Our teenage daughter is cutting. How do we help her?
July 13, 2013 1:04 PM   Subscribe

We discovered last week that our 14yo daughter is cutting. And that it has actually been going on for two to three years. We need help so we can help her.

Our oldest daughter, 15 in a couple weeks, has been cutting. I started suspecting a few weeks ago and my suspicions were confirmed last week. What I saw last week were several scratches at the top of her leg, but between then and early this week she now has cuts all along the side and front of her thighs.

She has had moderate to severe anxiety most of her life. She has trichotillomania which is restricted to her eyebrows and eyelashes. She has been on Zoloft for about two years, 50 mg currently. She has been seeing a therapist every other week for the last year or so.

The strange thing is, from outward appearances she seems to be doing great. She got almost all A's in her first year of high school. She has a nice group of friends from elementary and middle school, and made a number of new friends this year. She has a boyfriend. She seems happy, she is not moody or emotional. She is, however, extremely private bordering on secretive. She never even talked about boys (and I mean literally never even said, hey he's cute) and then surprise! here's a boyfriend. She was initially very resistant to therapy, but has seemed to become comfortable with her therapist and is opening up to her. The therapist knew about the boyfriend before we did.

Much of her anxiety revolves around school and the pressure she puts upon herself to be perfect. She has some degree of obsessive compulsive disorder. In the past it could take hours to complete an assignment because it was so difficult for her to start. In-class assignments are especially difficult for her. She sees an educational tutor who helps her not with subject matter but study skills, note talking, reading comprehension, that sort of thing.

My husband and I met with her therapist about a month ago for a status check and she agreed that things were going well. She made a point of saying that she would let us know if anything concerning came up in their sessions. However, we learned on Tuesday that my daughter had actually told her about the cutting at their last session (although she greatly downplayed it and gave no indication how long it had been going on). The therapist did not inform us. And worse, when we met with her on Monday to talk about the cutting and formulate a plan for talking to our daughter, she did not mention anything. When I confronted her Tuesday morning she said she didn't remember daughter telling her that. This did not increase our comfort level, as you can imagine. When daughter met with her shortly afterwards she told therapist that she felt like the cutting was out of control. She recommended a psych evaluation, and after consultation with our pediatrician we spent half a day in the emergency room. The psych clinician there was incredibly unhelpful and almost fatalistic about the cutting. She said it was epidemic among teenage girls and it wasn't something we could "fix" until she was ready to help herself. I know all this, of course, but I was hoping for referrals and advice, and we didn't get them.

Aaaaand, because that's not enough, daughter said the reason she cut last week (the few upper thigh cuts, not the dozens that came after; we still don't know what prompted those) was because she was mad at herself for eating too much. So possible eating issues in the mix, too, although right now we need to put those on the back burner.

We are feeling so lost right now. We really don't even know what direction to start. So, I am looking for advice on how to help her. If you have personal experience, either yourself or a friend or relative, what helped stop the cutting? If you have any referrals to therapists or programs in Massachusetts, particularly north of Boston, that would be extremely helpful. We haven't decided if we are going to let her continue with the current therapist, although she has said she wants to. We aren't happy about it, but we want to do what's best for her.

Any suggestions, including those involving what some here call "woo", are welcome. This is my first AskMeFi question, and I am immeasurably sad that this is its subject.
posted by Bresciabouvier to Human Relations (23 answers total) 11 users marked this as a favorite
Dialectical behavior therapy, a form of cognitive behavioral therapy, has been shown effective in treating adolescents who self-harm. I'd look for a therapist in your area that specializes in DBT.

I'm so sorry you and your family are going through this. Best wishes for your daughter's recovery.
posted by sevensnowflakes at 1:13 PM on July 13, 2013 [6 favorites]

I recommend you make an appointment with Boston Children's Hospital Psychiatry department. I have found through experience that children's hospitals and their staffs are much better equipped to deal with mental health than "regular" hospitals. If nothing else, you can start there and find a new therapist (I mean, really; she didn't remember your daughter telling her about the cutting?). They'll take your situation more seriously than the ER doc you saw (!!!).

