Does Cutting Mean My Teen Wants to Commit Suicide?

If you recently discovered your teen engages in self-harming behavior, we’re sure your first question is a short version of the title of this article:

“Why?”

We understand. Most people who learn about cutting – especially when one of their children cuts – are confused and at a loss about the reasons and motivation behind the behavior. It’s not easy to understand, at first.

We’ll explain in a moment – and hope to help you understand.

Your next question is most likely similar to the subtitle of this article:

Does cutting mean my child is planning suicide?

We understand that, too. It’s a rational follow-up question.

However, here are the facts about the relationship between cutting and suicide:

If your teen engages in self-harm, they’re at increased risk of both suicidal ideation (SI) and suicide attempts (SA), but teens who engage in self-harm rarely do so with the intention to die.

We wrote this article for you and other parents of teens who cut or engage in other forms of self-harm. We understand that the why is important – and you want to know why. We’ll get to that in a moment, we promise. But in order to understand the why, we need to help you with some general knowledge first.

We’ll start by offering a clinical definition of cutting, a.k.a. self-injury or self-harm.

What is Cutting?

Cutting is an informal name people use to describe a behavior mental health professionals and clinicians call non-suicidal self-injury (NSSI).

You may see or hear the behavior written as or referred to as self-harm, self-injury, or self-mutilation.

People may also substitute the specific type of NSSI as a name for the general phenomenon. They may call it cutting, burning, branding, carving, scratching, or others, depending on how a teen harms themselves.

Therefore, when someone says, “My teen is a cutter” or “My teen burns themselves” they mean “My teen engages in NSSI.”

Let’s look to the American Psychological Association (APA) for an official definition of the behavior:

“The condition…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.”

If your teen cuts or engages in any form of NSSI, it’s important to understand that, according to experts on the behavior in adolescents, most teens do not engage in the behavior with the intent to die.

Therefore, if your teen engages in NSSI, it does not mean they also engage in suicidal ideation (thinking or talking about suicide) or have plans to attempt suicide.

However, NSSI is associated with an increased risk of both suicidal ideation (SI) and suicide attempts (SA) for teens with mood disorders such as depression or bipolar disorder.

That’s why you should understand that cutting is a dangerous behavior. It suggests significant underlying mental health and/or emotional issues. If your teen cuts or engages in other forms of NSSI, you should take it very seriously. Because of the increased risk of SI and SA in teens with mood disorders who engage in NSSI, we recommend that if you learn your teen self-harms, you arrange a full biopsychosocial assessment administered by a licensed and qualified psychiatrist, therapist, or counselor as soon as possible.

Now that you have a clear idea of what cutting is – and how serious it is – we’ll discuss what we know about why teens engage in this type of behavior.

Why Does My Teen Cut?

A recent study offers the latest data on why teens engage in NSSI. We’ll share this data because this publication – released only two years ago – is the only meta-analysis to date that has collected reliable data on the various reasons people who engage in self-injury say they self-injure.

Note: a meta-analysis is a research effort wherein researchers find and analyze all the peer-reviewed scientific journal articles on a specific subject in order to identify trends and get a big picture idea of what the data say – over the long-term and including conflicting data sets – about the topic in question.

It’s a way of saying, “Look, we read everything available on [insert topic], analyzed the statistics with a fine-tooth comb, and this is our current state of knowledge, as of today.”

In this meta-analysis, scientists identify two primary motivations teens engage in NSSI: intrapersonal and interpersonal.

Intrapersonal motivations mean a teen engages in NSSI for reasons related to their inner emotional state.

Interpersonal reasons mean a teen engages in NSSI for reasons related to other people.

Here’s the data:

Why Teens Self-Harm

• 66-81% of adolescents report two main intrapersonal motivations:
  • To regulate their emotions
    • Teens may use NSSI as a coping mechanism to process overwhelming emotions and thoughts
    • Teens may use NSSI to replace negative emotions or thoughts with positive emotions or thoughts
  • To punish themselves
    • Teens may use NSSI because they think they deserve to be disciplined for disturbing or painful thoughts or emotions
• 33-56% of adolescents report three main interpersonal reasons:
  • • They may use NSSI to signal severe emotional and/or psychological distress
    • Teens may use NSSI in the hope that others will notice them, empathize with them, and/or do something to help them
    • They may use NSSI themselves to punish others for perceived wrongs

This information gives us, as clinicians, and you, as a parent, the most important thing there is to understand about NSSI: it’s more about emotional regulation and communication of emotional pain than it is about wanting to die.

Now that you know the reasons behind why your teen may be cutting or engaging in other self-harming behaviors, we’ll share the most common warning signs to watch for if you think your teen is cutting.

What Are the Signs of Cutting?

If you suspect your teen engages in NSSI, here are six things to watch for:

1. Wearing long sleeves and long pants all the time, even during summer or other warm months
2. Injuries they’re unable to explain, such as burns, cuts, or bruises
3. Spending time with peers who engage in NSSI
4. Missing hair, eyelashes, or eyebrows, with no good reason.
5. Objects capable of being used to inflict harm in their personal belongings
6. Retreating to their room or disappearing during or after intense conflict or heightened stress

To learn more about the warning signs of NSSI, please navigate to our article Self-Harming Behavior: Nine Warning Signs

If you see these signs in your teen, your first step should be arranging a comprehensive evaluation with a fully licensed and qualified mental health professional, as we mentioned above. This step is critical. If your teen has a preexisting mood disorder, it’s absolutely essential, because it means they may be at elevated risk of NSSI, SI, and SA.

