New Harbinger Publications: What are some of the signs parents can look for that suggest their child may be cutting?

Merry McVey-Noble: Apart from the obvious physical manifestations of self-injury—cuts, burns, punctures, scabs that won’t heal, and so forth—parents concerned that their child might be self injuring can look for an increase in negative emotional behavior. Has their generally happy child become very angry, depressed or volatile lately? They can also look for body-hiding behaviors. When a child starts hiding his or her arms or legs, refuses to change for physical education, or balks at going to the doctor for their yearly check up—these can be things to look out for.

In addition, self-injuring children and adolescents may carry around the implements that they use to injure and may become intensely protective of their personal effects for fear of having their implements discovered or confiscated. Parents may also find that self-injuring children tend to be in constant conflict with their families and friends—they just always seem to be fighting with someone. Also, parents can look for increased perfectionism in school, in appearance, in a sport, and so forth. This tends to be correlated both with self-injury as well as with a number of disorders associated with higher rates of self-injury like eating disorders, obsessive-compulsive disorder, and body dysmorphic disorder.

NHP: What are the first things parents should think about doing if their suspect their child is hurting him or herself?

MMN: The first step that a parent who even suspects that his or her child is self-injuring to take is to speak directly to that child. They should tell the child what they are concerned about and why. They should let the child know what behavioral and mood changes or injuries they’ve noticed. and ask them, point blank, if they are self-injuring. If the child admits to self-injury, the parents should find help right away and make the appointment.

NHP: What are the most common obstacles parents face when first approaching a child with the issue of self-injury?

MMN: The most common obstacles that parents face when approaching their children about self-injury are their own fears: the fear that their child might actually be hurting him or herself, and that the parent won’t know how to help them; the fear that cutting could just be the tip of the iceberg; the fear that they will have alienated their child if they have wrongfully suspected self-injury.

Parents may also worry about whether to believe a child’s denial or what to make of a lack of disclosure. Finally, parents may have difficulty finding qualified professionals to work with their families

NHP: What can happen when self-injury goes untreated?

MMN: When self-injury goes untreated, the child or adolescent may feel ignored and may escalate to more severe self-injury or more dangerous behaviors to get attention. The longer self-injury goes untreated, the harder it is to stop because it becomes biologically addictive. It may also be unwittingly reinforced and is therefore more likely to be applied as a future coping strategy.

Approximately 10 percent of those who self-injure go on to commit suicide. Though a child may not be even remotely suicidal currently, untreated the problems that led the adolescent to self-injure will likely not go away—and it may get worse.

NHP: What do we know about particular kinds of self-injury? Are individuals with certain other psychological conditions more likely to use one method than another?

MMN: We are not aware of any correlations between specific disorders and types of self-injury. However, individuals who are more impulsive in their self-injury tend to be more opportunistic about the means of injury and might tend to use found objects to hurt themselves. If they can’t find anything to use, they may punch themselves or twist their skin until severely bruised, out of desperation.

NHP: Would you say that self-injury has more to do with an individual’s brain chemistry or with cultural and environmental factors? What are some of the most common physiological and environmental factors associated with self-injury?

MMN: We believe that self-injury is probably less related to cultural factors and more the result of one’s biology and cognitive style. There are a number of biologically based theories as to why certain people self-injure. The likelihood is that those who have anxiety, mood and obsessive-compulsive spectrum disorders are also more likely to cut. This is probably due to inefficient serotonin transmission, or lower levels of serotonin in the brain.

However, if we had to boil down the psychological contributors to self-injury, we would clearly identify rigid, perfectionistic thinking as the biggest culprit. This type of thinking is intrinsic to the latter disorders, and can also be environmentally reinforced—by teachers, parents, friends, and so forth.

NHP: What sorts of treatment options are available to families? Are certain options generally more effective than others?

MMN: There are a variety of treatment options available to families, which can be overwhelming. We recommend that parents seek out a licensed psychologist, at the very least for the initial consultation, preferably one who is trained in either cognitive behavioral therapy or dialectical behavior therapy, as these are the empirically validated treatment options for addressing self-injury and the disorders that accompany it. This individual can accurately diagnose, recommend a specific treatment plan and determine whether a medication consultation is necessary.

NHP: Are there any specific courses of action parents can take to help their children avoid cutting in the future, after therapy has helped them cease the behavior?

MMN: Parents who are involved in their children’s treatment and who have established open dialogues about self-injury are likely to be able to apply therapeutic skills with their child to help prevent future incidences of self-injury. Also, identifying one’s own limits and knowing when to refer to the treatment professional for help can assist a self-injuring child in identifying her own emotional limits and engaging in appropriate help-seeking.