I'm so sorry you're dealing with this and I hope your daughter finds her way through.
posted by cooker girl at 1:24 PM on July 13, 2013 [1 favorite]

I think the potential eating issues shouldn't be put on a back burner if it may be a cause! Admittedly a very common cause, but you need to find out what is triggering it - if it is eating disorder/self esteem issues or something else specific or a manifistation of the anxiety - in which case you should maybe see about an adjustment of her medication. But really if there is a reason behind it, then that needs to be addressed. It isn't necessarily your role to find it out, as lot of teenage girls would prefer to talk to someone else, but make sure she has someone to talk it through with. And it sounds like you maybe need to find a new therapist.

The responce you have had from the professionals is shocking, but there are plenty that wont be dismissive like that; I think others will give you more pertinant recomendations than I could.

In the meanwhile or additionally, if she wants to stop, there are quite a lot of resourses out there with advice for distractions or alternatives (e.g. red ink to simulate the cuts or ice or a rubber band). I can find you some links if you'd like.

Probably the main thing you can do personally is to try and find a balance between being there for her, supportive and non-judgmental, and seeming controlling and intruding.
posted by an opinicus at 1:35 PM on July 13, 2013 [1 favorite]

Memailed you.
posted by zizzle at 1:36 PM on July 13, 2013

DBT is very helpful. She sounds a lot like me and the earlier you get help the better off you are. I go to mclean, and i think their services are quite good for adolescents and adults. children care there is not great at all. adolescent programs deal mostly with DBT skills and hopefully will help with the anxiety issues. I have horrid anxiety and it was even worse when i was younger. I feel like it has changed over the years.That usually comes hand in hand with depression, which i also have. Anyway, weekly i go to a DBT skills group and one on one therapy. She may benefit from a group to see that there are others out there dealing with similar issues and hear how they deal with these similar issues. I went to Children's for help too. i had an awesome therapist there, she currently is in private practice in Cambridge, which does not seem close enough to you. I have other names of people in Arlington. Memail me for these names. There is help out there. Everything is a work in progress. I just don't want her to end up like i did acting out in terrible ways later in life when more dangerous stuff is accessible to her.
posted by Jewel98 at 1:43 PM on July 13, 2013 [1 favorite]

Cutting is generally now regarded as a coping mechanism (albeit a potentially dangerous one) rather than as a prelude to suicide attempts, which was the older view. So up-to-date mental health professionals might be less worried about it than you want them to be (if you're worried about the cutting as some sort of suicidal act) but they should still be working on curbing it (because it can be dangerous if someone's hand slips or they misjudge how deep to cut).

I'm hoping that maybe helps you contextualize some of the responses you've gotten from mental health professionals. Cutting is usually in the "very concerning but not a crisis" category, but it's something that an ethical professional would be tracking at every meeting.

Therapists who specialize in eating disorders often also work with anxiety and OCD, because all three tend to be related (and cutting is often a way of relieving anxiety). I wouldn't toss out the idea of getting help for the eating disorder -- that's a condition that can quickly become an emergency medical crisis -- and I suspect that finding someone competent in treating that may also be helpful for the rest. The Therapist Finder lets you search by specialty and might be a good place to start.

I would also suspect that every-other-week therapy is not intensive enough for your daughter right now. If you all do decide to stick with her current therapist, you might want to talk to her about increasing the frequency of sessions. Teenagers change really quickly, and you might be amazed at how much more effective therapy can be if your teen is seen weekly.
posted by jaguar at 1:44 PM on July 13, 2013 [8 favorites]

The strange thing is, from outward appearances she seems to be doing great. She got almost all A's in her first year of high school.

I would like to gently suggest that you try to stop looking at her school performance as indicative of anything other than the ability to do well in school. I got very good grades in honors/AP classes (with not much effort) and did well in my extracurriculars (newspaper, theater, music) all through high school and, simultaneously, was deeply troubled.

For me, the trouble stemmed in large part from a belief that I was only lovable based on what I did (i.e., my accomplishments) and not on who I was (i.e., my inherent qualities as a human being). You mention your daughter's perfectionism, so I wonder if there may be a similar dynamic going on with her.

