I noticed Sarah’s arms as soon as I met her. It is hard not to, as 15 years of self-injury have rendered them more scar than skin. Sarah isn’t my student, but I’ve taught plenty of kids like her, and she offered to talk to me about why she has cut herself for a decade and a half, and how the adults in her life could have helped her manage the pain that prompted her to self-injure. 

By the time she first cut herself at 12, she’d already endured seven years of abuse at the hands of a parent. “Cutting was my comfort, from the very beginning. I know that sounds strange — to cause pain to feel better — but it worked. Sometimes, if I was feeling anxious in school, all I had to do was go in to the bathroom and look at my scars. Just seeing them comforted me.”

It can be difficult for people who have never sought relief through self-injury to understand Sarah’s actions, but to Dr. Michael Hollander, director of Training and Consultations on the 3East Dialectical Behavioral Therapy program at McLean Hospital in Belmont, Mass., and author of “Helping Teens Who Cut: Understanding and Ending Self-Injury,” her explanation makes sense. 

In Sarah’s mind, self-injury functions as an effective, albeit destructive and dangerous, coping mechanism. “The vast majority of kids who cut themselves do so as an emotion-regulation strategy, and, unfortunately, it works, which is why it’s so hard to get them to stop,” Dr. Hollander said. 

Kids who cut themselves are either jumping out of their skin and use self-injury to calm themselves down, or are numb and empty and use self-injury to feel something. A small percentage use it for avoidance, to create a distraction, and an even smaller percentage use it to get attention. Some, a very small group of kids, use it to punish themselves; kids who feel they don’t deserve to live, breathe or take up space may cut themselves, usually in the context of an extreme emotional situation.

Kids who self-injure tend to be particularly emotionally sensitive and vulnerable and suffer from what Dr. Hollander calls “emotional illiteracy.” They can’t name their feelings, let alone formulate a plan for managing and coping with them. Strategies that work with most kids, such as reassurance, minimizing the severity of difficulties, or offering to help them solve problems, can backfire with kids who self-injure.