Q: I have a friend who cuts, what can I do?

A: It can be hard to understand why a friend might injure himself or herself on purpose. Cutting is using a sharp object to cut your own skin on purpose until it bleeds, it is a form of self-injury. Guys sometimes self-injure by burning their skin with the lit end of a cigarette, a lighter, or a match. Their skin won’t show cut marks, but it might show the small, round scars of a burn.

Some people turn to this behavior when they have problems or painful feelings and haven’t found another way to cope or get relief.

Most of the time, people who cut themselves don’t talk about it or let others know they’re doing it. But sometimes they confide in a friend. Sometimes a friend might find out in another way.

It can be upsetting to learn that a friend has been cutting. You might feel confused or scared. You may feel sad or sorry that your friend is hurting herself in this way. You might even be mad or feel like your friend has been hiding something from you. You might wonder what to say, whether to say anything at all, or if there is anything you can do to help a friend who cuts.

It can help you to know more about cutting, why some people do it, and how they can stop. Sharing this information with your friend can be a caring act, and it might help her or him take the first step toward healing.

Ways to Help

Understanding why a friend may be cutting can help you be supportive. But what can you actually do to help your friend stop?

The first thing is to be realistic about what you can achieve: As with any damaging behavior (such as alcoholism, drugs, or eating disorders), some people just may not be ready to acknowledge the problem and stop. So don’t put too much pressure on yourself — your friend’s problem could be a long-standing one that requires help from a professional therapist or counselor. Therapists who specialize in treating adolescents are often experienced in working with people who self-injure, and can also help with other issues or emotional pain they might have.

Here are some things that you can try to help a friend who cuts:

Talk about it. You’ve asked your friend about the cuts and scratches — and maybe he or she changed the subject. Try again. Let your friend know that you won’t judge, and that you want to help if you can. If your friend still won’t talk about it, just let him or her know the offer stands and you are open to talking whenever he or she wants. Sometimes it helps to let a friend know that you care. Still, even though you do your best, your friend may not want to talk.

Tell someone. If your friend asks you to keep the cutting a secret, say that you aren’t sure you can because you care. Tell your friend that he or she deserves to feel better. Then tell an adult in a position to help, like your parents, a school psychologist or counselor, or a teacher or coach your friend is close to. Getting treatment may help your friend overcome the problem. Your friend may be mad at you at first. But studies show that 90% of those who self-injure are able to stop within a year of beginning treatment.

Help your friend find resources. Try to help your friend find someone to talk to and a place to get treatment. There are also some good books and online support groups for teens who self-injure. Be careful, though: Although some websites offer useful suggestions about how to resist the urge to cut, the stories or pictures some people send in may actually trigger the urge to cut in those who read or see them. And some sites promote a sense of sisterhood or solidarity that might interfere with a person’s getting help. There’s nothing cool about cutting — beware of people or websites that suggest there is!

Help your friend find alternatives to cutting. Some people find that the urge to self-injure passes if they squeeze an ice cube in their hand really hard, draw with a red marker on the body part they feel like cutting, take a walk with a friend (you!), rip up old newspapers, stroke their cat or dog, play loud music and dance, or find another distraction or outlet for their feelings. These strategies don’t take the place of getting professional counseling, but they can help in the short run.

Acknowledge your friend’s pain. Let friends who cut know that you get what they’re going through by saying things like, “Your feelings must just overwhelm you sometimes. You’ve been through a lot — no wonder you hurt. I want to help you find a way to cope that won’t hurt you any more.” Try to avoid statements that send the message you don’t take your friend’s pain seriously (statements like “But you’ve got such a great life” or “Things aren’t that bad” can feel dismissive to a person who cuts).

Be a good role model. Everyone experiences painful emotions like hurt, anger, loss, disappointment, guilt, or sadness. These emotions are part of being human. Coping with strong emotions — instead of dwelling on them and continuing to feel bad — involves a few key skills, like knowing how to calm yourself down when you’re upset, putting feelings into words, and working out solutions to everyday problems. Be the kind of person who can do this and your friend will learn from you.

And here are things you should avoid doing with people who cut:

Don’t deliver an ultimatum. The best thing friends can do is to be there for each other, accepting and supporting one another without judgment. Try to avoid issuing deadlines or ultimatums to people who self-injure (for example, don’t tell them you’ll stop being a friend if they don’t stop cutting). This strategy doesn’t work and it just puts pressure on everyone. Let your friend know that you’ll always be there to talk to.

Don’t accidentally reinforce the behavior. Among some people, cutting can have a certain mystique. If you’re concerned about a friend who cuts, don’t let your friend buy into the notion that the behavior is a sign of strength, rebellion, punk chic, or simply a part of his or her personal identity. Don’t reward drama with too much attention.

