Blunting Emotional Pain continued...

"Yet self-harm is different from taking drugs," Conterio explains. "Anybody can take drugs and feel good. With self-injury, if it works for you, that's an indication that an underlying issue needs be dealt with -- possibly significant psychiatric issues. If you're a healthy person, you might try it, but you won't continue."

Self-harm may start with the breakup of a relationship, as an impulsive reaction. It may start simply out of curiosity. For many kids, it's the result of a repressive home environment, where negative emotions are swept under the carpet, where feelings aren't discussed. "A lot of families give the message that you don't express sadness," says Conterio.

It's a myth that this behavior is simply an attention-getter, adds Lader. "There's a [painkiller] effect that these kids get from self-harm. When they are in emotional pain, they literally won't feel that pain as much when they do this to themselves."

What It Looks Like

David Rosen, MD, MPH, is professor of pediatrics at the University of Michigan and director of the Section for Teenage and Young Adult Health at the University of Michigan Health Systems in Ann Arbor.

He offers parents tips on what to watch for:

  • Small, linear cuts. "The most typical cuts are very linear, straight line, often parallel like railroad ties carved into forearm, the upper arm, sometimes the legs," Rosen tells WebMD. "Some people cut words into themselves. If they're having body image issues, they may cut the word 'fat.' If they're having trouble at school, it may be 'stupid,' 'loser,' 'failure,' or a big 'L.' Those are the things we see pretty regularly."
  • Unexplained cuts and scratches, particularly when they appear regularly. "I wish I had a nickel for every time someone says, 'The cat did it,'" says Rosen.
  • Mood changes like depression or anxiety, out-of-control behavior, changes in relationships, communication, and school performance. Kids who are unable to manage day-to-day stresses of life are vulnerable to cutting, says Rosen.

Over time, the cutting typically escalates -- occurring more often, with more and more cuts each time, Rosen tells WebMD. "It takes less provocation for them to cut. It takes more cutting to get the same relief -- much like drug addiction. And, for reasons I can't explain but have heard often enough, the more blood the better. Most of the cutting I see is quite superficial, and looks more like scratches than cuts. It's the sort that when you put pressure on it, it stops the bleeding."

What Parents Should Do

When parents suspect a problem, "they are at a loss of how to approach their child," Conterio says. "We tell parents it's better to err on the side of open communication. The kids may talk when they're ready. It's better to open up the door, let them know you're aware of this, and if they don't come to you, go to someone else ... that you're not going to punish them, that you're just concerned."

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