When Middle School Students Cut Themselves

Robert Evans, Ed.D.

In recent years a number of middle schools across America have reported outbreaks of cutting among students. The numbers of students involved are typically small, and their injuries are typically minor, but the episodes naturally cause concern among educators and parents alike.

Although cutting technically falls under the same “self-harm” heading as suicide, it is quite different from — and rarely a precursor to — suicide, especially among early adolescents. (Most adolescents who kill themselves are of high school age and do not have a history of cutting.) The challenge in responding is to assure the safety and well-being of the students who engage in cutting, but not spark “copy-cat” behavior among their peers.

Helping students who cut

Gauging the seriousness of cutting depends primarily on three factors: the severity and frequency of the actual injuries; the age of the student; and the presence of accompanying symptoms. There is much more reason to be concerned about teens who use a razor or knife and cut themselves badly and/or repeatedly than about those who scratch themselves once or twice with the tip of a paper clip. There is greater reason to worry if the cutting is serious and the student is very young (sixth grade, say), and/or if the cutter shows evidence of depression or other psychiatric symptoms.

Any students who cut themselves should be evaluated by a mental health professional. The school should require both this evaluation itself and the right to communicate directly with the clinician who conducts the evaluation. If the cutting is toward the serious end of the continuum outlined above, the student should be excluded from school until such an evaluation is completed. If the student has only scratched herself (cutters are overwhelmingly girls) but her parents resist the evaluation, she should be excluded until an evaluation is completed. In all cases, the school should reserve its right not to readmit a student if the evaluation itself or other aspects of her behavior cause the school concern about her continued safety or her impact on other students.

In my experience, the majority of middle school cutters are actually scratchers. Many are imitating the behavior of a peer. A typical pattern begins with or two students who may have significant psychological issues cutting themselves noticeably. The drama surrounding these events then stimulates a small bubble of copy-cats: students who do not have serious mental health conditions but who scratch themselves. Some of the latter envy the attention the cutters have gotten. Some turn out just to have been curious about the experience. Some have at least one parent who is intrusive and over-involved in their lives. (It’s almost as if these students are saying: “You fuss about me too much, so I’ll give you something to really worry about.”) When the school insists on a mental health evaluation some of the students who have only scratched themselves will resist, protesting that they didn’t really mean anything by it, and so on. It is still important to insist on the evaluation, both to rule out the presence of deeper issues and to make it less likely that the students will scratch themselves again.

Protecting the larger school community

The second facet of the school’s response to cutting involves a “public health” dimension. It is important not only to connect potentially at-risk students with appropriate caregivers, but also, for the sake of other students and their families, not to foster the spread of the cutting. Though it may seem paradoxical, this requires a wet blanket, not a megaphone.

Cutting, like many other psychiatric and medical symptoms, often provides “secondary gain.” It causes others to pay special attention, to express concern and sympathy, etc. It brings the “victim” a kind of special importance. Individuals do not consciously plan to hurt themselves in search of this benefit, but once they receive it, it can become a powerful unconscious motivator. This can be especially true among middle school students, who are at a developmental stage where achieving status and attention among peers is such a powerful drive.

But for the health and well-being of the broader school community it is important not to publicize and emphasize the cutting. Just as in cases of suicide, prominent, repeated expressions of grave concern, though aimed at preventing the behavior, risk making it more attractive to students who crave attention. They can stimulate copy-catting. The corollary to intervening promptly and firmly with individual students is not heightening public attention to their behavior.

This does not mean that educators should deny or avoid questions that may come from students about cutting. Students may say they’ve heard that a fellow student cut her wrist. They may ask why someone would do that. They may find it incomprehensible and disgusting. A few may seem fascinated by it. No matter what they ask or say, it’s always valuable to listen to them, to explore what they think about the situation, and so on—but in a calm, matter-of-fact, relatively brief way, not an intense, pressured, lengthy way. The goal is to rob the symptom of any appeal. It’s often good to end with a simple and accurate conclusion such as, “Sometimes it’s hard to understand what makes people do something like this, but most students don’t do it, and even the ones who do usually stop doing it and go on with their lives.”

This combination of reaching out assertively to students who have cut themselves while not fanning the flames among the majority of students is the best way for the school to take care of both.

 

Dr. Evans is a psychologist and the Executive Director of The Human Relations Service in Wellesley, Mass. A former teacher and a longtime child and family therapist, he has consulted to over 1,600 schools in the U.S. and internationally and is the author of many articles and three books, including Family Matters: How Schools Can Cope with The Crisis in Childrearing. He can be reached at www.robevans.org.