Dear Dr. Wes & Kelly: I have a friend that has recently started cutting herself. She did it last year for a couple of weeks and started again about a week ago. She isn’t suicidal, so right now I’m just trying to find reasons for her to stop. Unfortunately, the reasons I found were all about infections, but I was hoping to learn what the ill effects of cutting are and how to get her to stop.

Kelly: One of the worst feelings in the world is when your friend is hurt and you feel unable to help. Your friend’s constant urge to cut herself raises an immediate alert. You say she isn’t suicidal, yet her inflicting pain to herself could lead to more self-harmful behavior.

This is a serious issue and should be treated as such. You need to tell her parents immediately. I know it’s awkward for you to be the messenger, because if you do tell an authority figure, she may feel betrayed, putting a heavy strain on your friendship. It’s hard to make that decision, but you need to do the right thing. Sometimes we have to make difficult sacrifices for the better. You know you made the right choice out of concern and care. Let her know why you told her parents and that you will support her through this.

This isn’t just a matter of her cutting herself. There are deeper psychological issues that she may or may not be hiding, which require attention before they get worse. You shouldn’t have to give her reasons to stop. She has far more issue to be concerned beyond infections. Typically when one cuts himself or herself, it is either for attention, or an emotional escape. Have you been aware of any ongoing instances for her? Do you know why she thinks she cut herself the last time? If she’s done it before and is doing it now, chances are she will continue to cut herself until whatever psychological issue she has is resolved. It sounds like she needs counseling, which her parents can only provide if they know this is going on.

You are obviously a caring friend who only wants what is best for her. Continue to keep that up. She should be thankful to have you. She is about to endure some tough obstacles, and she will need a friend like you every step of the way.

Wes: Kelly is quite correct. Cutting goes beyond the physical scars. It tends to be a very persistent behavior intended to compensate for some serious emotional difficulties. Let’s face it, cutting isn’t very logical, so simply offering your friend 10 good reasons to stop won’t work very well. Believe me — we’ve all tried. Kelly is also correct in noting that your role here has to be one of a supportive friend, because you simply aren’t trained to figure out the underlying causes. In fact, a fair number of therapists struggle conceptually with this particular problem. Since Kelly’s covered what you can do, I’ll cover some larger issues associated with cutting.

Like anything else, cutting isn’t a random act, nor is it just a fad or attempt to get attention. We see that from time to time as teen trends change, but at this point I’m not thinking about it that way. Moreover, even if your friend picked this up from someone else, you have to stop and ask yourself why this particular behavior appealed to her at this particular time in her life. Our behavior is motivated in some way by underlying psychological processes — though most aren’t as dark as this one. If we like to sing in front of an audience, it’s not just because we have a nice voice. It probably means that we feel confident in that setting or we enjoy the adulation of the crowd. If we eat when we’re sad or bored, it generally means we find comfort in food. Someone else may feel comforted when running, talking to friends or (unfortunately) getting drunk or high. Others find comfort in NOT eating or, in this case, cutting themselves. As nonsensical as a given behavior may seem, it’s never inexplicable. We just have to figure out what it represents metaphorically.

It’s been my experience that the underlying personality dynamics of cutting are very similar to anorexia. This seems to make no sense on the surface because we associate eating disorders with a false sense of body image. That’s not inaccurate, but it doesn’t fully explain why someone would seek refuge in an activity that actually damages his or her body and makes it less appealing, which is also the case for cutting.

Kids who cut often feel that they have no other way to express or resolve conflict with others — usually their families. Often their parents have very high expectations that they feel they can’t meet, and without conflict they don’t have any avenues for expressing that feeling. Interestingly, these are often not the high-pressure, high-stress families. Those families have very overt, sometimes explosive, conflicts about achievement and self-worth. Families with cutters usually have expectations that come “under the radar” involving fairly anxious teens who try hard to please and feel they rarely succeed. Cutting is an expression of that conflict that conveniently leaves out everyone else involved in the conflict. It’s external disagreement turned inward on the young person.

As with a great many problems, cutting can move quickly from an occasional vice to a destructive and even addictive habit. There’s also a lot of brain chemistry involved — but I’ll save it for another column. The best you can do is help your friend admit what she is doing and encourage her and her family to find a good therapist. This is not a do-it-yourself process. A reasonable place to start might be your school counselor or social worker. Good luck and thanks for being a friend.

— Dr. Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. Kelly Kelin is a senior at Free State High School. Opinions and advice given here are not meant as a substitute for psychological evaluation or therapy services. Send your questions about adolescent issues (limited to 200 words) to doubletake@ljworld.com. All correspondence is strictly confidential.