On the topic of risk, data shows the following groups are at-risk for NSSI:

• Adolescents (12-18)
• Young adults (19-24)
• Females
• Adolescents with peers who self-harm
• Adolescents exposed to self-injury through social media, online, or in the news
• Any adolescent with a history of emotional, physical, or psychological abuse, i.e. trauma

Research also associates the following factors with increased risk of NSSI:

• Presence of mental health or behavioral disorder
• Previous instances of self-injury
• Previous suicide attempts
• Presence of suicidal ideation
• Family history of suicide
• Family history of NSSI
• Experiencing bullying online or in real life
• Identifying as LGBTQI +/non-binary/gender non-conforming

These mental health disorders are most commonly associated with NSSI:

• Clinical depression (a diagnosis as opposed to low mood)
• Clinical anxiety (a diagnosis as opposed to feeling anxious)
• Borderline personality disorder (BPD)
• Post-traumatic stress disorder (PTSD)
• Alcohol abuse (AUD)
• Drug abuse (SUD)
• Disordered eating
• Adverse childhood experiences (ACEs)
• Physical or sexual abuse
• Emotional neglect or abuse

These are the most common types of NSSI:

• Cutting
• Skin carving
• Burning
• Scraping
• Scratching
• Punching
• Hitting
• Breaking bones
• Biting
• Pinching
• Intentionally interfering with healing cuts, scrapes, or other injuries

That’s a fairly comprehensive list of red flags, at-risk groups, and the ways in which teens may engage in NSSI. Your next question may be:

Is my teen the only one who cuts? How many teens engage in this type of behavior?

How Many Teens Cut? Facts and Figures on Teen Cutting/NSSI

Recent reports show cutting is far more common than most parents think. Here’s data from a study that included information from over sixty thousand adolescents in the U.S.:

• 17% of teens say they engaged in NSSI
• 11% of males say they engaged in NSSI
• 24% of females say they engaged in NSSI

In another study – this one on teens in inpatient treatment for a mental health or behavioral disorder – scientists confirmed previous research indicating that rates of self-harm were higher in teens with a mental health diagnosis than in teens without a mental health diagnosis:

• 35-80% of adolescents in treatment reported NSSI
• 87% of teens who report NSSI had a diagnosed mental health disorder
• NSSI is associated with personality disorders, but not with a specific personality disorder

What we want you to take away from this – if you’re the parent of a teen who cuts – is that you are not alone. Using general population statistics and doing the math on the percentages above, we extrapolate that around four million teens in the U.S. engage in NSSI in a given year. By gender, that comes to around a million boys and close to three million girls.

We want you to learn something else: there’s a specific type of treatment that can help those millions – and help your teen, too.

It’s the answer to your next question:

How Do I Stop My Teen From Cutting?

Treatment for Teens Who Self-Harm: Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) is a type of therapy that’s particularly effective for teens who do not respond well to traditional talk-based therapies such as cognitive behavioral therapy (CBT). Don’t misunderstand us: CBT works very well, but some teens need tailored treatment to meet their specific needs.

That’s where DBT comes in.

DBT was developed in the 1980s by the well-known psychologist Dr. Marsha Linehan. Early in her career, Dr. Linehan treated adolescents with mental health diagnoses such as depression, anxiety, bipolar disorder, borderline personality disorder, and others. During her work, she learned that for teens who displayed high emotional reactivity, extreme moods, and unpredictable behavior, typical treatment did not always work.

That’s why she developed DBT: to help teens who displayed high emotional reactivity for whom traditional therapies were not effective. In the 40 years since, countless studies have shown DBT helps adolescents in severe emotional distress when other approached to treatment fail.

Last year, researchers published a new study that confirms DBT is an effective treatment for teens who engage in NSSI. During the study, researchers examined teens in inpatient psychiatric treatment for NSSI.

Here’s what they found.

DBT For Teens Who Self-Harm

In comparison to a typical treatment approach, teens who received DBT experienced the following outcomes:

1. They spent less time in treatment
2. During crises, they spent less time in restraints
3. They attempted suicide less frequently
4. They engaged in NSSI less frequently
5. When in treatment, they spent less time under heightened watch for NSSI

Those are important findings, because they show that for teens who self-harm – particularly those with a co-occurring mental health disorder – DBT helps reduce NSSI behaviors, helps them adhere to treatment, and helps them manage disruptive symptoms without using their previous, maladaptive coping mechanism, NSSI.

In other words, if your teen is cutting, DBT therapists can help them.

There’s more: a hallmark of DBT is that DBT-trained therapists can teach teens skills they can learn immediately and put in practice right away. DBT uses talk therapy, of course – where therapist and patient discuss issues, patients reflect, and subsequently change behavior – but where DBT is most effective is in building practical skills that help teens tolerate and manage emotional distress.

To learn more about how DBT helps teens, please read our article:

Treatment Spotlight: Dialectical Behavior Therapy (DBT) at Evolve

Self-Harm: Resources for Parents and Teens

If your teen engages in NSSI and is in crisis, here’s a list of resources they can use right now to find help and support:

• The National Suicide Prevention Lifeline (24/7/365): 1-800-273-8255
• The Trevor Project Phone (24/7/365): 1-866-488-7386
• Trevor Project Text (7 days/week, 6am-am ET, 3am-10pm PT): Text START to 678678
• The Trevor Project Chat: CLICK HERE
• The Crisis Text Line (24/7/365): Text CONNECT to 741741
• The Youth Yellow Pages TEEN LINE (6pm-10pm PT) 310-855-4673
• The Youth Yellow Pages TEXT: Text TEEN to 839863

Note: if you think your teen is in imminent danger, don’t wait to make a phone call. Take them to the emergency room at a regular hospital or psychiatric hospital or call 911 now. Do not wait.

If your teen is not in crisis and you’re seeking treatment for them, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.