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Cutting and Self-Harm: Warning Signs and Treatment

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

What Parents Should Do continued...

Be direct with your child, adds Lader. "Don't act out of anger or let yourself become hysterical -- 'I'm going to watch you every second, you can't go anywhere.' Be direct, express concern. Say, 'We're going to get help for you.'"

Parents often mistake cutting for suicidal behavior. "That's usually when they have finally seen the cuts, and they don't know how to interpret it," explains Rosen. "So the kid gets dragged into the ER. But ER doctors aren't always used to seeing this, and find it difficult to understand whether it's suicidal or self-injurious behavior. Many kids who are not suicidal at all are being evaluated and even hospitalized as suicidal."

Unfortunately, "the attitude in hospital emergency rooms can be very cavalier and harsh about self-injurers," adds Lader. "There's a lot of dislike, because it's a self-made injury, so ER personnel can be very hostile. There are all kinds of stories of girls getting stitched without anesthetic. The thing is, after they've self-injured, the girls are calmer -- so when they're getting stitches, they feel the pain. Yet the doctor is angry, wants to get this over with."

Psychotherapy should be the first step in treatment, Lader adds. The SAFE web site has a list of doctors who have been to her lectures, who want to work with self-injurers. With other therapists, ask if they have any expertise in working with self-injurers. "Some therapists have a fear reaction to it. The therapist needs to be comfortable with it," she advises.

However, the girl or boy must be ready for treatment, says Rosen.

"The ultimate lynch pin is -- the child has to decide they're not going to do this anymore," he tells WebMD. "Any ultimatum, bribery, or putting them in a hospital is not going to do it. They need a good support system. They need treatment for underlying disorders like depression. They need to learn better coping mechanisms."

When An Inpatient Program Is Necessary

When kids just can't break the cycle through therapy, an inpatient program like SAFE Alternatives can help.

In their 30-day program, Lader and Conterio only treat patients who voluntarily request admission. "Anybody who can't perceive that they have a problem will be hard to treat," says Conterio. Those who come to us have recognized that they have a problem, that they need to stop. We tell them in the acceptance letter we send them, 'This is your first step toward empowering yourself.'"

When admitted to SAFE, patients sign a contract that they won't self-injure during that time. "We want to teach them to operate in the real world," says Lader. "That means making choices in response to emotional conflict -- healthier choices, rather than just self-injuring to feel better. We want them to understand why they are angry, show them how to handle their anger."

Although self-harm is not allowed, "we don't take away razors," Conterio adds. "They can shave. We don't take belts or shoe laces. The message we're sending is, 'We believe you're capable of making better choices.'"

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