Adoelescents Who Cut:  Introspection and Intervention

Presentation by:  David A. Opalewski

ATTITUDE

• Our attitude needs to be “Not what is wrong with them, but what happened and/or what is presently happening to the child.”

•  Many times a prior trauma has occurred.

• “Nearly 50% report physical or sexual abuse during his or her childhood.” (S.A.F.E. Alternatives, form 022.1/2)

• In some samples, as many as 90% report that they were discouraged from expressing emotions, particularly anger and sadness. 

BEHAVIOR PATTERNS

• A significant number of cutters also struggle with an eating disorder. (S.A.F.E. Alternatives)

• Many are fearful of intimate relationships.

• Many are fearful of adult responsibilities.

PREVALENCE

• Most prevalent form of non-suicidal self injurious behavior

• Defined as purposely damaging body tissue without the intent to die

• Increasing in middle and high school students

• Prevalence studies report rates as high as 47% in community adolescent samples.

• Empirical evidence also supports that prevalence has increased in recent years.

THE DIFFERENCE FROM SUICIDE

• The person who engages in self-harm does not intend to die as a result of his/her acts

• They do this so they may continue to live by getting relief from intense emotions.

• Some do this to create feelings when they feel numb inside.

• A person who truly attempts suicide seeks to end all feelings whereas a person who self-mutilates seeks to feel better.

HOWEVER

• It is possible for both behaviors (suicidal and self mutilation) to co-exist in one person.

• It is also important to note that self harm could result in accidental death by cutting into an artery and being unable to stop the bleeding.Many times more harm occurs than intended

WARNING SIGNS

• Unexplained frequent injuries

• Wearing long pants and sleeves in warm weather

• Low self esteem

• Overwhelmed by feelings

• Inability to function at work, school, or home

• Inability to maintain stable relationships

CAUSATION

• Society

• Media

• Internet chat rooms dedicated to self injury

• Trends in music

• News highlighting violent & self injurious behaviors

Peer Group Influences

• Fitting in

• Cutting is a requirement to become a member of certain groups

• Popularity of body piercings/tattoos

Familial

• Viewing parents as unavailable or disinterested

• Parental substance abuse and psychological problems

• Difficulty tolerating the expression of strong or negative emotions

• Comment on Peer groups “Although it is normative to experiment with peer groups(dress, music, etc.) it is NOT normative when the values of a peer group to involve self injurious behaviors.” Dyl, Jennifer, PHD 2011

ALSO

• A sizeable proportion of adolescents cut themselves secretly, in absence of peer influences.

CLASSIFICATION OF FACTORS

Internal

• Cut to regulate emotions

• To punish themselves for improper behavior

• To solve interpersonal problems

• Internal negative reinforcement – to stop bad feelings

• To feel something – even pain

• To feel relaxed

• To avoid doing something unpleasant

• To feel “in control”

Social

• To fit in

• To let others know how desperate you are

• An alternative form of expression for those who have difficulty expressing feelings

PSYCHOLOGICAL ISSUES

Cutters frequently report:

• feeling temporary relief from unpleasant emotional experiences

• Release of feelings

• Reduction of tension

• To feel in touch with one’s body

• To feel anything, including pain

Other cutters report:

• A sense of loss of control

• Shame

• Alienation

• Helplessness

• Low self-worth

• A desire to punish oneself

“Cortisol: Why “The Stress Hormone” is Public Enemy #1. (Bergland, Christopher, Jan. 2013)

CORTISOL

Stress hormone

• Recently high elevations discovered in tears of people grieving the loss of a loved one or other traumatic event

• Elevated levels of cortisol increase the risk for depression and other forms of mental illness.

• If cortisol levels build up in the blood, it wreaks havoc on your mind and body.

LOWERING CORTISOL LEVELS

• Social connectivity – Two studies published in 2013 in the Journal of Science illustrate that social aggression and isolation lead to increased levels of cortisol that can trigger a cascade of potential mental health problems – especially in adolescence.

