Dear Dr. Wes and Miranda: We recently learned that our ninth-grade daughter cuts herself. She’s apparently been doing this secretly for a few months. We are at a bit of a loss on how to deal with this. We asked if she wanted to commit suicide. She claims she doesn’t, and the hospital we called said this isn’t a serious enough problem for her to be admitted, so we are confused and afraid for her.

Miranda: While this hospital downplayed your daughter’s condition, you should be proud of yourselves as parents for taking this seriously. If she won’t be admitted to a hospital, schedule an appointment with her regular physician and get a referral for a therapist. You can discuss all the options with your daughter’s doctor.

Your swift action is crucial. Just because your daughter claims she doesn’t want to commit suicide doesn’t mean she isn’t considering it. I can only imagine how hard it was for her to admit this situation in the first place, let alone come clean if she’s trying to end her life. Remember that she is going through an incredibly tough, personal struggle right now. For someone to start cutting herself, there has to be some underlying issue, and she needs professional assistance as soon as possible.

I would also call around to some more hospitals. To me, it seems strange for a hospital to reject someone who has a medical condition. Another treatment facility in the area may be willing to take your daughter with open arms.

Sitting down and letting your daughter know that you are here for her is the best way you can help. Once you get her to therapy, it’s your job to assist, but also to not interfere with treatment. Letting her know that she can always just talk to you may help her open up about whatever situation has brought on this behavior. This may have nothing to do with you or your family. Preteens and teenagers are pushed to grow up too fast and are put into situations they don’t know how to deal with.

Dr. Wes: The vast majority of teens who cut would never consider suicide. While it was wise to ask your daughter about this, her response is probably true and explains why a psychiatric hospital isn’t willing to admit her. For insurance to pay for an inpatient stay, there has to be imminent risk to the life of the patient, and that’s rarely the case for cutters.

Your daughter will be better served in outpatient therapy, or, if things are really serious, a day treatment program. Hospitalization just isn’t well-suited to treating long-term issues in a three-to-five day stay, which is what you’d be looking at. So here are a few quick things to know about cutting behavior while you’re looking up treatment options.

l Miranda is right. Cutting tends to be a persistent behavior intended to compensate for emotional difficulties. It’s not very logical, so simply offering your daughter incentives, punishments or a list of good reasons to stop won’t work. For serious cutters (as opposed to those who pick it up as a sort of “fad”), the underlying personality dynamic is similar to anorexia. Secret cutters 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 normal family conflict, they lack avenues for expressing that feeling. So you do need to be prepared to study your role in this.

l Families with cutters (and anorexics) rarely create overtly high-pressure, high-stress homes. Those kinds of families have very overt, sometimes explosive conflicts with their teens about achievement and self-worth and everything else. Families with cutters (especially the secretive ones) usually have expectations that appear “under the radar,” with anxious teens who try hard to please and feel they rarely succeed. Cutting is an expression of that hidden conflict. It’s external disagreement turned inward on the young person. So the last thing you want to do is sit around fighting about cutting. That will only make it worse. Better to encourage your teenager to fight and argue with you about the real issues in her life. I’m sure that’s great news to hear this Monday morning: that I want you to get your kid to be more argumentative. But it beats the inner conflict she’s going through now.

I agree with Miranda. You’re wise to take this seriously and act quickly. Cutting can move from an occasional vice to a destructive habit as the teen gets addicted to the endorphins released.