How should I approach my teen's possible cutting behavior?

November 20, 2010 11:07 PM

Today while walking with my 13 year old daughter, I slipped my hand under her arm just to give her a little squeeze, and I discovered about a dozen thin superficial cuts on the inside of her left forearm, just below the elbow. I think I handled it wrong and I’m hoping someone has first hand experience to share with me.

I immediately confronted her but she denied cutting herself and insisted that she had fallen and scraped her arm. I’m not aware of her ever causing harm to herself or lying to me, but my gut tells me she did this to herself. I backed off and told her I accepted her explanation but that I was still worried and would be watching her. I didn't feel good about this because, in truth, I don't accept her explanation plus I'm afraid my warning will result in her trying to hide it better if there is a next time.

She and I usually talk openly, so I know cutting has been a topic of discussion among her friends and classmates. I’m hoping she was just experimenting and now that she’s been caught, won’t ever try it again. If this isn’t a problem, I don’t want to blow it out of proportion. But if it is a problem, I don’t want to ignore it or cause her to try to hide it from me.

So what should I have done and what should I do now? I’m not just looking for opinions here – although I do think highly of the opinions voiced by many mefites. In your experience how should a parent of a young teen confront dangerous behavior - that may or may not be happening - without making matters worse?

posted by kbar1 to human relations (25 answers total)

Serious cutting is usually the result of serious issues that have not been resolved. Prior abuse, unsafe home environment, as an outlet for the pain they are feeling inside. So, I would just do everything you can to make sure she has a stable and loving home environment, and that she has an outlet to talk about any issues. Sometimes sharing emotional issues with their parents can be difficult for kids, so if it continues I would definitely consider a professional therapist.
posted by sophist at 11:26 PM on November 20, 2010 [1 favorite]

How did you question her? Did you say "oh dear what happened to your arm???" Or did you say "What is this?! Did you cut yourself?!" How you asked might have made the difference in her telling the truth.

I am absolutely speaking for no one else. But "being caught" *might* have been the idea. It *could* be a request for attention.

Being caught and never trying something again sounds more like it applies to doing something wrong like getting drunk underage, or stealing some money from your wallet. In a teenager's (or a depressed person's) there may be nothing "wrong" with cutting yourself. It can be a valid coping strategy. Notice I said valid, not healthy.

Maybe you should let it cool off for a day or two and then approach her again, more gently? "Hey, I'm sorry about how I freaked the other day (if you did), can we talk about those cuts on your arm again?"
posted by IndigoRain at 11:26 PM on November 20, 2010 [2 favorites]

In a teenager's (or a depressed person's) mind there...
posted by IndigoRain at 11:27 PM on November 20, 2010

Speaking from the perspective of being an aunt to many teenagers, and a teacher to many more, but not yet a parent to one:

In my experience, confrontation has never been really productive with teenagers. That said, I'm not at all blaming you for reacting that way. It's difficult not to react when you find out your kid is doing something scary.

If you hadn't specifically asked, I would simply have moved on to what you can do now. But for the future, try to react as non-judgmentally as possible. "Hey, you're hurt! How'd that happen?" expresses your concern at her being hurt, asks for more information, but does not suggest that she was at fault. I'm of two minds about whether it might be even better not to react, initially, but to give yourself time to process, so that you can ask "I noticed you've hurt your arm, do you want me to take a look at it?" Depending on what your communication style usually is with her, you should decide which would be more appropriate.

For the "what should I do now?" part, I would a) make sure that the cuts themselves are healing cleanly, first. b) I would be really really wary of treating a dozen cuts as "just experimenting." If you are sure they are cuts and not a scraped arm (and the two look pretty different in my experience), then you can't just shrug this off and hope for the best, I'm afraid. Were you able to get a look at the cuts? Were they all from the same time? I have to tell you that's pretty unlikely.

On preview, I agree with the suggestion that this could be a cry for help. Also, that apologizing for the confrontation and approaching the subject again more coolly, with a view to understanding what she's feeling, makes sense.

I think you need to focus more on why it's happened than on "this must not happen again." Of course you don't want her to cut herself again, the cutting is a symptomatic behaviour of some underlying problem.

Supportive sympathy being beamed to you from way over here.
posted by bardophile at 11:38 PM on November 20, 2010

Two problems are in play here: 1) the self-harm, and 2) whatever (sense of overwhelmedness or powerlessness or lack of emotional resources) is driving her to the self-harm.

Neither of these is the kind of problem that can likely be solved with
a) a single discrete intervention,
b) confrontations,
c) warnings, or
d) surveillance per se (which is not to say that you shouldn't be keeping an eye on her).

