Learning that someone you love is participating in self-injury behaviors, like cutting, can be very difficult to understand and accept. As a loving parent or friend, you want to know how to help.
This guide will help you:
- Understand self-injury.
- Know how to approach a loved one engaging in self-injury.
- Know when to seek professional help.
Why would someone cut themselves?
It is difficult to understand why someone would deliberately harm themselves despite the many consequences (scars, infection, and even death). Cutting always serves a function for the individual. The t question is “What function does cutting play for the given person?” Is it an escape from feeling sad, lonely, and depressed? Is it to cope with past traumatic abuse? Or maybe it is to cope with a parents’ recent divorce, an argument with a boyfriend or girlfriend, or feelings of numbness. Mental health professionals often see cutting as an unhealthy way to cope with internal emotions and troublesome life events.
Cutting as a Coping Mechanism
- Individuals who cut often do not know how to appropriately express their emotions; they may not even know what emotion they are feeling. To these individuals, cutting helps them cope and express those painful emotions.
- Common emotions preceding cutting include: anger, self-loathing, guilt, depression, frustration, loneliness, isolation, anxiety, irritability, and numbness or dissociation.
- Cutting is a way for these individuals to regulate painful emotions.
- If an individual continues to cut, then the act of cutting must have soothed the emotion and made the individual feel more in control of the situation (similar to other behaviors such as drinking in excess, smoking, and overeating).
Cutting as a Response to Immediate Environment
Cutting produces a response from others. Therefore, individuals who cut may use this behavior as a cry for help to communicate that they are in emotional pain. Examples include:
- Seeking help for individual’s suffering
- To communicate personal boundaries (“I wish you would get closer to me. I need help.” Or “I need space. It is not safe to be around me.”)
- To test other’s attachment (“Will you still love/like me if…”)
- To punish self or someone else (“I will hurt myself because no one could love me.” Or “I am punishing you because you betrayed me.”)
How Can I Talk to Someone About Cutting?
Pick A Good Time
- There is no perfect time to discuss this topic, but it is best not to discuss this issue in front of others.
- Pick a time when neither of you is under pressure, you are well rested, and do not have to compete with other stimuli.
- Choose a private place where both you and the individual feel comfortable.
Make Your Words Count
- Have a game plan. If you need to write down what you want to say or make a list, do it.
- You have about 30 seconds to get the individual’s attention before he/she is bored. So, say what you mean and mean what you say.
- Let the individual know that you care about him/her, are concerned (and why) that he/she is cutting (and why), and you would like to talk about it.
- Be honest with the individual. You are asking him/her to do the same.
- Listen to the individual’s response and be empathetic.
How to Directly Ask About Cutting
- It is very important to listen to the individual’s feelings and validate them.
- Ask open-ended questions (questions that do not have a simple yes or no answer) and focus on the individual’s feelings.
- Use a nonaccusatory tone.
- Remind the individual that you care about him/her and are concerned.
- Remember, that you are trying to obtain information about the cutting behavior. Make sure to ask:
- How long have you been cutting?
- How often do you cut?
- Where on your body do you cut?
- What motivates you to cut?
- Have you tried to stop?
- What happens when you try to stop?
- Example: As a concerned friend or parent you could say something like this: “I have noticed that you are not yourself lately. You seem lonely, sad, and frustrated. I care about you, and I am concerned about you. I know this is a crazy thing for me to suggest, but I am concerned that you may be cutting or thinking about it. What do you think and feel about what I have said?”
When Should I Seek Professional Help?
If you have had a conversation with your loved one about cutting, and you have discovered that he/she is engaging in self-injury and unable to stop, then it is best to seek professional help.
When Hospitalization Is Necessary
- The individual is unable to keep him/herself safe, even when he/she has committed to do so.
- The self-injury is causing serious physical harm and required medical attention.
- The individual is unable to stop self-injury for even one day.
- The individual is engaging in other behaviors posing an immediate risk to his/her health (drug or alcohol abuse, starvation, letting others abuse him/her).
- Impulse control and reality testing is impaired (the individual is experiencing mania, dissociation, or abusing drugs or alcohol).
- The individual is stating that he/she wants to kill him/herself.
When Hospitalization is Unnecessary
- The individual is actively participating in treatment with a clinician who is thoroughly managing the case.
- The individual commits to keeping him/herself safe and follows through with this commitment.
- The individual openly discusses self-injury with therapist and other concerned parties.
- The individual engages his/her treatment plan to stop self-injury and other symptoms.
- The individual actively works on developing safe and effective coping strategies.
- Therapy and medication regimes are followed.
- The individual is monitored for suicidal thoughts.
Recommended Reading and Reference:
McVey-Nobel, M. E., Khemlani-Patel, S., & Neziroglu, F. (2006). When your child is cutting: A parent’s guide to helping children overcome self-injury. Oakland, CA: New Harbinger Publications, Inc.
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