Should my daughter tell?

[Sci-2]

Reaching out and showing a person you care by being there as a friend isn't akin to doing surgery sciborg. It's really not.

As Bronn Stone notes, it has nothing to do with being a friend. It has everything to do with making an accurate assessment in a timely fashion.

[Pebble thats Stubby]

I think people need to step back a bit.

If your a person who truely believes the best course of action is to do A) second best thing is to do B) and almost worse thing to do is C) then yes its true if THAT person does B or C before A then maybe they don't care as much.

However this doesn't mean they can't recognise that other people will think B is the best most caring option. Thus these people will do B first because they also care and they think this is the best thing they can do.

Now, personally I think Cutting is a big deal, and I think telling the school is the best option because they are in a better position to see more of the picture. and can keep an eye on things. I personally beleive it would be irrisponsible for the child not to be assessed by a trained professional to see if there is more of a problem and to see what help (if any) the child needs.

[MisterOJ]

Okay, I'll come back for just one more post to apologize.

I never meant that turning someone over the authorities because you didn't care enough to personally try and see if there is a problem means you don't care at all.

If that's what people took from what I was saying, I am sorry. I don't think that's what I said, but some folks obviously understood me to be saying that.

Peace, brothers and sisters.

[Sci-2]

You keep associating going to the professionals immediately with lack of caring.

If this is your position, we should just agree to disagree, but it sort of implies you think everyone who has repeatedly said otherwise is lying about their motivations.

You can go immediately to the professionals AND be someone's friend after all.

[Balefont]

If my daughter noticed the cutting marks on her own and came to me and asked if she should tell someone, I'd probably tell her to stay out of it.

It the acquaintance outright tells my daughter she is cutting herself, we'd tell.

For an acquaintance of my daughters, I'd go to the school authorities because I care and I know neither my daughter nor I professionally trained to deal with what is a potentially serious issue and the trained professionals are. As Guy says, the trained professionals will assess the situation and judge if the girl is a threat to herself and if she needs continued care. If not, like Kay, she'll get through this period of her life and move on.

Neither my daughter or I will cry any tears if said acquaintance no longer wants anything to do with us because we told the professionals in an effort to help her.

If, however, the girl were a close friend, we'd start with the girl and then her parents. If the parents suck, we'd make it clear this is a reportable issue and if the parents continue to suck or are part of the problem, I think we'd let the professionals know but only after following what Terra previously suggested so that the girl didn't feel betrayed.

[Kelli Fury]

That's fine you feel that way, but keep in mind, this is not a debate thread, if you want a debate thread I think the type of discourse that can be expected is different. This is an advice thread, in which people who are well meaning come to give advice in good faith. They shouldn't be personally insulted for carrying their opinion. I suggested upthread to start a new thread if people want to argue about the best way to treat the situation, but this thread is asking for opinions. It's rude not to afford people the chance to state theirs and instead shout them down. If it were say, the politics thread, that'd be a different thing. I compare the book forums to Lord of the Flies because it is where new people (analogous to children in this illustration) go, in absence of longstanding board members, and fight- once in awhile, eating each other. Mostly, I was poking fun. It is a longstanding general chatter tradition to make fun of the other forums.

[Guy Kilmore]

I don't remember if it was in the report you linked or another article I read about a cutting study, but researchers found that many (or maybe most) young people who cut themselves as adolescents, simply grow out of that behavior once they reach college age or so. That sort of backs up my own personal experience with my friends who used to do it. Once they reached adulthood, the behavior stopped. They didn't require any sort of therapy or treatment. They just stopped.

And now, they're adults with children of their own. By all appearances, fairly successful well-adjusted adults. (At least as far as their facebook postings go.)

Not what I am saying at all. What I am saying is that there are many people doing it - many or most of whom don't need to be turned in to the authorities. Depending on what report you read, as many as 1-in-3 kids exhibit this kind of behavior. (That number seems high to me, but I still think it's a pretty significant percentage of teens.)

I simply don't think all those kids need some kind of professional help for this. I bet the vast majority of them grow out of that bad behavior without any sort of intervention whatsoever.

Some, though, will need help. They will do it too much and too often and it might be a sign for some really serious problem. I think those kids need help. Without a doubt.

All I am saying... and let me stress this - is that if the only information you have about a child is that she cuts herself (and you have no idea how much or how often this happens, or even if it was a one-time thing) - that does not automatically mean the girl needs the authorities sicced on her.

If you really care about the person, I think the responsible thing is to find out more information about her and see if she genuinely needs help. Running off half-cocked to the authorities about her based on very little information seems like an irresponsible thing to me, because that will immediately elevate things to a level that may not be needed.

The article does mention that people grow out of cutting, but it also mentions other complications that can arise. From the first link.

Why do People Self-Injure?

Reasons given for self-injuring are diverse. Many individuals who practice it report overwhelming sadness, anxiety, or emotional numbness as common emotional triggers. Self-injury, they report, provides a way to manage intolerable feelings or a way to experience some sense of feeling. It is also used as means of coping with anxiety or other negative feelings and to relieve stress or pressure. Those who self-injure also report doing so to feel in control of their bodies and minds, to express feelings, to distract themselves from other problems, to communicate needs, to create visible and noticeable wounds, to purify themselves, to reenact a trauma in an attempt to resolve it or to protect others from their emotional pain (Klonsky, 2007; DiLazzero, 2003). Some report doing it simply because it feels good or provides an energy rush (although few report doing only for these reasons). Regardless of the specific reason provided, self-injury may best be understood as a maladaptive coping mechanism, but one that works – at least for a while.

Is self-injury a suicidal act?

