Harm's Way
by Kathleen Seiler Neary March 25, 2010 Updated September 1, 2022
For adolescents in emotional pain, cutting becomes a dangerous way to cope. The good news: They can recover.
On the day after Valentine’s Day, 2005, Christine went into her bathroom and made some shallow cuts on her upper thigh with the broken-off top to a pen. The scratches scarcely drew blood. But the relief she felt from her overwhelming emotions was like “stubbing your toe when your arm is broken. Suddenly, your arm doesn’t hurt so much.”
A ninth-grader at a private school in Kensington at the time, Christine was a pretty, auburn-haired 14-year-old who played the harp and enjoyed theater class. But the previous 24 hours had been painful. Earlier that day she had written a note to a close friend, thanking her for saving her from suicide.
“She didn’t actually stop me from killing myself,” says Christine, who, along with others in this story, asked that her real name not be used. “But I was very dependent on her, and I saw her as a reason for living—I was a bit melodramatic.”
Her friend never got the note, but school authorities did and they called Christine’s mother, who picked her up from play rehearsal and drove her to a local emergency room. Diagnosed with severe depression, she signed an agreement not to harm herself and to begin psychotherapy.
During her evaluation, Christine was asked to remove the dozens of bracelets she wore, so that her arms could be examined for evidence of cutting. “I never had [cut],” Christine says, but the exam made her wonder. “I thought that if people were doing it, it must work.”
That night, as she and her mother drove home from the hospital, she felt exhausted from the experience of confronting the feelings she so often had managed to hide. The last straw, for Christine, was her mother’s seeming preoccupation with what others would think. “It was like I was going to ruin her reputation as a good mother when people found out she had a crazy daughter,” she says.
The next day, she experimented with cutting. “I was scared,” she says, “but I thought I knew what I was getting into.”
Joan Goodman, a clinical social worker and adolescent specialist in Rockville, has evaluated and/or treated nearly 400 adolescent self-injurers in Montgomery County in the past 14 years. Each has told her, in some way, the same thing: that physical pain is easier to deal with than emotional pain.
Goodman first began seeing teen self-injuries in her practice in 1996—the same year Princess Diana of Wales publicly admitted cutting herself during her unhappy marriage. Subsequent confessions by celebrities such as Johnny Depp and Angelina Jolie, as well as depictions of cutting in movies such as Thirteen, have led some parents to worry that the behavior is contagious, or a fad. An informal poll of Bethesda-area teens suggests a widespread awareness of cutting, including personally knowing another teen who has done it.
Statistics are difficult to come by, in part because the behavior is often kept secret. A 2007 study at the Miriam Hospital and Warren Alpert Medical School of Brown University in Providence, R.I., found that among 633 high school students, 28 percent reported injuring themselves moderately to severely at least once in the past year, with cutting the most frequent method.
Some public school districts, such as the Los Angeles Unified School District, have reported recent increases in students referred for non-suicidal self-injury. Montgomery County Public Schools does not keep such records, but Walt Whitman High School resource counselor Fran Landau says her office began seeing cases of cutting 10 years ago, and “more of it in the past five.” She says students who are not already in therapy are referred to the Montgomery County Crisis Center, and usually enter treatment from there.
Cutting can be a reaction to stress or social problems that are beyond a young person’s ability to cope, according to Dr. Steven Israel, medical director of Potomac Ridge Behavioral Health in Rockville. Or, he says, it can reflect a psychiatric illness, such as depression. Either way, self-injury as a “solution” can quickly become another serious problem. And “stopping the cutting doesn’t necessarily make the underlying problems go away.”
Goodman says cutting is not a new phenomenon. She points out that bloodletting was used as a means of getting rid of evil spirits centuries ago. But, she says, cutting has come out of the closet in recent years, much as anorexia and bulimia did in the ’80s, with teens more inclined to talk about it.
Goodman acknowledges that a young person who hears about cutting might be tempted to try it. But continued self-injury holds no appeal for those who aren’t troubled, she says. “I’ve had kids say to me, ‘I tried that, and it hurt. It’s stupid, and I’m not going to do it again,’” she says. “I have yet to meet a child so happy that they’ve had to cut themselves.”
