Dear Patti,

I just hospitalized my 15-year-old daughter Taylor at a treatment center for cutting herself. She’s used pop-tops from cans to damage herself for over six months and has tiny little scars up and down her inner thighs. The cuts were superficial until this last time when she needed stitches and that’s when I found out. I feel numb — in shock. I can’t believe it.

Taylor is seeing a therapist every day who reported she’s beginning to realize she’s angry. Even if she’s angry at her dad and me, why did she hurt herself instead of just getting mad at us? Is she doing this to get attention? Does this signify long-term mental illness?
— Angela

Dear Angela,

I’m very glad you got your daughter professional help immediately. You’re not alone, as it’s common, after initial shock, for your emotions to be all over the map — confusion, guilt, rage, sorrow and understandably, worried out of your mind. Anytime a parent sees their child showing signs of a serious illness — mental or physical — it’s both terrifying and heartbreaking.

Approximately one out of nine adolescents engages in self-harming behaviors, and it’s difficult to understand why one young person develops this addictive disorder and another with a similar history does not.

Typically, self-mutilators are people with unusually strong emotions that rise very fast and are very slow to dissipate. This leaves them in a constant state of feeling out-of-control as a result of an overwhelming emotional pain or a sense of inescapable numbness and emptiness. Mutilating themselves is a desperate attempt to regulate and relieve those feelings in order to feel “alive” again. To understand Taylor, it’s necessary to comprehend that, at this time, she doesn’t have any other way to handle her emotions, much less articulate them or form the trust and personal attachments with others that are necessary to the healing process. To her — as terrible as it may be — the self-inflicted pain is a welcome trade-off.

Imagine trying to enter a burning building. Your body would naturally cringe away from the painful heat and you’d stop. If a loved one were trapped inside, however, you’d block out the danger in order to save them. The high priority of your loved one’s predicament would, thus, allow you to ignore the pain and risk. It’s similar for self-mutilators, whose desperate need to be saved from their emotional predicament overrides normal defenses against pain and, instead, embraces that pain as relief from negative feelings.

It’s common to assume that teens cut themselves as a cry for attention. It’s actually the opposite. If Taylor were seeking attention, she wouldn’t have successfully hid her self-injuring behavior for six months. The act of cutting becomes a barrier that’s as laden with shame about one’s behavior as it is with fear about how family and friends will react if they’re discovered. Because they feel different and often lack the ability to easily attach to others, cutters become stuck in emotional hiding and rely on the crippling, nonverbal solution of attacking their own bodies.

Family counseling by treatment center psychotherapists or professionals who work closely with them is critical for information, guidance and emotional support. The degree of psychopathology can vary, and a complete diagnostic and developmental work-up is needed to determine if this is the major problem or part of another disorder. The relationship of trust that Taylor establishes with her therapist is vital to her learning how to build positive relationships, how to listen to her inner feelings, and how to assert her needs effectively.

A therapist will also help Taylor to recognize that the continued act of injuring herself gives only short-term relief to her sense of anguish and powerlessness and prevents her from confronting core problems and working toward resolutions.

Taylor’s recovery process may be lengthy or perplexingly uneven, so it’s vital that you have an alliance with someone communicating what to expect. It’s also important right now to have compassion and empathy for your daughter and for yourself as well. Remember to keep the long-term goal of Taylor’s recovery in your sight and continue to visualize that — with the love between you — this will ultimately pass.