Why Adolescents Cut When Dealing With Anxiety And Depression
Nonsuicidal self injury (NSSI) is more common in adolescent and young adult populations than previously thought. Although it is important to assess the associated risk of suicidal behavior, NSSI is generally used to cope with distressing negative affective states, especially anger and depression, and mixed emotional states. Although previously believed to be a characteristic of severe psychopathology, it now appears that NSSI is associated with a wide variety of externalizing and internalizing conditions. Effective treatment is grounded in a collaborative understanding of the function of the NSSI for the adolescent. Affective, psychosocial, biological and cognitive factors are addressed through psychotherapeutic, psychopharmacological and skill-building strategies appropriate for each individual.1
What exactly is cutting?
Cutting is a type of self-injury that falls under the NSSI criteria and is one of the most common forms of self harm.
People who cut often begin the practice as young teens and without treatment, the behavior can continue into adulthood.
Cuts are usually focused on the wrists, arms, legs, or bellies. When the cuts heal, long after the "rush of good feeling," they often leave scars or marks, which brings about an extra layer of emotional problems to now deal with, shame and guilt. People who injure themselves usually hide these cuts and marks in hopes that no one else will know, dealing in silence with the additional emotional burden.
It can be hard for parents to understand why their child is actively cutting. It seems like a modern phenomenon, and statistics support a large rise in this behavior, but like many complex issues in the past, they were often held in secret due to closed family systems and fear. Cutting is a way some teens try to cope with the pain of strong emotions, like intense pressure, social conflicts, and relationship problems. Cutting is a way for teens to deal with feeling out of control in situations they think will never change.
How does the idea of cutting even come to a young person's mind?
On a most basic level, people who choose to cut feel desperate for relief from bad feelings, have heard of it or seen it before, or on some primal level see the act of cutting as a crude and physical of releasing the pain from the hole of the cut, or even as a means of getting control over the pain (by releasing it) rather than continuing to deal with its perceived control over them.
These young teens are simply not equipped to deal with the range and intensity of emotions raging inside them. They just don't know what to do. When things get to be too much, when tension builds up, the resulting intensity or the lack thereof becomes unbearable. The seemingly animal urge to cut might well be triggered by roiling basic emotions like anger, hurt, shame, frustration, or even alienation.2
Social media has provided a platform where people share about cutting and it has positives and negatives with regards to the behavior. The idea of online support for someone who is cutting sounds like it could be an impactful, helpful tool but there are concerns there too. Statistically, it's impossible to determine how many healthy conversations are actively had compared to unhealthy in the social media realm. It cannot be considered a reliable source for support at this time.
How does hurting yourself make you feel better?
The biology of the act of injuring involves the release of endorphins, hormones, or brain chemicals, that relieve pain and can cause a temporary state of euphoria.3
It boosts the natural opioid levels in the body that inhibit emotional thought patterns in the brain. Essentially, it is like trading one form of pain for another, one that the cutter is willing to deal with on a physical level, in place of the one not wanted on an emotional level.3
"From a developmental perspective, [the time of adolescence is] a perfect storm for self-injury."
Janis Whitlock, Cornell University
Can cutting be helped?
The good news is that the ritual of self-harm can be overcome. People can be taught other ways to cope with deep emotional pain. You can learn to feel better without harming yourself. Especially effective is Dialectical Behavioral Therapy, proper medication determined through a psychiatric assessment, and education to learn alternative coping mechanisms. In the most severe instances, a short hospital stay followed up by the appropriate treatment center may make all the difference.
Cutting can be the beginning or an early identifier of a larger problem, it is a symptom of Borderline Personality Disorder, Major Depressive Disorder, eating disorders, severe anxiety, or PTSD, treating the act of cutting can be more complicated, but not impossible.4
1 "Nonsuicidal Self Injury in Adolescents", by John Peterson, MD, Stacey Freedenthal, PhD, Christopher Sheldon, PhD, and Randy Andersen, LCSW
2 "Cutting," Kids Health, by Nemours, 2015.
3 "Why Do Teens Hurt Themselves?" The Science of Self-Injury," Live Science 2010.