#2, at least, is the kind of problem that is better addressed holistically: by providing such resources as
a) direct emotional support,
b) explicit expressions of unconditional love,
c) continuous modeling of productive ways to deal with complex emotional states:
......i) acknowledging rather than denying their existence,
......ii) discussing them openly with loved ones and professionals,
......iii) addressing them unashamedly,
......iv) resolving them through small and rational steps rather than through outbursts or overwhelmedness.
d) nonjudgmental sounding-boards to the extent that she will accept them, and
e) completely unstigmatized access to professional psychological care.

I feel I should mention that my experiences are not with directly analogous circumstances.
posted by foursentences at 11:50 PM on November 20, 2010 [5 favorites]

IndigoRain:
I regret to admit that I was more confrontational than concerned in my questioning. I don't think I even asked her if it hurt! I believe my question was along the line of, "Did you do this to yourself?"
posted by kbar1 at 12:12 AM on November 21, 2010

When you saw the cuts, did she pull her arm away and try to hide it? Was she wearing a short-sleeved top?
posted by missmagenta at 1:13 AM on November 21, 2010

One minor thing to do would be to make sure that your first aid supplies are up-to-date and accessible: disinfectant, Neosporin, band-aids of various sizes, etc, in an obvious place like a bathroom cabinet.

You may not be able to stop her, as tough as that is, but you can at least indirectly help her afterwards and make sure she has access to safe aftercare.

I would also suggest gently bringing up the subject again in a few days, when you're both alone; make sure she knows that you aren't casting judgment, but you are acting out of concern. Don't explicitly tell or ask her to stop; like was said above, it's often a coping strategy for something else one is dealing with, and eliminating that option can lead to even more distress.

Sending hopeful thoughts your way; I struggled with self-injury in my teenage years and it was a hard road after my mother found out, but ultimately, having her on my side brought us closer together and was a huge help in my healing process.
posted by sarahsynonymous at 1:22 AM on November 21, 2010

As a depressed teen and occasional (experimental) cutter (always in places that were easily hidden, which is super easy to do if you're trying to hide the cuts), I really wish my parents had sent me to therapy and/or a psychiatrist when I was 13 instead of at 18. I'm not sure if that's the place where she is, but my mother seemed to actively discourage me from ever seeking therapy. I lost years of my adolescence to depression that could've been taken care of by getting medicated sooner.

What sophist said about cutting being an outlet for other bad stuff is true, but keep in mind that the bad stuff might be entirely in her head, and if she is depressed you can get her treatment now.

Other mefites might have better suggestions about how to breach the issue of therapy, but if her behavior suggests she's depressed, please do that. Teenagers tend to think that their emotions are a lot more obvious from the outside than they are because of how intensely they're feeling them; I thought my parents were just ignoring my pain when I was just not telling them about it because it was so all-consuming to me that it seemed absurd to think other people couldn't see it.
posted by NoraReed at 1:27 AM on November 21, 2010 [15 favorites]

Err, broach the issue, not breach the issue.
posted by NoraReed at 1:29 AM on November 21, 2010

I think if it were me, I'd say something to the effect of:

"Hey, can I talk with you for a minute? I wanted to say I'm sorry I kind of freaked out on you; it's just that the thought that you might be hurting yourself scared me a lot, because I love you a lot, and in the moment I kind of let my fear get the best of me. Honestly, I'm still scared, but I'm calm now, and I'm not going to freak if we talk about it. I care about you and I want to help, if you need it. So... are things okay, for real?"
posted by Menthol at 1:34 AM on November 21, 2010 [24 favorites]

I lost years of my adolescence to depression that could've been taken care of by getting medicated sooner.

This, massively this.

There are lots of reasons for self-harm, and depression is just one of them - but it's one of the most serious.

Menthol's opening is a good one, but be prepared that in both depressed and non-depressed teenagers the answer is likely to be a lack of eye contact and a mumbled 'dunno'. Your next step would be to offer and opportunity to talk to someone outside the family circle who is knowledgeable and helpful - it's often easier to talk to an outsider than someone close to you. Think of a list of possibles that she either knows or is familiar with - school staff, health staff etc, as she might have good reasons for not wanting to talk to a particular one. Hopefully either you or the person you suggest can find out what's behind the self-harm, and then proceed from there to appropriate treatment (or lack of treatment, depending on the circumstances).

Best of luck.
posted by Coobeastie at 2:06 AM on November 21, 2010 [1 favorite]

I'm going to go a bit against the flow here, I guess.

