Key Questions to Ask When Ordering Mental Cutter

“Can we go together to tell a trusted adult?”

“When did it all start?”

“How can I help?”

“Tell me more.”

“Does anyone else know?”

“How do you feel about this?”

You want to know how you can help a friend who is cutting. When someone tells you they are cutting, which is also called non-suicidal self-injury, they are struggling and probably want someone to listen.  (There are resources below.)

I want you to know, however, that you only have to listen long enough to recognize there is a problem.

Connect with the pain first

In other words, you don’t say things like, “You are so wonderful, why would you do that to yourself?” Phrases tend to make the sufferer feel misunderstood. The shame is likely to drive them to cut more because that is how they are coping with difficult emotions. So meet them where they are.

Cutting is an unhealthy coping strategy. Bullying, divorce, death of a parent, for example, can all be reasons that drive someone to cut but we do self-harm means something is gravely wrong in this person’s life.

Cutting can go from being a habit to addiction but it’s important not to shame the person as that can drive them to engage in more of the behavior. It is one in which someone might not be able to move away from right away and can have many relapses. It can be what prevents someone from taking their life. So it’s important that they replace that coping strategy slowly with a healthier one and that takes time. So what do you do or say?

How is this making you feel?

Since you looked this up, I want you to think about how the fact that a friend is self-harming makes you feel.

• Are you feeling helpless, confused, anxious?
• Are you afraid your friend will be mad at you if you do tell someone?
• Are you feeling overwhelmed that such a big problem was laid at your feet?

While you don’t need to share your reservations with the friend who is cutting, know that you might need to talk and have someone listen to you.

Next, ask yourself this very important question because it’s the answer that will drive what you will do about it.

• Since it is life-threatening do you think this is a secret you can keep?
• Is this behavior potentially life-threatening?
• Would you rather your friend be mad at you than dead?

Although self-harm is rarely an attempt at suicide, those who engage are at higher risk of taking their life due to being desensitized to pain and fear of harming themselves, so you want to say something before it escalates or gets out of control. Because it is dangerous.

Listening is the key skill

You may think that listening is not doing anything. But the more you listen and do not try to “fix” the more you are helping. It’s a skill that is way underrated. Just think about when you stated a problem how you felt when someone talked over you and started presenting solutions. Did you feel heard?

How do you feel when someone is quiet while you talk and even says things like “that must be really hard” or “tell me more?” Empathetic listening is a gift you can give someone and it’s a very valuable one.

Empathetic listening involves nodding your head, making eye contact if in person, and saying ummmmm to let the person know you are there and hearing what they have to say.

Ask open-ended questions

So key phrases and open-ended questions might be some of the following.

• Tell me more
• I’m honored you trust me enough to tell me this
• How long has this been going on?
• When did the self-harm start?
• How is all of this making you feel?
• Does anyone else know?
• Has anything else been going on in your life?

Connect with a trusted adult

This isn’t a secret you can keep to yourself. And you can encourage someone to go with you to tell a trusted adult, teacher, school counselor, parent, or a coach. But if they don’t, you need to tell someone. For one, you can fix this. And two, this person needs help and support that you are not qualified to fix.

7:45 minute video on What to Say to a Friend Who is Cutting

Sample conversation with someone who is cutting

The script below, although simplistic and probably corny, will give you the idea of a direction in which to go to help you help a friend who is cutting. 

Friend: I’ve been cutting

You: I’m honored you trust me. That took a lot of courage. It sounds so painful.  Do you know why you are cutting? 

Friend: I don’t know. 

You: When did it start?

Friend: I think it started after those girls texted that embarrassing picture of me with Jason naked from that party. It was so humiliating. I was so drunk.

You: I am so sorry that is really cruel.  Tell me how that made you feel. I’m listening.

Friend: It’s so stupid but when I think about that or a lot of things, I cut myself and at that moment it feels good… and then later I feel ashamed and embarrassed. I keep thinking I’ll stop but then I get those feelings again and I do it again. 

You: It sounds like something really awful happened that triggered the cutting. Do you cut when other bad things happen?

Friend: I guess I do. Yeah. A bad test score. An argument. But yeah.

You: I feel worried about you. Can we talk to an adult you trust? I can go with you. Who do you think would be good? How about your soccer coach?

Your job is to listen and let a trusted adult know so your friend gets help.

You can do that in partnership with your friend. But if she or he doesn’t want to, you’ll have to go forward and tell a trusted adult discreetly and in private. Because no matter why someone is cutting, you can be sure it is a sign that something is gravely wrong in that person’s life and they need help beyond what you can provide. But you can still be there for support.

