Why youth cut themselves?

I worked ER this past Easter weekend.  I was asked to see a 12 year old boy who had cut himself for the first time.  He did not know why he did what he did; so I explained it to him while I repaired his laceration.  He left smiling and satisfied. His mom sent me an email today thanking me for taking care of her son.

I recall another earlier incidence.  It was the weekend just before last Christmas.  I had been asked to see another 12 year old boy who had cut himself.  The story was that “he began cutting only after having met a female friend who cuts”.  This was his third ER visit for cutting. Mom is a social worker. He has been seeing a therapist for sometime but was recently referred onto another therapist.  I asked mom why? She was first quiet; and later said it’s because the therapist felt that the new therapy team can provide the needed family therapy.

I asked him why he cuts?  He looked up briefly and said it’s because “everyone hates me”.  I asked him why if other hate him, they aren’t doing the cutting.  He looked puzzled. I then asked him if it is possible that he is struggling with difficult thoughts which he can’t stop; and that he is using  the pain of cutting to interrupt the thoughts. He then looked up and held my gaze and nodded his head. I then asked him what else he does to stop his thoughts.  He looked at his mom briefly but said nothing. I asked if he plays video games. He quickly denied it. His mom was also quick to point out that he is in rep hockey and has no time to waste.  I then asked him again what else he does to stop his thoughts. His mom looked surprised when he finally said he punched walls. I asked him again if the pain helps him stop his thoughts. He said yes.  I then asked him what else? He said he banged his head against walls. His mom looked shocked.

I asked him if I may share with him a painless technique called “Take Five” that may help him deal with difficult thoughts.  He looked at me earnestly and agreed. I instructed him as follows: 1. hold up one spread hand and hold out the index finger in the other.  2. Slowly trace the outline of the spread hand with the index finger of the opposite hand in the following way. 3. wait for the next (preferably involuntary) breath. 4. and trace up the digit with each inspiration.  5. and trace down the digit with each expiration. 6. repeat the same until the entire spread hand is traced.

I explained to him that by intentionally paying attention to the sensation of his breath and the tracing of his hand, he can redirect his attention away from his difficult thoughts without the the pain and trouble of his current methods.  I encouraged him to practice this new technique at every chance he gets. I suggested that his ability to direct his attention and manage difficult thoughts will improve with these regular practices - no different than how hockey drills improves his play.

I then asked him who else suffered difficulty with thoughts.  He said “my twin”. I said, “who else?” He pointed to his mom.  I asked, “how about your dad?” He said, “no.” I said, “what about when he loses his temper and yells at you about hockey?”  He thought and began smiling and nodding. So I suggested that he might find an appropriate moment to share his new learned knowledge and “Take Five” with his father.

He held my gaze continuously; and in my peripheral vision, I then noticed he had continued to practice “Take Five” by tracing his hand!

I then suggested that difficulty with thoughts is a problem most people suffer from; and that he is not alone with his challenging experiences.  I told him by developing his ability to choose the object of his moment to moment attention, he shall open many exciting possibilities.

I also pointed out to him that even the olympic silver medalist may cry for being only the second best; that the “worst” player exhibits great courage for simply being part of the game; and that everyone has the right to be happy.

He then reached out and shook my hand firmly for helping him.

His mom, sensing the interview is coming to an end,  voices her concerns of the repetitive nature of his past cutting behavior.  I explained to his mom that events in the past can not be changed. While they are informative; holding onto these thoughts may be depressingly harmful; and it’s best to let go of these thoughts by redirecting attention to the present.  She then asked what she should do if the his cutting behavior recurs. I explained to her that fear is a thought of a future possibility that may or may not happen; and preoccupation with them are not helpful and may lead to unnecessary anxiety.  I also pointed out that her son is no longer the same person as he now possesses new perspectives and an alternative method for dealing with difficult thoughts. I suggested that she might want to support her son by practicing the “Take Five” technique as well. I also shared a free 8 week online mindfulness training course with them.

As I was leaving, he shook my hand with both of his hands and thanked me again.