Be an Informed Friend

Anna was wearing long sleeves under her soccer jersey again. She told Monica she was worried about getting too much sun. But when Anna raised her arm, Monica noticed fresh cuts on her forearm. When she saw Monica looking at them, Anna said something about losing a fight with her mother's rose bushes.

You're aware that some people — both guys and girls — cut themselves on purpose. Could your friend be one of them? If so, what should you do?

It can be hard to understand why a friend might injure himself or herself on purpose. Cutting — using a sharp object to cut your own skin on purpose until it bleeds — is a form of self-injury. People sometimes self-injure by burning their skin with the lit end of a cigarette, a lighter, or a match. Their skin won't show cut marks, but it might show the small, round scars of a burn.

Some people turn to this behavior when they have problems or painful feelings and haven't found another way to cope or get relief.

Most of the time, people who cut themselves don't talk about it or let others know they’re doing it. But sometimes they confide in a friend. Sometimes a friend might find out in another way.

Your Feelings

It can be upsetting to learn that a friend has been cutting. You might feel confused or scared. You may feel sad or sorry that your friend is hurting herself in this way. You might even be mad — or feel like your friend has been hiding something from you. You might wonder what to say, whether to say anything at all, or if there is anything you can do to help a friend who cuts.

It can help you to know more about cutting, why some people do it, and how they can stop. Sharing this information with your friend can be a caring act, and it might help her or him take the first step toward healing.

Understanding why a friend may be cutting can help you be supportive. But what can you actually do to help your friend stop?

The first thing is to be realistic about what you can achieve: As with any damaging behavior (such as alcoholism, drugs, or eating disorders), some people just may not be ready to acknowledge the problem and stop. So don't put too much pressure on yourself — your friend's problem could be a longstanding one that requires help from a professional therapist or counselor. Therapists who specialize in treating adolescents often are experienced in working with people who self-injure and can also help with other issues or emotional pain they might have.

Ways to Help

Here are some things that you can try to help a friend who cuts:

• Talk about it. You've asked about the cuts and scratches — and maybe your friend changed the subject. Try again. Let your friend know that you won't judge and that you want to help if you can. If your friend still won't talk about it, just let him or her know the offer stands and you are open to talking anytime. Sometimes it helps to let a friend know that you care. Still, even though you do your best, your friend might not want to talk.
• Tell someone. If your friend asks you to keep the cutting a secret, say that you aren't sure you can because you care. Tell your friend that he or she deserves to feel better. Then tell an adult in a position to help, like your parents, a school psychologist or counselor, or a teacher or coach your friend is close to. Getting treatment may help your friend overcome the problem. Your friend may be mad at you at first. But studies show that 90% of those who self-injure are able to stop within a year of beginning treatment.
• Help your friend find resources. Try to help your friend find someone to talk to and a place to get treatment. There are also some good books and online support groups for teens who self-injure. Be careful, though: Although some websites offer useful suggestions about how to resist the urge to cut, the stories or pictures some people send in may actually trigger the urge to cut in those who read or see them. And some sites promote a sense of sisterhood or solidarity that might interfere with someone getting help. There's nothing cool about cutting — beware of people or websites that suggest there is!
• Help your friend find alternatives to cutting. Some people find that the urge to self-injure passes if they squeeze an ice cube in their hand really hard, draw with a red marker on the body part they feel like cutting, take a walk with a friend (you!), rip up old newspapers, stroke their cat or dog, play loud music and dance, or find another distraction or outlet for their feelings. These strategies don't take the place of getting professional counseling, but they can help in the short run.
• Acknowledge your friend's pain. Let friends who cut know that you get what they're going through by saying things like, "Your feelings must just overwhelm you sometimes. You've been through a lot — no wonder you hurt. I want to help you find a way to cope that won't hurt you anymore." Try to avoid statements that send the message you don't take your friend's pain seriously (such as "But you've got such a great life" or "Things aren't that bad," which can feel dismissive to a person who cuts).
• Be a good role model. Everyone experiences painful emotions like hurt, anger, loss, disappointment, guilt, or sadness. These emotions are part of being human. Coping with strong emotions — instead of dwelling on them and continuing to feel bad — involves a few key skills, like knowing how to calm yourself down when you're upset, putting feelings into words, and working out solutions to everyday problems. Be the kind of person who can do this and your friend will learn from you.

Things to Avoid

Here are things to avoid doing or saying:

• Don't deliver an ultimatum. The best thing friends can do is to be there for each other, accepting and supporting one another without judgment. Try to avoid issuing deadlines or ultimatums to people who self-injure (for example, don't tell them you won't be a friend if they don't stop cutting). This strategy doesn't work and it just puts pressure on everyone. Let your friend know that you'll always be there to talk to.
• Don't accidentally reinforce the behavior. Among some people, cutting can have a certain mystique. If you're concerned about a friend who cuts, don't let your friend buy into the notion that the behavior is a sign of strength, rebellion, punk chic, or simply a part of his or her personal identity. Don't reward drama with too much attention.
• Don't join in. A few people may try to get others to cut as a way to be part of the group or to seem cool. They might dare you or try to convince you to cut to see how it feels. Don't let peer pressure pull you into doing something you know isn't right for you. Someone who tries to pressure you probably isn't a true friend after all.

How Important Is It to Help?

People who cut usually don't intend to injure themselves severely, and cutting isn't usually a suicide attempt. Most of the people who cut themselves say they don't mean to die and that they know when to stop.

But even when suicide is not the goal, cutting can still cause severe injury or death. People who self-injure risk infections, scarring, and shock (from blood loss), and they can die as a result of extreme injury or bad cuts that don't get treated promptly.

Without help, people who cut also may continue to feel socially isolated and depressed. People who self-injure may have other problems (such as eating disorders, obsessive-compulsive disorder, bipolar disorder, borderline personality disorder, or severe depression) that require long-term professional care.

By helping a friend address cutting problems, you may open the door for him or her to resolve other issues, too. The first step to getting help is usually the hardest.

What If a Friend Rejects Help?

It's often difficult to help a friend who cuts. You may not see changes overnight, if at all. Some people aren't ready to face what they're going through — and you can't blame yourself for that.

Some people might not be ready to ask for or receive help with their troubles. You can encourage a friend to get help, but he or she might not open to the idea, at least not right away. You might need to be patient. Your friend could need time to think about what you've said.

People react in different ways when someone tries to help. But don't be afraid to try. Sometimes, honest concern is just what a person needs. By reaching out, you might just help a friend take the first step toward healing.

Sometimes when you try to help, your friend might be angry or say you don't understand. Or the friend might really appreciate that you care but still not be ready to accept help.

It's natural to feel helpless, worried, sad, or upset — especially if you feel you're the only one who knows what your friend is going through. Sometimes it helps to confide in an adult you trust about the situation.

It can be really hard when a friend just won't let you help. But don't take on the burden as your own or feel responsible for someone else's behavior. Sometimes even the truest friend may need to take a break from an intense situation. Be sure to care for yourself and don't allow yourself to be drained or pulled down by your friend's situation.

Reviewed by: D'Arcy Lyness, PhD
Date reviewed: June 2012