Cutting: Parents' Nightmare

Form Of Self-Injury Draws More Attention And Is Growing

(WebMD)  "Many kids have difficulty dealing with situations and people that make them angry," Lader adds. "They don't have great role models for that. Saying no, standing up to people — they don't really believe they're allowed to do that, especially girls. But if you can't do that, it's very difficult to maneuver the world, survive in the world without someone stronger, more capable than you to fight your battles."

Circular negative thinking keeps kids from developing self-esteem. "We help them empower themselves, take risks in confrontation, change how they view themselves," says Conterio. "If you can't set limits on someone else's behavior, stand up to them — you can't like yourself. Once these girls learn to take care of themselves, stand up for what they want, they will like themselves better."

"We want them to get to the point where they believe, 'I am somebody, I do have a voice, I can make changes, instead of, 'I'm nobody,'" she says.


Staying Safe

One study of the SAFE program showed that, two years after participating, 75 percent of patients had a decrease in symptoms of self-injury. An ongoing study is indicating a decrease in hospitalizations and emergency room visits.

"I've been doing this for 20 years, and the success rate is far greater than the failure rate," says Conterio. "We truly believe that if people can continue to make healthy choices, they won't go back to self-harm. We get e-mails that are a blast from the past. Some patients do extremely well. Others regress. Others have finally decided to do the work they learned here. When they apply it, they do well. It all goes back to choice."

The bottom line: "When kids decide they don't want to cut any more — and they get stressed again — they have to be able to manage stress as it arises," Rosen says. "They can't succumb to cutting. People who can figure out some alternative way to manage stress will eventually quit it."

Parents can help by providing emotional support, helping identify early warning signs, helping kids distract themselves, lowering the child's stress level, and providing supervision at critical times, Rosen says. "But a parent can't do it for them. It takes a certain level of resource to be able to stop cutting, and many kids don't have those resources. They need to stay in therapy until they get to that point."

Self-harm is not a problem that kids simply outgrow, Rosen adds. "Kids who develop this behavior have fewer resources for dealing with stress, fewer coping mechanisms. As they develop better ways of coping, as they get better at self-monitoring, it's easier to eventually give up this behavior. But it's much more complicated than something they will outgrow."

Sources: Karen Conterio, author of Bodily Harm; founder of SAFE (Self Abuse Finally Ends) Alternatives at Linden Oak Hospital in Naperville, Ill. Wendy Lader, PhD, clinical director for SAFE Alternatives. David Rosen, MD, MPH, professor of pediatrics at the University of Michigan; director of the Section for Teenage and Young Adult Health at the University of Michigan Health Systems in Ann Arbor.