By Dr. Jan Hittelman
“My 13-year-old daughter is a cutter. She also smokes. I have done everything I can to stop her, but she did it again last night and I took her to the emergency room. On the way home, I asked her what I could do to help her stop cutting. She said if I would let her smoke cigarettes at home, that would help, because smoking soothes her and helps alleviate her need to cut.”
“What should I do?”
Cutting and cigarette smoking share a common thread; both are unhealthy ways to deal with negative emotions. While all of us struggle with feelings like sadness, anger, and anxiety, we each deal with our feelings very differently. Some adolescents have tremendous difficulty experiencing and working through their negative emotions and are limited to self-harm behaviors as a maladaptive coping mechanism. It is difficult for most of us to understand, but for some individuals cutting can seemingly provide their only source of relief and often develops into an addictive behavior that is very difficult to stop.
Common misconceptions regarding cutting are that it is a suicidal gesture and/or attention-seeking behavior. Those that cut use it as “a way to survive” and are usually not looking to kill themselves. Given how effectively they hide their scars by wearing long sleeves and purposely cutting in areas that are generally under clothing, this is clearly not an attention-seeking behavior. Rather, cutting is a desperate behavior that demands our attention.
Self-harm behaviors are a serious indicator that the individual needs professional help. It is important that the mental health professional have expertise in not only treating adolescents but also self-harm behaviors. Common co-occurring issues that also need to be treated or ruled-out include: history of sexual abuse, family dysfunction, risky sexual behavior and substance abuse.
Finding the right therapist for your daughter, who can help her learn how to deal with negative emotions in a more effective way and thereby reduce (and eventually extinguish) her self-harm behaviors (including cigarette smoking), would be the critical next step.