Here are the basic steps:

1. I am honored you trust me enough to tell me about this

2. Listen empathetically–with your heart without judgment 

3. Ask if they are thinking of or are attempting suicide

4. Say things like, “I’m concerned about you.”  

5. Tell a trusted adult.  

   You may fear they might get mad at you but I imagine you’d rather a friend be mad than dead. And often no one stays mad. An alternative is to engage that friend and tell that trusted adult together. A trusted adult is a teacher, parent (yours or someone else’s), school counselor, coach, minister.

This doesn’t fix everything but it’s a start. It’s a scary, frustrating and baffling behavior for most of us. We want to say, “just stop cutting.”

Please understand that it’s more complicated than that.

Resources:

There are few things more disturbing for moms and dads than finding out that your child is intentionally hurting themselves. Unfortunately, it’s very common, especially among girls. Experts call it “self-injury,” and as many as a quarter of all teenagers do it.

The most common form of self-injury is cutting or scratching the skin with anything that can draw blood, such as razors or even paperclips and pen caps, but people also self-injure by burning themselves, picking at skin and wounds, or hitting themselves. They often start around puberty.

When a person develops a habit of cutting their arms it might look like suicidal behavior, but it actually isn’t. People who self-injure aren’t trying to kill themselves, they are trying to alleviate some emotional distress they are feeling. However, the behavior indicates a depth of psychic pain that could lead to a suicide attempt. The behavior is also inherently dangerous because people who self-injure may hurt themselves more seriously than intended or develop infections or other medical complications.

Understanding the drive

It’s hard to understand why anyone would want to intentionally hurt themselves or why that injury would come as a relief, as many self-injurers describe it. Some people report that it serves as a distraction from some other intense emotional pain, says Ron Steingard, MD, a psychiatrist at the Child Mind Institute.

Others self-harm because they feel deadened inside. “They’ve locked down so tightly because of whatever’s going on in their lives that they feel they’re incapable of feeling anything at all,” says Dr. Steingard. “So they hurt themselves in order to feel something.”

In some cases self-injury can also become a way of communicating. When a young person is found to be cutting, it’s likely to elicit empathy and concern from parents and other adults. Next time they are feeling desperate, they might use self-harm as a way to communicate their feelings.

A way to cope

But self-injury isn’t always a form of communication. Some kids are very secretive about the habit, and are focused only on ameliorating their own pain, not sharing it. It’s what clinicians call a maladaptive coping tool: Even though self-injury isn’t the best way to manage a problem, it might bring temporary relief.

Unfortunately that relief makes self-injurious behavior very reinforcing, so kids come to rely upon it as a way to deal with their painful feelings. And the longer they practice self-injury the more reinforcing it becomes.

Red flags for cutting

If you suspect that your child may be self-harming but you’re not sure, look for these signs:

• Talking about self-injury
• Suspicious-looking scars
• Wounds that don’t heal or get worse
• Cuts on the same place
• Increased isolation
• Collecting sharp tools such as shards of glass, safety pins, nail scissors, etc.
• Wearing long-sleeved shirts in warm weather
• Avoiding social activities
• Wearing a lot of band aids
• Refusing to go into the locker room or change clothes in school

Triggers

The impulse a teenager feels to harm themself is almost always triggered by a specific event in their life. The most common “trigger” for cutting is feeling rejected: by a romantic interest, by their close friends, or by a general feeling of being left out or criticized.

Cutting can also be copy-cat behavior inspired by videos and images that show other people cutting.

Getting self-harm help

If you discover that a child has been self-harming, even if they say it was a one-time thing, it’s important to get help. It’s true that kids might experiment with self-injury, especially if they have friends who are doing it, but it’s a serious and dangerous behavior, and you don’t want to ignore what might be a real mental health issue.

• Evaluation: To begin with, you should have your child evaluated by an experienced mental health professional to find out what their reasons for self-harm are and what emotional difficulties they’re experiencing.

• Dialectical behavior therapy (DBT): One highly recommended treatment is DBT, in which a psychologist works with your child to help them learn how to tolerate uncomfortable feelings, anger, anxiety and rejection without resorting to cutting.

• Cognitive Behavioral therapy (CBT): In CBT, a psychologist teaches your child to challenge negative, distressing thoughts, to recognize the pattern and train herself to think outside it. In many cases, particularly with teenagers, this treatment is very successful.

• Family Therapy: If there are things going on at home–fighting, job loss, a death–that could be the source of your child’s emotional troubles, family therapy is a good way to begin treatment.

• Medication: Often if there is another disorder involved, a doctor will prescribe medication to treat that condition. The combination of medication and psychotherapy is very successful at treating kids who self-harm.

Finally, Dr. Steingard recommends that families try to be open and supportive. “This is a behavior that’s very hard for people to get inside and empathize with. But it isn’t something that a person can just stop; it’s something that needs to be understood.”

Important:
If you or someone you know needs help now, call 988 to reach the Suicide and Crisis Lifeline.