But, she says, for a teen who finds that cutting “works”—like exercise, it releases mood-lifting endorphins—“the behavior is highly addictive and can easily take over a young person’s life.”
For Christine, cutting became an obsession. But in order to continue to find that release, she found she had to cut herself deeper, using sharper implements. “I eventually built up to scissors,” she says. “I thought I was being courageous.”
She began carrying sharp implements with her, going into the nearest bathroom and cutting herself, usually on the upper thigh where nobody could see it, as often as two or three times a day. “It was a way to scream and cry and moan,” she says, “without making a sound.”
Paradoxically, one motivation for teens to cut themselves is to hide their emotional pain from their parents, Goodman says. “To the outside world, it may look like the family’s perfect: two educated, hardworking, successful parents, a nice house,” she says. “Many of these young people are also high performers who excel in many activities. They feel tremendous pressure to achieve and be perfect—it’s not OK for them to not be OK.”
Many parents don’t realize that something is seriously wrong until they discover that their child is cutting.
Linda was stunned when her daughter, Jessica, then a high school sophomore, got into the car after field hockey practice one day and announced she had something to tell her: She had been cutting herself for the past six months. A Bethesda native in her mid-50s who exudes cheerful competence, Linda describes Jessica at 15 as a girl who appeared to have no problems: attractive, athletic, charismatic—somebody others confided in. “I must have had some vague idea of what cutting was, because I didn’t say, ‘What’s that?’ ” Linda recalls. “I said, ‘I’m glad you told me, and don’t worry—we’ll get you some help.’
“But inside, I was dying.”
Jessica, now a 21-year-old college junior, says that far from feeling popular in high school, she was a “traveler” who fit in nowhere. “I was the person that people went to with their problems because they knew they could trust me,” she says, “but I never felt comfortable trusting anyone else.”
She had “heard about cutting from random people, but had never really taken it into consideration” until she had a huge fight with her father one night and couldn’t stop crying. She can’t even remember what the fight was about, but afterward she took a razor and cut her wrist. The physical pain immediately relieved her mental distress, and soon she was cutting at least once a week—“sometimes every day, depending on how bad my state of mind was.”
Cutting, Goodman says, “provides teens with a false sense of control by allowing them to choose when, where and how much they will hurt. And because it makes them feel better, the young person will often say, ‘What’s wrong with it? I’m not hurting anybody else.’ ”
Jessica didn’t see a problem with cutting until six months in, when she had trouble stopping the bleeding. She realized she needed help. She hadn’t told her mother because “I was afraid she would get mad, which would have made me cut more. I literally could not deal with anyone yelling at me or feeling disappointed in me.”
As Jessica recalls the scene in the car, her mother began to cry and said she would do anything to help her. As soon as they got home, Linda got on the phone and started setting up appointments. “It was exactly what I needed,” Jessica says. “She gave me the support I needed to begin my recovery.”
Recovery was a long process, however. Jessica entered both individual and group therapy and took medication for what was diagnosed as clinical depression and bipolar disorder. “But then she would feel better and take herself off the medication,” Linda says.
Israel, who is a psychiatrist, says teens as well as parents can be resistant to the idea of medication if depression or a mood disorder is diagnosed. “I often hear kids say, ‘I don’t want to have my mind controlled by medicine—I like my edge,’ ” he says. “So what I say to that—especially for kids around here, where there’s a lot of interest in science—is that just as electrons have different energy levels and orbits, [medicine] increases the time that kids are in their best state. That stability frees them to develop their own inner resources.”
A 2004 study published by Cornell University in Ithaca, N.Y., found self-injurious behavior most often begins in early adolescence. Cecilia, a soft-spoken 14-year-old from Rockville, says she began cutting herself in eighth grade, after her emotionally troubled younger sister attempted suicide and was hospitalized.
“It gave me something else to think about,” she says. In contrast to her more dramatic sibling, Cecilia describes herself as a low-key person who “doesn’t like a lot of people crowded around me or looking at me.”