My parents and grandparents unwittingly contributed to this "worthwhile only as long as you succeed" message by constantly praising me for being a genius, for being smarter/better than my peers, for my presumed future life of going to Harvard and winning a Pulitzer prize (neither of which happened), etc. They absolutely meant well, but this wound up putting pressure and expectations on me that led to deep feelings of frustration, anger, panic, and fear of failure. But what I wasn't really praised for or even encouraged to develop were qualities like compassion, resilience, acceptance, self-soothing, etc.

You may not be doing anything like that -- the fact that you're inquiring about therapy is great; my parents actively refused to consider anything of the sort for me solely because I was getting good grades and therefore was fine -- but this might be a clue to a similar thought process going on in her head, and perhaps a place to start the conversation with her.

tl;dr -- good grades don't mean much other than being good grades. Help her understand that her self-worth doesn't have anything to do with her GPO. This might seem confusing and even frightening to her at first -- but it may ultimately prove to be liberating. (It's a lesson I wish I'd learned decades earlier than I eventually did.)

I wish you and your family all the very best.
posted by scody at 1:45 PM on July 13, 2013 [64 favorites]

To be slightly more helpful, here's the Psychology Today search results for therapists in Boston who treat adolescents and eating disorders. You can expand the search geographically (by zip code) from the links on the left navigation menu.

And while ongoing therapy should be in the mix, I agree with previous posters that further psychiatric help should be in that mix as well.
posted by jaguar at 1:48 PM on July 13, 2013

IAAT, IANYDT, this is NOT therapeutic or professional advice. First, as hard as it is, try not to see the cutting as an emergency. If the cuts *cause* an emergency because of bleeding that won't stop, infection, etc., that's different, of course, but generally speaking cutting behavior does not cause infection, does not do lasting damage to the body, and does not cause dangerous levels of bleeding. One way to approach the issue with your daughter may be to talk about cutting behavior in terms of these safety parameters.

I don't want to make it sound as though I think cutting behavior is good and healthy, because it isn't. It is, however, a common coping skill among young people who don't know how else to handle their times of emotional intensity. One specific alternative to cutting that helps some people is rubbing an ice cube on the area where they would normally cut--the extreme cold sensation is another kind of intense stimulus.

For the immediate future, I wouldn't worry about stopping the cutting, unless that's what your daughter would like the primary goal to be. It sounds like it would be worth having a family meeting about how therapy is going for your daughter where you express your concerns about the therapist "not remembering" that your daughter said she was cutting, and your worry that you didn't want your daughter to have to deal with her problems alone or have to rehash everything twice (once for therapist, once for you), but you didn't have confidence that her therapist was giving you a clear picture of even the broad strokes of what was going on.
posted by epj at 1:50 PM on July 13, 2013 [6 favorites]

I used to cut myself when I was a teenager. As people mentioned above, it was not about suicide and it WAS about relieving anxiety and feelings of low self-worth. It was a way of transferring inside pain to the outside. It was a coping mechanism for the times that I felt completely overwhelmed. I needed better coping skills.

While this is a symptom of a larger problem, and while I'm sure it feels urgent to you (being a parent myself, now, I can only imagine), it's not actually an emergency, per se. The cuts are probably shallow and don't seem to be life-threatening, from your question. Please do provide her proper first-aid supplies and be sure she understands how to be safe.

I stopped after about a year -- when my serious depression lifted some, after meeting weekly with an awesome therapist. I do still have scars, but I'm generally perfectly fine. I send hugs to your daughter -- no doubt she is feeling extremely crappy right now.

Here are some things that would have helped me: reassurances that I was loved and cared for no matter what; alternate coping mechanisms; distractions that were not screen-based, or means to have a hobby of some sort; learning about self-care and having encouragement to do things that made me feel good.
posted by woodvine at 2:00 PM on July 13, 2013 [7 favorites]

"Cutting is generally now regarded as a coping mechanism (albeit a potentially dangerous one) rather than as a prelude to suicide attempts, which was the older view."

