Harm's Way

For adolescents in emotional pain, cutting becomes a dangerous way to cope. The good news: They can recover.



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On the day after Valentine’s Day, 2005, Christine went into her bathroom and made some shallow cuts on her upper thigh with the broken-off top to a pen. The scratches scarcely drew blood. But the relief she felt from her overwhelming emotions was like “stubbing your toe when your arm is broken. Suddenly, your arm doesn’t hurt so much.”

A ninth-grader at a private school in Kensington at the time, Christine was a pretty, auburn-haired 14-year-old who played the harp and enjoyed theater class. But the previous 24 hours had been painful. Earlier that day she had written a note to a close friend, thanking her for saving her from suicide.

“She didn’t actually stop me from killing myself,” says Christine, who, along with others in this story, asked that her real name not be used. “But I was very dependent on her, and I saw her as a reason for living—I was a bit melodramatic.”

Her friend never got the note, but school authorities did and they called Christine’s mother, who picked her up from play rehearsal and drove her to a local emergency room. Diagnosed with severe depression, she signed an agreement not to harm herself and to begin psychotherapy.

During her evaluation, Christine was asked to remove the dozens of bracelets she wore, so that her arms could be examined for evidence of cutting. “I never had [cut],” Christine says, but the exam made her wonder. “I thought that if people were doing it, it must work.”

That night, as she and her mother drove home from the hospital, she felt exhausted from the experience of confronting the feelings she so often had managed to hide. The last straw, for Christine, was her mother’s seeming preoccupation with what others would think. “It was like I was going to ruin her reputation as a good mother when people found out she had a crazy daughter,” she says.

The next day, she experimented with cutting. “I was scared,” she says, “but I thought I knew what I was getting into.”

Joan Goodman, a clinical social worker and adolescent specialist in Rockville, has evaluated and/or treated nearly 400 adolescent self-injurers in Montgomery County in the past 14 years. Each has told her, in some way, the same thing: that physical pain is easier to deal with than emotional pain.

Goodman first began seeing teen self-injuries in her practice in 1996—the same year Princess Diana of Wales publicly admitted cutting herself during her unhappy marriage. Subsequent confessions by celebrities such as Johnny Depp and Angelina Jolie, as well as depictions of cutting in movies such as Thirteen, have led some parents to worry that the behavior is contagious, or a fad. An informal poll of Bethesda-area teens suggests a widespread awareness of cutting, including personally knowing another teen who has done it.

Statistics are difficult to come by, in part because the behavior is often kept secret. A 2007 study at the Miriam Hospital and Warren Alpert Medical School of Brown University in Providence, R.I., found that among 633 high school students, 28 percent reported injuring themselves moderately to severely at least once in the past year, with cutting the most frequent method.

Some public school districts, such as the Los Angeles Unified School District, have reported recent increases in students referred for non-suicidal self-injury. Montgomery County Public Schools does not keep such records, but Walt Whitman High School resource counselor Fran Landau says her office began seeing cases of cutting 10 years ago, and “more of it in the past five.” She says students who are not already in therapy are referred to the Montgomery County Crisis Center, and usually enter treatment from there.

Cutting can be a reaction to stress or social problems that are beyond a young person’s ability to cope, according to Dr. Steven Israel, medical director of Potomac Ridge Behavioral Health in Rockville. Or, he says, it can reflect a psychiatric illness, such as depression. Either way, self-injury as a “solution” can quickly become another serious problem. And “stopping the cutting doesn’t necessarily make the underlying problems go away.”

Goodman says cutting is not a new phenomenon. She points out that bloodletting was used as a means of getting rid of evil spirits centuries ago. But, she says, cutting has come out of the closet in recent years, much as anorexia and bulimia did in the ’80s, with teens more inclined to talk about it.

Goodman acknowledges that a young person who hears about cutting might be tempted to try it. But continued self-injury holds no appeal for those who aren’t troubled, she says. “I’ve had kids say to me, ‘I tried that, and it hurt. It’s stupid, and I’m not going to do it again,’” she says. “I have yet to meet a child so happy that they’ve had to cut themselves.”

But, she says, for a teen who finds that cutting “works”—like exercise, it releases mood-lifting endorphins—“the behavior is highly addictive and can easily take over a young person’s life.”

For Christine, cutting became an obsession. But in order to continue to find that release, she found she had to cut herself deeper, using sharper implements. “I eventually built up to scissors,” she says. “I thought I was being courageous.”

She began carrying sharp implements with her, going into the nearest bathroom and cutting herself, usually on the upper thigh where nobody could see it, as often as two or three times a day. “It was a way to scream and cry and moan,” she says, “without making a sound.”

Paradoxically, one motivation for teens to cut themselves is to hide their emotional pain from their parents, Goodman says. “To the outside world, it may look like the family’s perfect: two educated, hardworking, successful parents, a nice house,” she says. “Many of these young people are also high performers who excel in many activities. They feel tremendous pressure to achieve and be perfect—it’s not OK for them to not be OK.” 

Many parents don’t realize that something is seriously wrong until they discover that their child is cutting. 

Linda was stunned when her daughter, Jessica, then a high school sophomore, got into the car after field hockey practice one day and announced she had something to tell her: She had been cutting herself for the past six months. A Bethesda native in her mid-50s who exudes cheerful competence, Linda describes Jessica at 15 as a girl who appeared to have no problems: attractive, athletic, charismatic—somebody others confided in. “I must have had some vague idea of what cutting was, because I didn’t say, ‘What’s that?’ ” Linda recalls. “I said, ‘I’m glad you told me, and don’t worry—we’ll get you some help.’

“But inside, I was dying.” 

Jessica, now a 21-year-old college junior, says that far from feeling popular in high school, she was a “traveler” who fit in nowhere. “I was the person that people went to with their problems because they knew they could trust me,” she says, “but I never felt comfortable trusting anyone else.” 

She had “heard about cutting from random people, but had never really taken it into consideration” until she had a huge fight with her father one night and couldn’t stop crying. She can’t even remember what the fight was about, but afterward she took a razor and cut her wrist. The physical pain immediately relieved her mental distress, and soon she was cutting at least once a week—“sometimes every day, depending on how bad my state of mind was.”

Cutting, Goodman says, “provides teens with a false sense of control by allowing them to choose when, where and how much they will hurt. And because it makes them feel better, the young person will often say, ‘What’s wrong with it? I’m not hurting anybody else.’ ”

Jessica didn’t see a problem with cutting until six months in, when she had trouble stopping the bleeding. She realized she needed help. She hadn’t told her mother because “I was afraid she would get mad, which would have made me cut more. I literally could not deal with anyone yelling at me or feeling disappointed in me.”

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