Dear Dr. Wes and Jenny: I have a young friend who cuts herself when she is upset. I would like to help her, but I do not understand why she does it. What is behind this sort of behavior? Is there anything that a friend can do to help convince her to stop doing it?

Jenny: A friend of mine is a cutter. I have watched her for more than a year now destroy herself and her body, so I understand your struggle. It is hard to sit back and watch a friend you care so much about do so little to help herself. To explain this topic, I talked to people who I know have cut — and I talked to my friend — and I found that it is the pain.

The pain in their lives hurts, but for a brief second when they are cutting themselves, all they can feel is the pain of the cut. All other pain goes away. The stresses, the anger, the past memories are all gone with a drop of blood. It seems like it can be a rush of some sort. It is self-mutilation for the purpose of forgetting. It is pain that helps you keep all other pain in check. It is a constant reminder of how your life is easily gone. It isn’t for show-and-tell. It isn’t for sympathy. It is for that one moment where nothing else matters accept the blade meeting your skin. It is a release, but the wrong release.

Cutting is addictive. Every person that I have talked to about this says you get a rush. Although your friend may not realize the danger in cutting, she needs to see that there are people out there willing and ready to help her. And there are better alternatives to dealing with the emotional pain, rather than adding to it with physical pain. I have battled with my friend to try to understand why she does it. She can’t even go swimming anymore because her legs are scarred, and that hurts.

Encourage her to get help from someone who can listen, maybe in counseling. No matter how much she says nothing is wrong, she needs support. She also needs to know how much seeing her this way confuses and upsets you. I am proud of you for taking the first step in helping your friend. If you want to understand more on this topic, I would recommend the book “Cut” by Patricia McCormick.

Wes: From the research and our experience, self-mutilation is usually done as a response to emotional pain or distress, through either cutting (72 percent of those who self-harm) or burning (35 percent). It is surprisingly common, with about 1 in 200 teenage girls estimated to practice it. Fewer boys are cutters, but in recent years we have seen a rise there, too. As usual, I suspect those statistics are low.

In the 1990s we thought cutters were usually victims of sex abuse, but it has now grown beyond that population. Many think self-mutilation is related to suicidality, but most cutters would not seriously consider suicide. In my experience — and newer research is bearing this out — cutting is akin to anorexia with many of the same dynamics in the home and community.

As we’ve discussed here before, teens seem to be coping (or not coping) with greater levels of stress in school, families and personal relationships, feeling overscheduled and hurried through adolescence by both parents and peers. Cutters often see themselves as emotionally disconnected from families who they perceive as having excessive expectations. Many of these families do not even realize they convey such demands, many of which are simply built into the family and seem very reasonable. Cutters tend to feel they cannot please their parents or live up to their siblings’ achievements and may cut to cope. Cutters also feel disconnected from peers, and may in fact seek out other disaffected kids to compensate. This is how cutting becomes a peer activity.

As for the addictive potential Jenny cited, cutting quickly releases endorphins into the bloodstream, leading to a numbing or pleasurable sensation. This helps soothe unpleasant thoughts and feelings or provides a mild high, relieving emotional distress and other stressors in the cutter’s life. Simply put, cutters becomes addicted to their own brain chemistry, and the fact that more and more scars are developing on key areas of the body is not sufficient reason to stop.

As for helping your friend, it would be wise to speak to the parents and encourage them to take this seriously — without becoming overly upset. The first rule of parenting in this and every matter is “try to remain calm.” It is generally believed that, as with anorexia, the best treatment for this problem is family therapy. It is a significant error to send a cutter solely to individual treatment, though some private sessions are often helpful as an add-on.

Since the problem tends to be chronic, hospitalization is not very helpful over the long haul. Finally, without getting too deep into the therapy, I can tell you that it involves helping kids become much more overt in their expressions of anger and teaching families to better resolve conflicts and manage anxiety and expectations. Just what parents wanted to hear — teach your kid to be more angry! But I can assure you that it is better than the silent anger of self-mutilation.