It's actually a bit more complicated that that - yes, cutting is often a way of coping with overwhelming emotions rather than an attempt at dying. However, research indicates that people who cut (even with no suicidal intentions) are more likely to become suicidal and make suicide attempts in the future, so this definitely isn't something to ignore. Nthing DBT for adolescents (see this MA referral page.)
posted by synchronia at 2:14 PM on July 13, 2013

To add to woodvine's excellent list of things that would have helped her, I would like to say that I would have been helped tremendously by having the freedom to express difficult emotions without any fear of defensiveness or dismissiveness on my parents' part. That is, I really needed the freedom to openly express sadness, fear, anger, ambivalence, etc. in a family context where these feelings were treated as perfectly normal parts of being alive rather than terrible things that must be repressed and/or signifiers of me being an ungrateful child. Again, not accusing you of doing this at all, but just a thought that some of her intense privacy/reticence may be stemming from an internal sense that she must keep her "imperfect" feelings bottled up.
posted by scody at 2:14 PM on July 13, 2013 [21 favorites]

I was put on Zoloft at 13 and began cutting and burning myself shortly after starting the drug. Like your daughter, I was an excellent student and did a good job at presenting myself as "normal" at school, etc. Zoloft (and many SSRIs) can be very, very dangerous for young people, leading to an increase in violence, self directed violence, and suicidal thoughts for a significant minority of children and teens who are prescribed these drugs. My desire to harm myself ended completely once I stopped taking psych drugs.
posted by horizons at 2:27 PM on July 13, 2013 [9 favorites]

Who prescribed the Zoloft for your daughter? I would suggest that she may want to see that person again to be reassessed, as it sounds like maybe you daughter might need an adjustment. Girls change a lot, of course, both mentally and physically, between 13 and 15. She may very well have additional stressors on her now, and is finding it harder to keep the anxiety at bay.

I'd consider at least looking for another therapist if your daughter is okay with that (dropping the therapist abruptly may cause her more anxiety; routines are important for the anxiety-ridden), and then work on a gradual transition to the new therapist. But I'd want a new one if I were you. "Not remembering" is completely unacceptable! Why is the therapist not writing all this down in your daughter's file? she should be taking notes during the sessions, even dictating in-between patients. I think it is important to your daughter's treatment plan that these things--feeling like cutting is out of control, I mean--are documented somewhere. Please ensure the therapist gets on that because, jeez, that's just unprofessional. I'm sorry she pit you in that position.

Now, about that increased anxiety level, I do have some thoughts, being familiar with teenagers. Please do not freak out, I could be wrong, but--is it possible your daughter and her boyfriend are now sexually active?

Being anxious about the possibility of an unplanned pregnancy would certainly explain the sudden change in her anxiety levels. The eating issues fall into play when teens become sexually active, too, as now someone whose acceptance they want very, very much (the boyfriend) is seeing them naked, with all their real or imagined imperfections on display. Just consider the possibility, and see if you feel like it's likely.

You might just want to sit down and talk to her (in general terms, you don't want to make her defensive!) about "dating stuff"now, either way. Set some house rules, talk about boundaries and responsibility (in my house, with my boys, this would include discussing condoms and how important they are, but you do what's right for you, this is your daughter), maybe even about abuse and how teen girls are especially vulnerable statistically, so she can feel free to confide in you if something feels wrong, because after all you have a bit more experience in the relationship department. She may be years away from needing to know all this, but this is not stuff she will feel comfortable bringing up with you herself, so taking the initiative, I think, is the way to go even so.

I am so sorry for what your family's going through right now. This is a tough age for teenage girls and your daughter is fortunate to have such caring, involved parents looking out for her welfare. Please watch out for yourselves, too, and take care of each other.
posted by misha at 2:49 PM on July 13, 2013 [3 favorites]

Sadly I have no suggestions for you, but I wanted to express deep gratitude for how you are approaching this, and that you are approaching it at all. I wish my parents had seen issues like this as something beyond their children's unaided control rather than adding an extra layer of anxiety about desiring help at all.

I suspect that you probably have surrounded yourself with a community that approaches these issues similar to how you approach them, so you may not realize just how uncommon this kind of fantastic parenting is on average. Most parents I know personally would be assuming (and eventually accusing) their child of seeking drama, seeking attention, having no self-control, or some other behavior problem that they would blame the child for. So I really, really wanted to emphasize to you that you are doing a fantastic job. You probably don't hear that as often as would be ideal.