My daughter's only eight, so this isn't something I've dealt with as a parent, but I was pretty seriously into cutting when I was your daughter's age--probably from when I was ten to when I was nineteen. I was pretty rough on myself--I'll be thirty in a few months, and I still hesitate to wear short sleeves to gatherings where there will be people I don't know, because there's a good six inches of my inner wrist that's completely covered in thick, obvious scars. I don't wear shorts for similar reasons.

For various reasons, I was an intensely unhappy adolescent, and cutting was one of the few things that consistently gave me any sort of stress relief. My parents handled it incredibly poorly, first ignoring it altogether, and then believing that I was doing it for attention. (And the solution to that, obviously, was to not pay attention to me.)

Now I have a daughter of my own, and she's getting alarmingly close to the age I was when I started cutting (I was ten), so this is something that I've given a great deal of thought to--what my parents did, what they could have done, and what I would have been able to accept from them at that point. That's a lot of backstory, but I'm telling you so you know where I'm coming from.

I'd definitely bring it up with her again at some point, but--and I know this is going to sting--make it sound like you're the bad guy. Catch her sometime when she has an easy out (not, for the love of god, in the car, unless you want her to dread getting into the car with you for the next five years) and say "Hey, I wanted to apologize--I was rude/prying/overreacting [as appropriate] the other day, and I'm sorry for it. I was startled and freaked out, but that doesn't excuse my reaction. I didn't mean to make you feel like you were being attacked."

Then tell her that you're not going to push (because if she's anything like most kids, it won't do any good anyhow), but that if she ever wants to talk to you about anything, you're glad to listen, even if she wants you to just shut up and listen and never mention it again. I wouldn't push her into going to see a therapist right now, but you might also want to say that if she'd rather talk to someone else--a therapist or whomever--you'd be glad to facilitate that. If she's not getting too squirmy at this point, you might want to also make it clear (if appropriate) that she's not going to get in trouble for anything that she brings up in a telling-you-what's-going-on or confessional way.

And then let it drop. Put bandages and antiseptic and all of that in an easily accessible place, and keep an eye on her behavior (and her arms), but don't make her talk about it. You've made it clear that you're happy to listen to her if she wants to talk, and since you guys already seem to have a pretty good relationship, I don't feel like this warrants anything else right now. Obviously you don't want her engaging in self-destructive behaviors, but your first conversation with her already put her on the defensive, and I'd argue that maintaining a friendly, open relationship is more important than addressing some fairly superficial scratches. You don't want to make her feel like she's being punished, especially if she is trying out cutting as a coping mechanism--imagine feeling bad enough that cutting made you feel better, and then imagine that you were getting in trouble for trying to make yourself feel better. Ick, right?

If you start seeing other signs of depression--if her grades drop, if you notice that the bandaids are getting used up quickly, if she withdraws from her friends, if she starts avoiding you--then you're going to want to press the issue more, but it doesn't sound to me like you need to right now.

Remind yourself that cutting, in and of itself, isn't the problem. It's a symptom of a bigger problem, one that your daughter may or may not be aware of or able to recognize in herself. From what you've described, it sounds (to me, at least) like it's quite possible that the only "problem" here is that she didn't know what cutting was like and/or was trying to understand it, so she tried. Not the approach that you'd like her to be taking, but ultimately relatively harmless.

All of this to say, really, is that from where I'm sitting, it sounds like you're doing the right thing.

One other thing--you asked about how to confront this sort of thing. It might be worth it, in the future, to consider an alternate method of confrontation--not necessarily to make it easier on her when it happens, but to facilitate discussion. A friend of mine had parents who, when they noticed something worrying, would write her a letter that just said hey, we've noticed x and y and we'd like to talk to you about it. Can you pick a time and place in the next week for us to discuss this? They wouldn't say anything until that time came, and they'd sit down and talk about whatever it was. They had a remarkably happy, close, and functional family relationship, and I've always thought that it was a really amazing, brilliant move on their part. She had enough control over the situation that she didn't feel attacked and defensive, and the setup gave her parents a great deal of access to and influence on her life. Your daughter sounds like she might have the maturity and communication skills to make something like this work for you, and it could help you avoid some of the worry that your knee-jerk reaction wasn't what it should have been.
posted by MeghanC at 3:24 AM on November 21, 2010 [39 favorites]

Has she been wearing long-sleeved shirts or other concealing clothing when it didn't make sense to, given the weather? That would be a pretty strong suggestion that she's been deliberately cutting. If so, please get her to a psychologist ASAP, because that's usually a sign of some sort of underlying cause like abuse or mental illness and self-mutilation is often a precursor to other more serious self-harm like eating disorders and/or suicide attempts.