• “These findings may have wide-reaching implications in both the prevention and treatment of severe depression and other mental illnesses.” Journal of science, Jan. 2013

• Regular physical activity – kick boxing, sparring, or a punching bag lets out aggression (without harming anyone) and reduces cortisol

• Any aerobic activity – jogging, biking, etc.

• Meditation – simply taking a few breaths engages the vagus nerve which triggers a signal within the nervous system to slow the heart rate, lower blood pressure thus decreasing cortisol level. (Bergland, Christopher, Published January 22nd, 2013)

DANGER

• Overtime, cutting becomes psychologically and behaviorally addictive

• Reasoning is with greater exposure to this behavior over time, the fear of injury declines and internal reward increases.

• Many cutters report the need to cut deeper overtime

WARNING

“Although cutting is not initially a suicidal behavior, overtime it can manifest to suicidal behavior.”

INTERVENTION

• Cutting will increase rather than decrease overtime in the absence of treatment

• The issue must be taken seriously and addressed as soon as possible. 

• Address the problem without reinforcing the behavior.

• Focus on the underlying feelings and what the act does for the cutter, not the physical effects.

RELIEF

• One of the most common reasons is to get relief from intense emotions because they are not able to regulate or control their feeling response.

• Cutters tend to fail to identify, express, or release their emotions.

FEELINGS

• For some, cutting is used as a form of communication.

• They use this behavior to communicate to those around them what they are experiencing inside.

• They are actually saying “See my pain.”

INTERVENTION

• The goal should be to help the person find healthier ways to meet interpersonal needs.

• Need to communicate

• Need for attention

• Develop resiliency skills

TREATMENT

Dialectical Behavioral Therapy (DBT)

DBT skills taught include:

• Mindfulness

• Emotional regulation

• Distress tolerance – resiliency skills

• Interpersonal skills such as normalizing emotions, and empathizing feelings are not the problem, but how you deal with those feelings.

• Physical exercise

• Journaling or art work

TREATMENT

Cognitive Behavioral Therapy (CBT)

CBT combines cognitive and behavioral therapy

• Cognitive - Shows how certain thoughts cause uncomfortable feelings or distorted views of feelings.

• Behavioral – provides an awareness of triggering situations and harmful reactions to them.

• When a person becomes aware, triggers lose their power to create negative emotions.

PREVENTION

• Encourage positive peer group conformity

• Teach both parents and adolescents to identify triggers such as emotional reactions and perception distortions which may lead to negative behaviors including cutting.

• Help each child to develop their endowed gifts.

• Attend social, athletic, school functions

• Contact professional help when if you suspect these behaviors(school personnel – parents)

HELPING FRIENDS OF CUTTERS

• Ask about it. If your friend is hurting herself, she may be relieved you brought it up so she can talk about it. If she isn’t cutting, she isn’t going to start because you brought it up.

• Help your friend see ways to get help. Don’t tell him what he has to do!

• Consider telling a teacher or other trusted adult.

• Remember, you are not responsible for ending the self-abuse.

SUMMING UP THE WHYS

•  To escape tension and anxiety

•  To escape feelings of depression and emptiness

•  To relieve anger and aggression

•  To gain a sense of control

•  To maintain a feeling of uniqueness

•  To obtain a feeling of euphoria

•  A response to self-hatred or guilt

•  As a symptom of more severe mental disorder

KEY POINT

Clinicians often state that it is a mistake to come down hard on a cutter as they tend to be very hard on themselves!!!!!!!!!!!!!!

September 2026 Class Dojo message

Overall Theme: Stronger Together: Connect. Support. Prevent. 

Suicide prevention is not one moment or one person's job. It lives in the relationships we build, the support we offer, and the communities we create together. This year's theme highlights the importance of: 

• Strengthening connections that protect people before a crisis occurs

• Making sure everyone knows where to turn and knows it before they need it

• Building communities where people feel safe reaching out for help

• Supporting recovery and healing long after a crisis has ended

Suicide prevention touches every part of life – from families and schools to workplaces, faith communities, and health care systems. When people feel connected, valued, and supported, they are more likely to seek help. And when communities come together around a shared commitment to prevention, lives are saved.