She recalls seeing an episode about cutting on the teen soap opera Degrassi, but was not really thinking about the TV show on the September day when she began idly scratching her arm with a safety pin. After a while, she stopped and began to cry—not because of the pain or fear that she would seriously injure herself, but because she worried about adding to her family’s troubles.
“I just wanted to keep out of my parents’ hair so they didn’t have to worry about me,” she says with a sigh. “First they had one bad kid, and now they had two.”
Cecilia didn’t cut herself again until January, after her sister was released from the hospital and life at home became stressful again. Finally, she confided in a therapist who had come to their home to work with her sister. The therapist recommended that Cecilia be hospitalized, and it was there, she says, that her cutting worsened. Although inpatients were not allowed to have sharp objects, she quickly learned how to fashion one from a broken plastic utensil. Cecilia’s hospital roommate told on her, and she was watched even more closely.
The next few months, for Cecilia, were a blur of repeated hospitalizations and outpatient treatment. She missed most of the second half of eighth grade. But despite her almost desperate efforts to find or fashion sharp objects (her parents by this time had locked away knives, scissors, even thumbtacks), she says her cutting was never an attempt to kill herself. On the contrary, “it made me feel better.”
Goodman says cutting is often an attempt to get through the moment, rather than a suicidal gesture. However, because self-injuring teens are emotionally fragile, she says, “it is crucial to ask whether a recent episode of self-injury was a suicide attempt.”
Although some teens appear defiant or even exhibitionistic about cutting—writing about it on Facebook, for example—all the young people interviewed mentioned feeling shame. “You become very secretive and fake with everyone you love,” says Christine, the Kensington girl, “which just adds to the guilt and the feelings of why you need to cut.”
Warning signs, according to Goodman, include wearing bracelets, watches or wristbands that are never taken off; wearing long sleeves even in summer; or making excuses for not putting on a bathing suit or going to the beach. When cuts are visible, a teen may dismiss them as cat scratches, even if the cuts are suspiciously straight and parallel.
Often, self-injurers seem to be simultaneously hiding and crying out for help. Max, 22, an athletic and genial former football player from Silver Spring, says he never fit the “emo” stereotype. But in the winter of his freshman year in college, he cut his face with a paring knife after a longtime friend rejected his romantic overtures. Although the cuts soon healed, he couldn’t get the girl out of his head, and a few months later he made deeper wounds in the same spot. “I just wanted it to be visible, so that everyone would know I was hurting,” he says. “But I ended up lying and saying I got hurt playing football.”
After spotting the girl at a party with another guy, he got drunk and slashed his wrists, this time hiding the scars with an athletic sleeve. “The rush [of cutting] only lasts a few seconds, so you have to keep doing it,” he says. “Not only was I hiding the problem of not being able to get over the girl, but I was hiding another of self-mutilation.”
One day, when his friend dropped by to borrow something, he felt he couldn’t stand the secrecy any longer. He pulled off the sleeve and showed her his wounds. “She was pretty shocked,” Max says. “She knew that I liked her, but not that I was gashing myself over it.” He says they’re still friends, although they never talk about that day.
Max decided to seek psychological help, realizing he probably had needed it for years. “Starting in middle school,” he says, “I tried for the longest time to tell my mom and dad I was depressed, but they just wouldn’t buy it.”
Experts who work with teens agree that adolescent self-injury is highly treatable when parents, teachers and mental health professionals work together. Walt Whitman High School counselor Jenny Higgins says that while Montgomery County does not require parents to allow schools to be in contact with a student’s therapist, “those who do allow it get the best wraparound support for their child.”
“It’s important for parents not to feel defensive or like a failure,” Israel says, “but to feel that [cutting] is a danger sign that needs to be looked at with understanding and the intention of solving it to make it better.”