However, if she's been generally dressing weather-appropriately (short sleeves or sleeveless when it's hot) and there haven't been any other visible cuts before now, then it could genuinely be scratches from falling. Were there also bruises? That would also support her story that it was just a fall.
posted by Jacqueline at 3:32 AM on November 21, 2010

Relevant resources for you.
posted by allkindsoftime at 4:47 AM on November 21, 2010 [1 favorite]

As a parent of a teenage daughter who went through the same thing, here are my thoughts:

* get her help NOW because it may be nothing, but if it isn't you're going to feel terrible because you saw a sign that your daughter was confused (which is really normal) but you waited it out.

* get her help NOW because once a kid starts cutting, they've unintentionally created a gigantic cycle of shame that their developing brains can't self-navigate. When she cut herself, she undoubtedly experienced a lot of conflicting emotions (emotional release but probably more fear and shame), and she needs guidance from a trained professional about how to deal with that tempest in her head. Developmentally, it's highly unlikely she can clearly think her way out of this. But a therapist can help her.

* get her help NOW because yes you're an awesome parent, but to help keep it that way she should have someone else to talk to. At her age, it's her biological imperative to NOT TELL you things. That's normal. But she needs some guidance here (with difficult emotions, school, other kids, and the urge to make it go away by cutting); let it be from someone who really understands teenage girls and isn't you.

* get her help NOW because it will teach her that it's okay to feel things and to have stress and feel cloudy and murky and like sh*t because there are people who can help you and you don't need to try to fix everything yourself.

I'd sit her down and have the "Sorry I flipped out" discussion. Then I'd tell her some variation of what I said previously. Tell her this person is going to be her safety valve; a place where she can vent (and you won't be told any of it) or she can sit there and just do her homework (a good therapist can deal with a teenage girl who doesn't want to talk).

Then I'd call her school counselor, tell them what's going on so the teachers can keep an eye on her and her friends, and ask for recommendations.

But the last thing I'd do is minimize this as a one time thing and do nothing.

Good luck.
posted by dzaz at 5:07 AM on November 21, 2010 [1 favorite]

****sorry, one last reason to have her talk to someone now.

Right now, she's probably even more upset because she knows that you know, and that's freaking her out a little bit. She's wondering if you're mad at her (in which case you don't understand her), if you're disappointed in her (in which case she's mad at herself), if you think she's crazy (in which case are you going to send her to a psychiatric ward), if you think this is a little emotional blip on the screen (but for Pete's sake, you've SEEN she's upset; when are you going to take her sadness seriously?).

What I mean is that right now she's undoubtedly freaking out even more because she doesn't know how you're going to deal with this. So I'd deal with this asap.
posted by dzaz at 5:18 AM on November 21, 2010 [1 favorite]

I knew someone who cut himself as a teen. When his father spotted it, he took him to the ER immediately. From there he got serious counseling (maybe some time in a psych ward?) and went on to weekly therapy for a while. AFAIK he never cut himself again, and he eventually turned into one of the most together, self-confident, and generally happy people that I know.

At the time he was cutting himself, he was acting like it was unimportant, he was acting like he wanted to do it for reasons other than cutting himself ("won't this leave an interesting scar when it heals? cool!") and so on. He completely blew off the seriousness of what he was doing. He was in very bad shape, but just not telling anyone, and doing his best to disguise it. I am so glad his dad intervened immediately and got him the help he needed.
posted by galadriel at 7:00 AM on November 21, 2010

I think Menthol is giving excellent advice above. She needs to know she can come to you if she wants to talk and not feel judged by you.
posted by spikeleemajortomdickandharryconnickjrmints at 7:11 AM on November 21, 2010

I used to be a cutter at a few different times in my life, mostly in my young teenage years. I did it whenever I'd get depressed enough to feel helpless. Physical pain to replace the mental anguish. My parents never said anything about it, aside from "oh, what happened to your arm?" A boyfriend got confrontational with me about it, but he didn't realize it was a symptom of depression, so it just made me work to hide it better.

My grades didn't slip noticeably, I didn't avoid my friends, I kept a good mask up. I saw the school counsellor on occasion of my own accord, but otherwise I didn't get therapy. Perhaps I should have, but I was under the impression that formal therapy was reserved for those who went through traumatic events or couldn't function without meds for their depression. I tried to approach my mom, but as a high school teacher she laughed off my issues as typical teenage drama and paid no attention. So as a result of all this, whenever I get my rare bouts of deep, inexplicable depression, I still resort to a little pain. I get tattooed now whenever I'm in need of some therapeutic pain - same feeling, but prettier, more socially acceptable results.