Don’t join in. A few people may try to get others to cut as a way to be part of the group or to seem cool. They might dare you, or try to convince you to cut to see how it feels. Don’t let peer pressure pull you into doing something you know isn’t right for you. Someone who tries to pressure you probably isn’t a true friend after all.

How Important Is It to Help?

People who cut usually don’t intend to injure themselves severely, and cutting isn’t usually a suicide attempt. Most of the people who cut themselves say they don’t mean to die and that they know when to stop. But even when suicide is not the goal, cutting can still cause severe injury or death. People who self-injure risk infections, scarring, shock (from blood loss), and they can die as a result of extreme injury or bad cuts that don’t get treated promptly.

Without help, people who cut may also continue to feel socially isolated and depressed. People who self-injure may have other problems (such as eating disorders, obsessive-compulsive disorder, bipolar disorder, borderline personality disorder, or severe depression) that require long-term professional care. By helping a friend address cutting problems, you may open the door for him or her to resolve other issues, too. The first step to getting help is usually the hardest.

It’s often difficult to help a friend who cuts and you may not see changes overnight, if at all. Remember, some people aren’t ready to face what they’re going through — and you can’t blame yourself for that. You may need to be patient. But don’t take on the burden as your own or feel responsible for your friend’s behavior.

Sometimes even the truest friend may need to take a break from an intense situation. Be sure to care for yourself, and don’t allow yourself to be drained or pulled down by your friend’s situation.

PART II

Cutting is one of the more common forms of intentional self-injury. It is estimated that over one percent of the population are self-injurers, primarily adolescents and young adults, and predominantly young women. The true prevalence of this behavior is likely higher, though.

Many who injure themselves try to keep it secret, because they feel ashamed or guilty about their behavior. They try to hide scars with clothing, and if discovered, make up explanations for the injuries (“cat scratches” are among the most common).

Self-injurers are not trying to kill themselves. They inflict harm on themselves to bring relief from some kind of inner distress. Physical pain is used as a way to try to escape emotional pain. Many self-injurers report a great sense of calm and relief after hurting themselves.

Self-injurers tend to be perfectionists, unable to handle intense feelings, unable to express their emotions verbally, and can at times feel overwhelmed by dislike for themselves or their bodies. They may turn to self-injury as a way to relieve intense anger, sadness, or emotional pain, to express their emotions and pain, to try to gain a sense of control of themselves and their lives, or to punish themselves.

Experts point out that self-injurers commonly struggle with low self-esteem and feelings of invalidation.

They may have been taught from an early age that their ideas about things were wrong or bad. They may have been left feeling numb, unreal, so dead inside that seeing their own blood when they cut themselves is their only way to feel real, to feel alive.

Many self-injurers come from broken homes, from alcoholic homes, or from families where parents were emotionally absent. One half to two thirds of self-injurers also struggle with disordered eating.

Nearly 90 percent are survivors of sexual or physical abuse.

Your friend, P.E.B., needs help for a number of reasons. She must be struggling with her own very significant issues and pain and would benefit from professional help and support. Suggest to her that the two of you make an appointment at the Counseling Center or talk to someone at the Health Center or Res Life, if those options seem less threatening. Tell her how concerned you are, how much you care about her pain, how you want to help her get help.

Although your friend’s cutting does not represent a desire to take her own life, it can nonetheless be very dangerous. A cut can go too deep, or involve an unseen artery, tendon, or nerve. An untended wound can become infected.

There are a large number of helpful web sites to consult about self-injury. Among them, S.A.F.E. Alternatives (“Self-Abuse Finally Ends”) at www.selfinjury.com includes a good deal of information about various aspects of self-injury, including treatment options and referrals, books, audio, and video resources. Deb Martinson’s “Secret Shame (Self-Injury Information and Support)” web site (www.palace.net/~llama/

self-injury) is equally comprehensive and more personal. Colleen Thompson’s “Mirror, Mirror” web site (www.mirror-mirror.org/selfinj.htm) explores various aspects of eating disorders, including relationships between eating disorders and self-injury.

Acts of self-injury often bring out uncomfortable and negative feelings in others, especially friends and care-givers. It is sometimes hard to remember that the self-injurer is only trying to cope with her or his own pain and inner turmoil, not to hurt or frustrate others. What the self-injurer needs most from us all, is care and support and help finding help. You’re on the right track, P.E.B.

Be well!

Written by:

Jeff Benson, M.D.

Dudley Coe Health Center

Tagged as: cutting, helping friends, intervention