Help! I think my teenager is cutting

Self-injury or cutting often starts in the preteen or early teen years. Parents, siblings, friends, teachers or mentors may identify behaviors that indicate self-harm, such as:

• "She's been wearing long sleeves even when it's really hot out."
• "She refuses to go swimming even though it was her favorite summer activity."
• "He stays in his room most of the time and spends longer than usual in the bathroom."
• "She is sensitive, moody and gets very angry, very quickly."
• "I discovered razor blades under his mattress."

No simple reason or diagnosis can explain why someone engages in self-harming behavior, but emotional pain almost always is a constant.

Risk factors that place teens at an elevated risk for self-harm include:

• Borderline personality disorder
• Conduct disorders
• Depression and anxiety
• Developmental disorders, including autism and intellectual disability
• Post-traumatic stress disorder
• Substance use

Self-harm behavior can lead to significant problems including infection, permanent scarring and disfigurement. In extreme cases, the injury could be fatal.

Self-injury typically is not meant as a suicide attempt, although it still is serious and is associated with elevated suicide risk. Seek medical help if you suspect such behavior. Many patients report that before engaging in such behavior, they experience either an uncomfortable sense of numbness inside, or they feel overwhelming or confusing emotions and don't know what to do with them.

Cutting or other modes of self-injury, such as burning, biting, scratching, head banging, hitting oneself, or self-inflicted piercing or tattooing, all relieve these feelings — albeit momentarily. The temporary relief experienced after self-injury leads to a flood of other emotions — guilt, shame, fears and return of the previous emotional pain. This can lead to a vicious cycle of self-harm.

There is no one-size-fits-all kind of treatment for someone who is exhibiting self-harm behaviors. A treatment plan will include therapy to get to the root of the emotional pain and, at times, medications to help with underlying mental health issues, such as depression or anxiety.

Management of cutting or other such behaviors will require time, hard work and a desire to learn healthier coping skills. A specific kind of therapy called dialectical behavioral therapy, or DBT, may be helpful.

Creating a crisis plan of things to do when in such a frame of mind also will be beneficial. This can include:

• Doing activities such as walking or listening to music to distract oneself until the impulse to self-harm passes.
• Having a crisis number at hand, such as the 988 Suicide and Crisis Lifeline.
• Identifying someone to call or talk to when one feels like they might cut.
• Using free apps available to help with a safety plan.

If, despite a crisis plan, the person does not feel safe, they should go to the nearest emergency department for help.

Patrick Bigaouette, M.D., is a psychiatrist in Psychiatry & Psychology in Mankato, Minnesota.