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Today, Dr. Mary is addressing the topic of adolescents and self-injury, also referred to as "cutting."
Q: My 13-year-old niece told me that some of the girls at her middle school purposely cut parts of their body. She made it sound like this was pretty common. What's going on here and what does the school do about this sort of thing? I don't recall this happening when I was in middle school.
A: It sounds like your niece is describing something that in clinical circles is known as Non-Suicidal Self-Injury (NSSI). Other terms for this behavior are "cutting," "self-mutilation," and "self-injury." These all refer to the intentional harming of one's body, without the intention of dying. While the most common form of self-injury is cutting the skin, other methods include burning, biting, scratching, picking at wounds, punching or poking oneself, and inserting objects under the skin (known as "embedding").
Most experts agree that these behaviors usually begin in adolescence, typically between the ages of 12 and 14 years. Recent data show that anywhere from 12 to 40 percent of adolescent samples surveyed have said that they've injured themselves, and this doesn't include kids who are already getting psychiatric help.
At this point, you're probably wondering why teenagers would do this sort of thing. Experts agree that understanding these behaviors is complicated, partly because there are many reasons that kids do this. It sort of boils down to this: Self-injurious behaviors are used to control both one's internal and external world. Internally, these teenagers report feeling very intense, painful emotions and self-harm appears to serve as a release from these feelings. Adolescents may self-injure to feel relaxed, to stop feelings of numbness, or to stop negative emotions. Externally, these behaviors serve as a way of managing or controlling one's environment. For example, self-injury may be used to avoid activities (like school), avoid being with people, and/or to receive attention from friends or family. It goes without saying, but I will say it anyway: Self-injury can be thought of as an extremely poor coping skill in the face of extreme feelings. Ironically, kids often report not feeling physical pain from their injuries, and in fact feel a sense of satisfaction. During the act of NSSI, it's thought that the brain releases endorphins, which help to improve one's mood. All of this only further reinforces these behaviors.
Clearly, it's important for school staff to be educated and aware of possible signs of self-injury. PE teachers and/or coaches may be more likely than other teachers to actually see the physical signs of self-injury. Frequent or suspicious scars, burns, and bruises on the arms, legs, and upper body are red flags. Spending an inordinate amount of time in the restroom or other remote areas of the school, owning sharp items such as tacks or razors, and wearing clothes in an effort to hide signs of self-injury (e.g., repeatedly wearing long sleeves on hot days) are all additional signs of possible NSSI. Other things teachers may observe are signs of intense anger or sadness, social isolation, and "images" of physical harm in students' class work (e.g., a creative writing piece that depicts emotional pain and self-harm). Teachers must make efforts to control any inadvertent shock at discovering these behaviors and provide support in a non-judgmental manner.
Ultimately, the school's job is to make sure that a student gets the help she/he needs. Once NSSI is identified and the student's parents notified, the hope is that private mental health treatment will be pursued by the family. The school psychologist, social worker, and/or counselor should have ongoing communication with the student's clinician, so that everyone is on the same page about how to work with the student. For example, at school, students may need a "safe" place they can go when they feel the need to self-injure, such as the counselor's office. Or, if a student is learning more healthy ways of coping with emotional stress, she/he may need encouragement from a trusted adult to try out these new behaviors at school.
Since your niece has witnessed NSSI among her peers, and she obviously felt she could trust you with this information, I'm wondering if she's told any of the adults at her school what she's seen. In general, educating students about self-injury is tricky because we know that this behavior tends to be imitated by peer groups, especially by kids who have other risk factors. Experts agree that giving students information about how or why kids self-injure isn't a good idea, nor are school-wide assemblies or videos on this subject, because of their potentially suggestive messages. What kids should know is that self-injury is a problem that can be helped, that there are adults at school who know how to help, and that it's okay for students to tell an adult if they know someone who's hurting themselves. Sometimes, this is easier said than done.
Dr. Mary Rosen is here each week to provide answers to your most pressing school issues. She's a school psychologist, licensed counselor, graduate school instructor, and parent.
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