When you first learn your daughter engages in the behavior informally known as cutting, you’re probably at a total loss. For many people – especially parents – it’s difficult to understand. You probably feel a mix of confusion, shock, and worry. You wonder why your child would want to harm themselves. And you may feel guilty and think that somehow, it’s your fault.
With all these emotions swirling in your mind, you wonder what you can and should do.
You ask yourself the following questions:
Can I help her?
Is there treatment for cutting?
Is there such thing as a cutting treatment center?
Do other teens cut themselves, too?
The answer to all four of these questions is yes.
Yes, you can help her. You’ve already started by getting online, clicking our link, and reading this article.
Yes, evidence-based, effective clinical treatment for teens who engage in cutting is available. Over the past twenty years, mental health professionals specializing in treatment for adolescents have developed approaches to cutting treatment that work.
Yes, there are cutting treatment centers. Most adolescent behavioral health treatment centers offer treatment and support for teens who engage in cutting.
Yes, other teens cut themselves, too. Cutting is more common than most people realize. That means yes, other kids cut themselves, too.
This article will offer a clinical definition and description of cutting, discuss the causes, risk factors, and prevalence of cutting among adolescents generally, and teenage girls specifically, and then review the various treatments for cutting available at most adolescent behavioral health treatment centers, which may also be called cutting treatment centers.
What is Cutting? Clinical Definitions
The clinical name for this type of behavior is non-suicidal self-injury (NSSI). Psychiatrists and therapists may refer to NSSI as self-injury (SI), self-harm (SH), deliberate self-harm (DSH), and self-mutilation (SM). Mental health experts label the various forms of NSSI, collectively, as self-harming behaviors. In addition to cutting, they may include self-directed harm or injury such as branding, excessive scratching, or biting.
The National Alliance on Mental Illness (NAMI) provides this short, simple definition of NSSI:
Self-harm or self-injury means hurting yourself on purpose.
The American Psychological Association (APA) provides this more complete, clinical definition:
“The condition – clinically known as non-suicidal self-injury or NSSI — is characterized by deliberate self-inflicted harm that isn’t intended to be suicidal. People who self-harm may carve or cut their skin, burn themselves, bang or punch objects or themselves, embed objects under their skin, or engage in myriad other behaviors that are intended to cause themselves pain but not end their lives.”
You should understand the difference between self-harm and self-injury, however. Self-harm is a general classification that includes risky behavior, feeding and eating disorders, and alcohol/substance use disorders (AUD/SUD). Clinicians identify NSSI as a subtype of self-harming behavior among these broad categories, although clinicians and people familiar with adolescent behavioral issues often use the terms self-harm and self-injury interchangeably when talking about NSSI.
Why do Teens Engage in Self-Harming Behaviors Like Cutting?
In the same way we offered a simple and in-depth definition of NSSI, we’ll offer a simple and in-depth explanation for why teens – or anyone – may engage in NSSI. Self-harm awareness advocates at LifeSigns Self-Injury Guidance and Support Network offer both, which are based on data and other information found in two peer-reviewed journal articles: Non-suicidal Self-Injury in Adolescence (2017) and Nonsuicidal Self injury in Adolescents (2008).
(Those look like the same article but they aren’t.)
We often extract definitions and explanations of troubling teen behavior directly from peer-reviewed journal articles, then summarize them in our own words. That’s part of our function in articles like these: helping you understand what’s going on with your teen in language you don’t have to work to understand. We see one of our primary duties as translating complex jargon into readable content for the parents of the teens we support every day.
In this case, though, we’re going to give you the summaries offered by the people at LifeSigns, because the founder of the organization has personal experience in engaging in cutting and self-harm behaviors, and the population they support and interact with most often are teenagers, the same population we support and interact with on an ongoing basis.
In other words, we’ll let them say it because they’ve experienced what we’re talking about: NSSI.
