How Can I Help a Friend Who Cuts?
Nemours Foundation

Anna's wearing long sleeves again under her soccer jersey. She tells you she's worried about getting too much sun, but when she raises her arm, you see fresh cuts on her forearm. When she sees you looking at them, she says something about losing a fight with her mother's rose bushes. You're aware that some kids cut themselves on purpose. Could Anna be one of them? If she is, what should you do?

Be an Informed Friend
About 1% of people in the United States, nearly all of them girls or women and many of them teenagers, cope with sadness, depression, stress, guilt, or anger by cutting their own skin with knives, razors, broken glass, or other sharp objects. Cutting is the most common form of self-injury (sometimes referred to as SI), but others include head banging, hitting, burning the skin, picking at scabs or wounds to prevent healing, or even breaking bones on purpose.

Most teens who self-injure come from middle- or upper-class families and are well educated and bright. Many have at least one parent who is alcoholic or depressed. Some are victims of neglect or abuse or have been through other painful life circumstances. Cutters often feel that they have little control over their lives. They may also believe that it's useless, inappropriate, or not allowable to express anger or distress directly toward a person or situation.

Some cutters may feel guilty and self-injure to punish themselves for things they've done or things done to them. Some - although definitely not all - cutters have experienced neglect or physical, emotional, or sexual abuse. In addition to anger at their abusers, they may harbor feelings of guilt or shame.

It's normal for teens to feel some anger, guilt, shame - or other difficult emotions - from time to time. Most find healthy ways to deal with their feelings, such as talking with friends or parents, playing sports, or expressing themselves through writing, music, or art. Most are able to get past difficult emotions, learn the lessons emotions can teach, and shift into a different mood. Cutters, however, live with powerful emotions like sadness, stress, guilt, and anger much of the time. They haven't developed healthy and appropriate ways to deal with their strong feelings, learn from them, or shift out of them.

Some cutters say they do it because they feel so dead inside that even a bad feeling is better than no feeling at all. Some say cutting brings a momentary sense of relief from a dreadful emotional emptiness. Some cutters are driven by powerful compulsions or urges to self-injure - and feel a brief, fleeting relief from uncontrollable tension when they indulge the urge to cut.

It can be hard for someone else to understand how self-injury can feel "good" to some people. That can make the idea of cutting difficult for friends to grasp or understand.

Because some people find cutting brings temporary emotional relief, the behavior can become addictive. And the longer a person practices self-injury, the harder the habit is to break. A powerful urge or compulsion may influence a person to continue the behavior, even though he or she may want to stop.

Cutting is typically not in itself a suicide attempt. Most cutters say they don't mean to die when they cut themselves and that they know when to stop. Cutters are, however, at increased risk of attempting suicide. That's because many cutters have deep emotional pain that can lead to suicidal feelings or behaviors.

Ways to Help
Understanding why a friend may be cutting allows you be supportive, but what can you do to actually help your friend stop? The first thing is to be realistic about what you can accomplish: As with any damaging behavior (such as alcoholism, drugs, or eating disorders), some people just may not be ready to acknowledge their problem and stop. So don't put too much pressure on yourself - your friend's problem could be a long-standing one that requires help from a professional therapist or counselor. Therapists who specialize in treating adolescents are often experienced in working with people who self-injure.

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

Talk about it. You've asked your friend about the cuts and scratches, and he or she may have changed the subject. Try again, letting 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. Sometimes it helps to let a friend know you care and that you don't believe self-injury is the only way to deal with emotional pain. Still, even though you do your best, your friend may 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 for cutters offer useful suggestions about how to resist these urges, the stories or pictures some cutters contribute may actually trigger the urge to cut in those who read or view them. And some promote a sense of sisterhood or solidarity among cutters that might interfere with a person's 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 to urge 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 it 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 any more." Try to avoid statements that send the message you don't take a cutter's pain seriously (statements like, "But you've got such a great life," or "Things aren't that bad," can feel dismissive to a person who cuts).
And here are two things you should avoid doing with cutters:

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'll stop being a friend if they don't stop cutting) - these don't work and they just put pressure on everyone. Instead, reinforce that you will 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 the cutter buy into the notion that the behavior is a sign of strength or simply a part of the cutter's personal identity.
How Important Is It to Help?
Cutting can result in severe injury or death, even when suicide is not the goal. People who self-injure risk infections, scarring, 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, cutters are also likely to continue to feel socially isolated and depressed. They 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.

Any time a person self-injures, that person's emotional state and physical injuries should receive serious attention from an adult in a position to help, such as a parent, doctor, or school counselor.

What to Do in an Emergency
If you're with a friend who has a serious injury from cutting, call 911 immediately and notify a parent, teacher, or other responsible adult. Get your friend to a hospital or emergency medical clinic. Make sure the emergency room staff knows how the injury occurred. Stay with your friend. Even cutters who say they're not suicidal are often interviewed by hospital mental health professionals when they're admitted for treatment. Urge your friend to be honest and cooperative with the emergency staff.

It's often difficult to help a friend who cuts and you may not see changes overnight, if at all. Remember, some people aren't ready to face what they're going through and you can't blame yourself for that. You may need to be patient and keep working with your friend. Be prepared for ups and downs, and know that you have what it takes to be a true friend. But don't take on the burden as your own or feel responsible for your friend's behavior. Sometimes even the truest friend may need to take a break from an intense situation. Be sure to care for yourself, and not to allow yourself to be drained or pulled down by your friend's situation.

Reviewed by: D'Arcy Lyness, PhD
Date reviewed: July 2004