Week 1 (September 1–6): Cultivating Connection Nationwide: Strengthen Suicide Prevention Together

• The people in our lives can be a lifeline. Strong relationships and trusted connections help protect people when life gets hard.

• Suicide prevention starts long before a crisis. Open conversations, shared resources, and visible awareness make a real difference.

• Knowing the warning signs of suicide, in adults and in children and teens, means being able to recognize when someone needs support and connect them to help sooner.

• Communities that talk openly about mental health and suicide help reduce the stigma that keeps people from asking for help.

• Prevention is everyone’s responsibility, not just one organization’s. Families, schools, workplaces, faith communities, health systems, and individuals all have a role to play.

• Small acts of connection, such as a check-in, a shared resource, a moment of genuine attention, are how communities take care of each other.

Week 2 (September 7– 13): Support Saves Lives: Connecting People to Crisis Support and Resources 

• 988 is there for anyone who is struggling, not only for people in a full crisis. Feeling overwhelmed or in emotional pain is reason enough to reach out.

• A real person answers every call, text, and chat to 988. The support is free, confidential, and available any time of day or night.

• 988 is available in Spanish, for Veterans, for deaf and hard of hearing callers via ASL Videophone and chat, and in more than 150 languages. Help is there for everyone.

• Knowing about 988 before you need it, and sharing it with the people in your life, is one of the most important things any of us can do.

• Crisis care goes beyond 988. Mobile crisis teams, stabilization centers, and community behavioral health clinics are part of a network that helps people through their hardest moments.

• Reaching out early, to a trusted person, a provider, or 988, before things reach a breaking point leads to better outcomes and more paths forward. 

Week 3 (September 14–20): Building Communities of Care Through Connection

• Treatment works. People who receive timely, compassionate care for suicidal thoughts or behaviors can and do heal.

• A safety plan gives people something to hold onto in their hardest moments: warning signs to watch for, coping strategies, people to call, and 988.

• Suicide prevention should be part of everyday health care, not only a crisis response. Screening, planning, and follow-ups belong in routine care.

• The days after someone leaves a hospital or emergency room are among the most difficult. Follow-up care and a call within 72 hours can change everything. Suicide prevention is possible.

• Getting care early, before a crisis escalates, is one of the most powerful things health care can do for someone who is struggling. 

• Connection, planning, and follow-up care make a real difference. When these pieces work together, they save lives. 

Week 4 (September 21 – 30) Healing Together: Supporting Recovery, Families, and Communities

• People come through crisis. They survive loss. They find their way back. Healing is possible.

• Those who have lived through suicidal crisis or a suicide loss carry something that matters — insight, resilience, and stories that make prevention more human and more hopeful.

• Being there for someone after a loss or an attempt isn't just an act of kindness. It is a form of prevention.

• Real change starts with real voices. Peer support, and connection with others who have been through something similar, is part of how recovery happens.

• Schools, workplaces, and communities with a plan in place after a suicide loss can respond with care, support healing, and help prevent further harm.

• Dignity starts with being heard. When people feel respected and valued, they are more likely to seek help and stay connected to care.

• September is one month. The commitment to connection, support, and healing is for all year long.  

Community Resources:

Visit NAMI for toolkits and community action guides: https://www.nami.org/stay-connected/events/awareness-events/suicide-prevention-month/

Nevada Office of Suicide Prevention:

https://suicideprevention.nv.gov/

988 Lifeline (National Suicide Prevention Lifeline): https://988lifeline.org/ 

Your Life Your Voice: https://www.yourlifeyourvoice.org/Pages/home.aspx

Crisis Support Services of Nevada:

https://cssnv.org/

Child Mind Institute: https://www2.childmind.org/webmail/908232/244177977/bf07ff6d164fabe389da3098b334f916598f6d271383c03215eac41f0bbae4f7

Safe Voice Nevada (reporting application):

http://safevoicenv.org/ 

Touro University Nevada - Center for Autism and Developmental Disabilities

ABA Therapists

Art Therapists in Las Vegas

UNLV The Practice  

#702-895-1532

Psychological Testing and Assessment Clinic 

#702-895-0296