Here’s their short explanation of why people engage in NSSI (cutting):
“Self-injury is a coping mechanism. An individual harms their physical self to deal with emotional pain, or to break feeling of numbness by arousing sensation.”
And here’s the in-depth explanation of NSSI (cutting):
“Self-injury is any deliberate, non-suicidal behavior that inflicts physical harm on our body and is aimed at relieving emotional distress. Physical pain is often easier to deal with than emotional pain, because it causes real feelings. Injuries can prove to a person that their emotional pain is real and valid. Self-injurious behavior may calm or awaken a person. Yet self-injury only provides temporary relief. It does not deal with the underlying issues. Self-injury can become a response to the stresses of day-to-day life and can escalate in frequency and severity.”
Clinical Diagnosis of Cutting/NSSI
Those definitions and explanations are accurate and help us understand why people engage in self-harm. There’s more to NSSI that’s important to understand as well, which is explained in the Diagnostic and Statistical Manual of Mental Disorders – Volume 5 (DSM-V), the standard diagnostic manual in use by clinicians around the world.
We list the criteria a clinician uses when diagnosing NSSI using the DSM-V below.
- In the last year, the individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body, of a sort likely to induce bleeding or bruising or pain (cutting, burning, stabbing, hitting, excessive rubbing), for purposes not socially sanctioned (body piercing, tattooing, etc.), but performed with the expectation that the injury will lead to only minor or moderate physical harm. The absence of suicidal intent is either reported by the patient or can be inferred by frequent use of methods that the patient knows, by experience, not to have lethal potential. The behavior is not of a common and trivial nature, such as picking at a wound or nail biting.
- The intentional injury is associated with at least 2 of the following:
- Negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self-injurious act.
- Prior to engaging in the act, a period of preoccupation with the intended behavior that is difficult to resist.
- The urge to engage in self-injury occurs frequently, although it might not be acted upon.
- The activity is engaged in with a purpose. This might be relief from a negative feeling/cognitive state or interpersonal difficulty or induction of a positive feeling state. The patient anticipates these will occur either during or immediately following the self-injury.
- The behavior and its consequences cause clinically significant distress or impairment in interpersonal, academic, or other important areas of functioning.
- The behavior does not occur exclusively during states of psychosis, delirium, or intoxication. In individuals with a developmental disorder, the behavior is not part of a pattern of repetitive stereotypes. The behavior cannot be accounted for by another mental or medical disorder.
How to Read These Criteria
We want you to focus on the specifics: NSSI is related to emotional states and negative feelings associated with depression, anxiety, self-criticism, and psychological distress. Also, while people who engage in NSSI show increased risk of suicide or suicidal ideation, a characteristic of NSSI is that the act of self-injury, in the context of NSSI, is not performed with the intent to commit suicide or the expectation the act will be fatal.
Risk Factors for NSSI (Cutting)
Evidence shows the following groups are at-risk for engaging in NSSI:
- Teens with friends who engage in NSSI
- Teens who encounter examples of NSSI on social media
- Adolescents with a history of early trauma
In addition, the APA indicates the following factors correlate with elevated risk of NSSI:
- Previous diagnosis of a mental health or behavioral disorder
- Previous instances of self-harm
- Suicide attempts
- Suicidal ideation
- Previous self-harm, suicidal behavior in the immediate family
- Family history of suicide
- Previous experience of bullying, either in-person or online
- Identification as a member of LGBTQI and/or non-binary community
The data are clear on these risk factors. Teenagers are at elevated risk of engaging in NSSI. Bisexual teenage girls are at the greatest risk of all groups included in the scientific research. That research (linked to above) indicates that almost 47 percent of females who self-identify as bisexual also report engaging in NSSI.
