Non-Suicidal Self-Injurious Behavior

I’m washing dishes with my daughter, Emily, when I notice superficial cuts all down her arm. 

“Emily, what is this?!” I ask in an alarming tone.  Maybe, I’m over-reacting, but I’m afraid this is a suicide attempt!  Immediately, Emily pulls down her sleeve to hide her cuts. 

“It’s nothing, Mom. I just got scratched by a cat.” But we don’t have a cat. My heart’s racing too much, that I don’t think I can handle this properly. I don’t say anything else, and Emily goes back to her room and closes the door. 

I have so many questions. Why would Emily do this to herself? Is she just trying to get attention?  Did her friends put her up to this? Is it better to ignore this? Does my daughter have a mental illness? Is her life in danger? What will my family think if they find out?  Finally, I decide that Emily and I need to find answers together.  I make an appointment with our family clinician.

Emily’s clinician is happy to see us again and asks, “How can I help you today?”  Emily is slumped down in her chair with her head down.

“Show her your arms” I say gently. 

The clinician doesn’t seem shocked. In fact, she calmly says, “So, you’ve been cutting, Emily.  I want to understand better. Take me through this like I’m watching a video. What happened first?”

“I got into a really big fight with my best friend. We’d known each other since we were babies.” Emily answers.

“How did that make you feel?”

“Sad, hurt, and overwhelmed.  I just wanted to get my mind off my problems.”

For the next half hour our clinician listens to Emily and asks clarifying questions about what happened, what Emily saw, thought, and felt. She draws the steps on a piece of paper. As I see the steps leading to her cutting unfold, I become aware of a lot of the emotions Emily was experiencing.  There are opportunities all along the way to problem solve. I realize that Emily is hurting, but doesn’t know how to express her feelings in a healthy way. She needs my help. Maybe the best way I can help is to show her that it’s okay to get professional help.

Since Emily is a teenager, I give her some time to talk to our trusted clinician one on one. I want Emily to feel free to answer honestly about thoughts of suicide, use of drugs, or alcohol.

Our clinician explains that cutting usually starts in the early teen years and that non-suicidal self-injurious behavior (cutting, burning, skin picking, etc…) can affect as many as 15-20% of young people.  Most teens that cut aren’t attempting suicide, but it’s important to understand why they are cutting. Before we leave the appointment, she puts us in contact with a counselor and she has Emily sign a paper that states, “Before I engage in self-injurious behavior, I will try these five things…” She has a list of Dialectical Behavior Therapy Skills to choose from:

Activities: Hobbies, walks, sports, etc…

Contributing: Volunteer work, chores, etc…

Comparisons: Others coping better or worse; Coping in the past and now

Emotions: Read, watch or listen to material that represents the opposite of the emotion. If sad watch a funny movie.

Pushing away: Leave the situation mentally for a little while. Take a walk.

Thoughts: Distract your thoughts by engaging in a mental task. Count floor tiles. Solve a puzzle. Read a book.

Sensations: Change the physical sensation. Hold an ice cube. Smell something sweet.

I was thankful I had not ignored the cuts on Emily’s arm. I plan to follow up with the counselor and encourage Emily to express her emotions in healthy ways.

*Information in this post does not replace sound counsel from a trusted health care provider or counselor. Anyone having thoughts of suicide should not be left alone and should be seen as soon as possible.

Information retrieved from professional lecture “Evaluating Non-Suicidal Self-Injurious (NSSI) Behavior in Youth” by Colleen Cullinan, PhD, Pediatric Psychologist given November 14, 2018 accessed from on July 14, 2020.

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