Romeo and Juliet, Hamlet— even Twilight’s Bella— all flirted with the concept. Throughout history (both real and fictional) many adolescents have felt so victimized by a world outside their control that they’ve harbored thoughts of self-harm. Though the causes tend to differ with age, sex and culture, it seems the stresses of teenage life—and some of their more troubling coping mechanisms— have been around for ages. But a study by a researcher from Cornell University shows that one reaction to stress and feelings of helplessness is more prevalent among young teens than many people may realize. According to the study, cutting, the act of marking one’s body through self-inflicted scratches and lacerations, is practiced by as many as 12 to 37 percent of kids during early adolescence.
Stuart Goldman, MD, co-director of the Mood Disorder Program at Children’s Hospital Boston, says the high prevalence of cutting cases is somewhat troubling, but also notes that teenagers hurting themselves as a form of stress management or self punishment when feeling overwhelmed is nothing new. “Non-suicidal self-injury (NSSI) has been around for a long time; cutting has just become more prevalent in the past decade,” he says. “In the same vein, eating disorders were very rare until the 1970s, but then because of social factors and media attention, the reported cases of anorexia increased around that time.”
While the high numbers presented in the study may seem alarming, Goldman says they most likely reflect the vagueness used to define cutting: anything from light scratches in times of great distress to daily cuts so deep they draw blood. Like anorexia, there are many levels of cutting behavior and the method of treatment used to curb the behavior should reflect the severity and frequency of the cutting, as well as any underlying disorder that may be present. The occasional self-induced scratch is cause for concern, but not a reason for an immediate trip to the emergency room he says.
“If a kid who is generally doing very well is scratching himself on occasion I think it’s a call for help and support, but not a reason for panic,” he says. “On the other hand a child who is more socially isolated and has a decreased school performance, hobbies or ability to function in the home may be at risk for a more serious problem.”
Cutters tend to mark themselves on the inner wrist, upper arms and inner thighs. Goldman suggests parents who see marks in theses areas, or suspect their child may be cutting as method of stress management, speak with mental health professionals about how to approach the problem.
“If concerned, parents should get a mental health consultation because most adolescents don’t tell their parents everything that’s going on in their minds,” he says. “With these behaviors there’s often a sense of shame or embarrassment, so kids might minimize the problem, which can make it hard for the parents to know if the child is downplaying their emotions or if there’s a lot to worry about.”
Professionals are also more likely to be able to recognize the difference between cutting as a form of stress release and cutting as a precursor to suicidal behavior, which Goldman says is an important distinction. Still, despite their expertise in the field, the limited clinical data collected on cutting suggests that more needs to be done to help mental health workers treat teens who use self- harm as a form of stress management.
“We know the problem is out there; now the real question is how can we use that information to help clinicians, pediatricians and mental health workers differentiate the NSSI act from real suicidal behaviors? It can be a real challenge,” Goldman says. “There’s an increased knowledge on the subject and an increased prevalence of the problem and we need to use that find a way to help these kids.”