Prevalence of NSSI Among Teens
In a study published in 2018 containing data on over 60,000 teenagers, researchers revealed that NSSI is much more common than most people – especially parents of teens – think. Here’s what the researchers found:
- 17% of adolescents reported instances of NSSI
- 11% of males said they’d engaged in NSSI
- 24% of females said they’d engaged in NSSI
In addition, a study published in 2019 on adolescents receiving behavioral health treatment showed the following:
- 35-80% of teens in inpatient treatment reported NSSI (variation attributed to differing methods and definitions)
- 87% of teens who engage in NSSI have a psychiatric disorder
- The presence of NSSI correlates with the presence of a number of personality disorders, but does not significantly correlate with one specific personality disorder
Let’s look at the first bullet list in this section. 17% of adolescents in the U.S. means roughly 4.25 million. 11% of boys means roughly 1.25 million, and 24% of girls means roughly 2.7 million. What you can take away from this data is that you are not alone. There are literally millions of families who’ve experienced this. They’re not in your exact shoes, but they understand where you are and some of the emotions you may feel. This goes for your teenage daughter, too: she may feel completely alone in her experience, but the data shows that she is not alone.
There are families who know how to handle this situation. They’re out there and willing to help. Also, you can find licensed mental health professionals who specialize in working with adolescents who engage in NSSI.
That’s what we’ll talk about now: treatment and support.
Effective, Evidence-Based Treatment for NSSI
Research shows that three modes of therapy are effective for adolescents who engage in NSSI:
- Cognitive behavioral therapy (CBT)
- Dialectical behavioral therapy (DBT)
- Mentalization-based treatment for adolescents (MBT-A)
A study published in 2020, though, offers evidence that dialectical behavioral therapy (DBT) is the most effective approach of the three.
Researchers reviewed statistics related to over four hundred adolescents hospitalized for suicidal ideation, suicide attempts, or NSSI. These adolescents received one of two treatment approaches: DBT or treatment as usual (TAU). Compared to patients who received TAU, patients who received DBT showed:
- Decreased time in the treatment
- Less treatment time in restraints
- Fewer suicide attempts
- Fewer instances of self-injury
This is a powerful argument for the use of DBT as a treatment for adolescents who engage in NSSI. Experts in adolescent behavioral health agree that reduced time in treatment, reduced incidents of self-injury, and reduced suicide attempts are all treatment goals – and are positive outcomes – for adolescents who engage in cutting or other self-harming behaviors.
What to Do When You Find Out Your Daughter Is Cutting: Seek Treatment
Appropriate treatment for a teen who is cutting takes place at adolescent behavioral health treatment centers, which may be known informally as cutting treatment centers.
If your daughter is cutting herself, your first step is to talk to her about what you see. Be calm and nonjudgmental. She may or may not open up to you: it all depends on her.
However, you should inform her about your next step, which we recommend now:
Get professional help and support as soon as possible.
That means arranging an appointment with a psychiatrist or therapist who specializes in treating adolescents. A professional evaluation will help determine if your teen has an underlying psychiatric disorder that’s contributing to the behavior. A qualified psychiatrist or therapist can also recommend the best course of treatment, depending on the outcome of the evaluation.
Your third step – which is contingent upon the evaluation – is to arrange for treatment, if recommended by the professional who evaluates your daughter. Treatment may involve one of the following levels of care: outpatient, intensive outpatient (IOP), partial hospitalization (PHP), or residential treatment (RTC). Treatment typically involves a combination of individual therapy, group therapy, family therapy, experiential therapies, lifestyle modifications, and community support.
The exact combination of treatment approaches is determined through a collaborative process that includes you, your daughter, and the therapist(s), counselor(s), and/or psychiatrist(s) who make up her treatment and support team.
Treatment works. Teens who engage in NSSI can and do learn to manage their emotions without harming themselves. During treatment, teens can learn practical, evidence-based coping skills and techniques to process their emotions in productive ways.
Your daughter can learn those skills, and the sooner she gets professional treatment and support, the sooner she can apply those skills and rediscover balance and harmony in her life.