I know that it can be frustrating and overwhelming when you care for someone and cannot help them the way you want to help them, and it is easy to believe that you are not doing enough, especially for your own child. I wanted to make sure that you heard a voice telling you that that your efforts will have a profound positive effect on how your child views her problems and her right to seek help for them, rather than blaming herself for them. Even if every approach you took made no other impression, allowing her to view her struggles just as a thing she copes with and not as a deserved punishment or a deep character flaw will significantly help to carry her through adulthood.

Again, this Internet stranger is just so grateful to know that parenting like this is happening out there in the wild. Thank you.
posted by tllaya at 3:11 PM on July 13, 2013 [12 favorites]

The BF might be abusive to her. That you didn't know about him (his desicion? hers?) is a huge red flag to me.
posted by brujita at 5:17 PM on July 13, 2013 [2 favorites]

About 12 years ago I went through dealing with this with a girl I was living with / dating. I've got an awesome resource for you but I'm nowhere near where I can really look it up. It was just south of Stoneham - residential, three weeks+, absolutely the best care I could have found for her in the Metro Boston area. I'll get it sent to you tomorrow night.
posted by Nanukthedog at 5:28 PM on July 13, 2013

The starting point is the anxiety/perfectionism - everything else is a coping mechanism for that (the cutting, the secrecy, etc - when one feels out of control, one tries to control what one can).

As others have mentioned, DBT helps emotional regulation and will give her those tools she needs. Mindfulness meditation could also be good to calm herself whilst giving her power over herself. Transferring the cutting as an emotional outlet to something else like running or music or art might be productive. I know that sounds really simplistic, but at the moment she's thinking - in order to make myself feel better I need to cut myself - and she does it because it is working as the outlet. She would also know that running/music/art exist but the concept of using them instead of the cutting might not be apparent. Things that are obvious to an outsider are not necessarily obvious to someone who's incredibly anxious all the time (and particularly a teen who has less life experience). I would also get her meds reevaluated and probably increase the frequency of her therapy.

I definitely wouldn't be doing any laying down of the law, particularly re: the boyfriend and I would make her feel as if her value as a person who you love matters the most, not her grades or how many friends she has.
posted by heyjude at 12:53 AM on July 14, 2013

This podcast would be worth your time (transcript is also available at this link).
posted by HuronBob at 12:04 PM on July 14, 2013

Thank you so much to everyone for the answers and memails. They've been incredibly helpful, especially in terms of reassuring me that we will get through this.

They have prompted a bit of self examination on my part, too. When I talked about her doing well in school, friends, etc., I was intending to just list some things that make it appear that she is handling things well, with her anxiety under control. Really the most important part of that was that she seems happy, acts happy, without even what you would think of as typical teenage moodiness. However, the fact that I led off with the school stuff is telling, and is making me think more carefully about the subconscious messages I send to her.

We do realize that this is a coping mechanism for her, as is the trich. We just want to help her find a different way of coping. We don't have any concerns about her being suicidal.

I can also definitely see how the secret boyfriend comes across as a red flag, but unfortunately the secrecy (about everything) is totally in character for her. I have seen some text exchanges between them and he seems affectionate and supportive, and startlingly understanding about what we are going through as parents.

Tllaya, your response brought me to tears. I didn't anticipate how much the kind words of an Internet stranger would mean to me.

Thanks again.
posted by Bresciabouvier at 1:41 PM on July 14, 2013 [3 favorites]

cbt therapy will help her.
posted by barexamfreak at 6:35 PM on July 14, 2013 [1 favorite]

[One comment deleted. There are a lot of things that could be going on, but please let's stick to things suggested by the question and not speculate about other terrible things that might be happening.]
posted by LobsterMitten (staff) at 8:12 PM on July 15, 2013

I just memailed you as well. We're going through the same thing here with my son. He's been seeing a psychiatrist and a therapist, and they all seem to think it's going really well. They don't seem concerned about the cutting either, but it's just killing me knowing it's happening. I don't have any brilliant suggestions for you, although I'll be marking this thread as a favorite for all the suggestions from others.

One thing I am learning about my son through all this is that he needs more hugs than he admits. He needs more love than he is willing to ask for, although he's learning to ask, which makes me hold my breathe for fear I'll inadvertently dampen that willingness to speak up.
posted by routergirl at 8:13 AM on August 6, 2013

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