Dear Counselor,
On a recent youth mission trip I noticed some marks on the lower forearms of a teenage girl in our youth group. I was concerned that she had hurt herself while working on a clean-up project in a poor neighborhood where we were serving, but on closer inspection the marks were strategically placed and, in confidence, the teenager confessed to cutting herself with a large safety pin on a regular basis. This girl comes from one of our committed church families and I am not sure why she is doing this or how I can help.
— Concerned Youth Pastor
Dear Pastor,
All young teenagers develop coping behaviors to deal with the social and emotional stressors normal to adolescent development. Self-injurious behavior, which can include cutting or ripping the skin, carving words or signs into the skin, burning the body, over-dosing on over-the-counter drugs, etc., is a “less than healthy” form of coping with stressful life events that in its own way can bring to the adolescent a sense of control, a reduction of numbness, a block to traumatic memories, or a discharge of anxiety, anger, despair, or disappointment. While self-injurious behavior is usually not suicidal in intent, it is linked to a risk of suicide or accidental suicide (Garner, 2008). For instance, if your teenager were cutting with a knife or razor blade, the risk of suicide would be far greater and need immediate intervention.
As seen with your own experience, self-injurious behavior is more prevalent with adolescent girls with the average age for first-time cutters at 13.9. While a history of sexual abuse and family violence are the greatest predictors of self-harm, other mental health issues, body image issues, significant losses, bonding issues with parents, etc. can also be predictors. Even in the case of teenagers from “good/normal” families, there can be subtle pressures to perform, isolation through computer use and parents working long hours, or loss of a friend or a close relative, that creates an environment conducive to developing injurious forms of coping.
Cutting behavior always has unique meaning for the adolescent, and as a youth pastor you can join in the process of increasing awareness of internal feelings, developing other coping skills, and finding alternative ways to achieve impulse control (Turning to scriptures like Ps 23:6; Proverbs 3:5; Ps. 54:4, or Phil. 4:13 would be an example – cf. Teasley, 2011.). But the family needs to be involved and you are strategically placed to help this adolescent open up to her parents, to invite all of them to get professional help, and to coach all of them to be curious about the full meaning of this harmful way of coping with adolescent stress. (A possible website resource is www.selfinjury.org.)
Tom Rodgerson