So don't treat her cutting as something to be addressed unto itself, there's a reason she's doing it and that is what you need to help her with. You don't need to wait and watch for other signs of depression, there might not be any obvious ones. I like what people had to say in the above comments on how to approach her.
posted by lizbunny at 7:46 AM on November 21, 2010 [1 favorite]

I have to reiterate the suggestions to be as calm and non-judgemental about broaching the subject again with her. Speaking from personal experience, my mom freaked out when she found out that I was cutting. There was a huge row- I wouldn't talk to her because I was scared/not ready/ confused and she got more mad and more frustrated that I wouldn't let her help me. It was embaressing enough in the living room, I can't imagine how it must have felt on the street. Not that you're a bad person for reacting how you did, but you need to talk to her somewhere quiet and private in a few days after she's had some time to adjust to the fact that you're suspicious of her. After you've gotten her permission to talk to her again [because it's not going to work if you haven't], maybe talking to her in her bedroom in the evening when you both are a bit calmer and she is more at ease. The notion of writing a letter apologizing for freaking out and asking to talk at a date of her choosing is an excellent one.
I don't even remember when I started cutting myself. I think it was when I was 11. The first day I started shaving I accidentally nicked myself with the razor and after that I just couldn't stop.What started off as just a few scratches soon became an entire maze of cuts all over my body. Granted, I have a lot of issues besides the cutting, but it helped me deal with the pain a lot better than how i was before. My mom eventually found out and I was shuttled off to therapy. I had several trips to the mental hospital and about five years of therapy before I could stop doing it on a regular basis. It's still difficult not to sometimes because your brain hard-wires it like an addiction. My mom put up with a lot during that time, and it really strained our relationship when we were going through it. But through my therapists and my friends, I was able to do it.
I would also suggest keeping tabs on her in the future, regardless of whether or not she is in fact cutting. This is a pretty vulnerable stage in her life and she's going to need you looking out for her in order to get through it. Try and talk with her- maybe when you're walking the dog, at the breakfast table, before bed, during the commercials of your favorite shows. It doesn't have to be about cutting [actually I'd advise it not to be- It would probably make her just dread interacting with you], or even your relationship. It could be about how hot Robert Pattison is or how her friend at school has the ugliest sweater EVER. The point of it is to let her know that you care about her for more than the scratches on her wrist.
Her teachers should be able to give you a heads-up on how she's doing in school. Make sure they know you're concerned about her mental health and they should be able to tell you how she's interacting with her friends, if she's shy or withdrawn, whatever. It was years before I knew my mom did this [I probably would have freaked out that she was spying on me if I had known], but it helped stave off a few crises.
Make sure she's still interacting with her friends. Encourage them to come over and hang out at your place if you haven't already. Whether or not she is cutting, a strong social network is important at that age.
And good luck. It's going to suck and be awkward and painful and you might feel like you don't know your daughter anymore. But she's still the same person and I'm sure she loves you.
posted by shesaysgo at 7:51 AM on November 21, 2010

As someone who used to cut, the thing that saved me (eventually, it took a long time) was having sane adults in my life who cared. If there are sane adults that both you and she trust, perhaps try to make sure she spends more time with them. If not, try to find some (and, I've no idea how to do that, frankly). In my life, some were teachers, some good friends of my mother, Girl Scout leaders, camp counselors and librarians.

She needs safe space with sane adults. Therapy can provide that, but there are other ways, too, and exploring all of them can't hurt.
posted by QIbHom at 7:58 AM on November 21, 2010

* get her help NOW because

The hard part is determining what is helpful to her, though. I was sent to a therapist when I was 13 (not for cutting) and I just resented my parents for sending me there, and thought the therapist was clueless and had no idea about anything... Personally I wished my parents would have tried to talk to me directly, or maybe schedule dependable "family time" because I think my house felt sort of chaotic growing up. But I don't think I could have articulated that then, because I had nothing to compare it to. I felt ungrounded, but it's only in retrospect that I can see where that feeling came from.
posted by mdn at 8:57 AM on November 21, 2010 [1 favorite]

Thanks to all who replied - including a few who emailed me directly. I’m a single parent and she’s my only child, so I really appreciate this forum as a means of learning from the experience of others.
posted by kbar1 at 11:26 PM on November 21, 2010

Depending on your relationship with her, it may help to explain why you freaked on her ass as well as apologizing for doing so. Both sides of mental health problems (subject and observer) can be intensely frightening. Make sure you communicate effectively how you love her and want to help her overall health.

A reference for you, the person who loves someone who may SI.

A reference for your daughter to learn more about how to deal with SI.
posted by thatdawnperson at 10:33 AM on November 22, 2010