Goodman has provided symposia and seminars to mental health professionals, teachers, parents and teens on the subject of self-injury. She says the revelation that a teen is cutting should be met with concern and as much calm as a parent can muster, and professional help should be sought as soon as possible. Recovery, she says, doesn’t happen quickly; it is a process that can take months or years. “Life is not a race, and a successful recovery is rarely a straight line,” she says. “Just as a teen learns how to cut, each self-injurer needs time and strategies to learn how to stop.”
Alternative coping strategies can include everything from art and journal-writing to snapping a rubber band or holding ice cubes instead of cutting. Recovery is accomplished, Goodman says, when teens can identify and express their feelings in words.
And for recalcitrant teens who stonewall an individual therapist, a weekly group therapy meeting can melt their resolve not to talk. “They come into a group of peers,” Goodman says, “and you can’t get them to stop talking.”
Jessica says her therapist urged her to try group therapy for a couple of years before she agreed to it. “I was scared of having people look at me like I was crazy,” she says, “but I met other people my age who were going through similar things, and I felt like I was no longer alone.”
Christine also ended up in group therapy. “When you start group, you’re really afraid of being judged by others,” she says. “But once you create those bonds and share so much of yourself, and get so much in return, you share so much more than the story of a scar…. Even when we talked about superficial things, about how much homework we had, there was still that understanding.”
Christine eventually was diagnosed with bipolar disorder and hospitalized in 2006. She saw several psychiatrists and tried various medications, including lithium. At 19, she has not cut for more than a year. “With me, it’s not even a day-to-day thing, it’s more hour to hour, but I’m getting there,” she says. “I feel pretty damn good now, for the most part.”
She attends junior college and has begun playing the harp again—an instrument she dropped during the chaos of her high school years. She also goes to yoga each day. She used to feel self-conscious about her scars, and tried over-the-counter creams to make them less noticeable. But now, “I don’t want to forget them, or what I’ve been through,” she says, “and I like seeing them slowly fade away.”
Max also stopped cutting and is studying for a master’s degree in education. He has a girlfriend and a circle of friends. Recently, he learned his father also suffers from clinical depression and has taken medication for years. Thinking back to his efforts to convince his parents of his depression, “I think they just didn’t want to believe their son would have this problem,” he says.
Last summer, after her third release from the hospital, Cecilia decided she wanted to stop cutting. “I knew it was bad and that I was hurting my parents,” she says with the same quiet nonchalance with which she described her first self-injury. “I knew I wanted to do something different.”
She has not cut since entering ninth grade, and says that high school is better than middle school. “You have a lot more freedom.” Only once has she run into another girl aware of her problem. “She looked at all the cuts on my arm and said, ‘You’re showing.’ I looked at her funny, but I knew what she meant. And she said, ‘It’s OK. I do it, too. I won’t tell anybody.’ ”
Asked what advice she would give parents of self-injurers, Cecilia doesn’t hesitate: “The first thing you should do is give your kid a hug.”
Linda, Jessica’s mom, joined a therapy group for mothers. “As a parent, it helps you to understand where your child is coming from,” she says. “There were times I couldn’t deal with her, and when my husband couldn’t deal with her, so we’d be like a tag-team. But I do think she knows we’ve tried. Once she said, ‘Mom, you’re really good at handling all this now.’ ”
Jessica recovered enough to feel ready to go away to college, but her first year was tough. “I still have my problems,” she says, “but I work through them without even thinking about cutting. I look down at my wrist and wonder why I ever did it. I will have my scars for the rest of my life.”
For more information, help or referrals:
Montgomery County Crisis Center
1301 Piccard Dr., Rockville240-777-4000www.montgomerycountymd.gov/hhstmpl.asp?url=/content/hhs/crisis_center/default.asp
Mental Health Association of Montgomery County
1000 Twinbrook Parkway, Rockville301-424-0656www.mhac.org
Montgomery County Youth Hotline
301-738-9697
Self Abuse Finally Ends (S.A.F.E.) Alternatives
Lists treatment agencies and therapists across the United States, books and other resources.www.selfinjury.com
Adolescent Self Injury Foundation
Offers information, local resources and forums for teens and parents.www.adolescentselfinjuryfoundation.com