There are important distinctions between those attempting suicide and those who practice self-injurious behaviors in order to cope with overwhelming negative feelings. Most studies find that self-injury is often undertaken as a means of avoiding suicide. Perhaps one of the most paradoxical features of self-injury is that most of those who practice self-injury report doing so as a means of relieving pain or of feeling something in the presence of nothing. Nevertheless, the particular relationship between self-injury undertaken without suicidal intent and self-injury undertaken with suicidal intent are not clear since individuals who report the former are also more likely to report having considered or attempted suicide (Whitlock, Eckenrode, & Silverman, 2007; Muenhelkamp & Guitierrez, 2004; Nock, Joiner, Gordon, Lloyd-Richardson, & Prinstein, 2006; Hawton, Fagg, Simkin, Bale, & Bond, 2000). Moreover, although it is common to assume that non-suicidal self-injury may be linked solely to suicidal ideation, a recent studies show that individuals with a history of non-suicidal self-injury were over nine times more likely to report suicide attempts, and seven times more likely to report a suicide gesture and nearly six times more likely to report a suicide plan than individuals without a history of non-suicidal self-injury (Whitlock & Knox, 2007). Nevertheless, since the majority of individuals (approximately 60%) with self-injury history report not considering suicide, non-suicidal self-injury may be best understood as a symptom of distress that, if unsuccessfully mitigated, may lead to suicide behavior.

What factors contribute to self-injury?

In clinical populations, self-injury is strongly linked to childhood abuse, especially childhood sexual abuse (Brodsky, Cloitre, & Dulit, 1995; Kolk, Perry, & Herman, 1991). In addition, there is evidence that earlier, more severe abuse and abuse by a family member may lead to greater dissociation and thus greater self-injury (Brodsky et al., 1995). Self-injury is also linked to eating disorders, substance abuse, post-traumatic stress disorder, borderline personality disorder, depression, and anxiety disorders (see Yates, 2004, for review). The lack of empirical research in non-clinical populations reinforces the assumption that most or all of SIB is a product of pre-existing disorders, although more recent research in general populations of adolescent and young adults challenges this assumption (Kokaliari, 2004; Whitlock et. al., 2006).

Is self-Injury addictive?

Most self-injury researchers agree that self-injury does show some addictive qualities and may serve as a form of self-medication for some individuals. In our recent research with college students, a significant number of individuals who practice self-injury report having a difficult time controlling their urge to self-injure and interviews conducted for several of the studies associated with this project shows that many self-injurers describe both the immediate effect and overall practice as something with addictive properties. For example, many interviewees talk about moments of feeling the strong need to injure even when there is no obvious trigger and about having "self-injury free" hours or days. They also liken it to other drugs and talk about needing increasingly more or deeper injuries to feel the same effect. Recognition of the addictive properties of self-injury for some individuals is the basis for the "addiction hypothesis" noted by Grossman and Siever (2001) and summarized by Walsh (2005). The addiction theory suggest that self-injurious acts may solicit involvement of the endogenous opioid system (EOS) which regulates both pain perception and levels of endogenous endorphins which occur as a result of injury (Winchel & Stanley, 1991). The activation of this system can lead to an increased sense of comfort or integration, at least for a short period of time. Repeated activation of the EOS can cause a tolerance effect: Over time those who self-injure may feel less pain while injuring. Overestimation of the EOS can then lead to actual withdrawal symptoms which in turn lead to more self-injurious behavior.

What are the dangers of Self-Injury?

About a quarter of all adolescents and young adults with a history of self-injury report practicing self-injury only once in their lives. Many of these only flirt with the behavior and do not show heightened distress in other ways. However, at least one study has shown that for some youth, even a single episode of self-injury can correlate with a history of abuse and conditions such as suicidality and psychiatric distress (Whitlock et al., 2006). This suggests that there may be a group of adolescents in which a single incident of self-injury is an indicator for other risky behaviors and even a single self-injurious act should be given attention. Studies also show that relatively few individuals who self-injure seek medical assistance when they severely injure themselves. Because of the potential link between self-injury and suicide, self-injury should always be taken seriously, particular if a person is injuring regularly or using methods that can cause a lot of damage to the body (like cutting).

All the above reasons listed in the article is why the "authorities" need to be involved, love or hate it, in our society adults are responsible for the safety of children. Now I think the word "authority" is a loaded word for people. By authority, in this case, I am thinking the girl's parents, the girl's teacher, a counselor at school, contacting child protective services for suggestions, and/or utilizing some of the resources provided in that first link I threw up. This is something that needs to be assessed. I will also say that I think friends are incredibly important and everyone will need friends as part of their security blanket. Making friends with someone in a time of crisis is not something that is very successful, the foundation of that friendship becomes based upon the need of the person who is in crisis and can lead to co-dependency, it needs to have the oversight of someone who can guide the growth of the friendship in a positive way. Very few things are worse than when a person feels alone and lacks connections to others to have a new relationship flame out, it reinforces all those little issues going on and a sense of failure.

You can be supportive of the other person, but also get them in touch with people who can also be supportive and can create a relationship based upon this existing inherent imbalance. I will give two examples of interventions that existed with clients that I have. (I am a mental health case manager, basically a social worker.) The two clients I am thinking of is Mickey and Minnie (They have never been the same since Walt died.) Mickey is self-isolating. He is a 16 year-old Caucasian male. He can't leave the house, he is missing school, he barely eats and drinks. He is refusing to get out of bed, and will wet it at times. We are attempting interventions that keep him in the home. The only provider he will interact with is me, but he won't go to an appointment. We are in the process of getting an in-home therapist or CTSS worker involved to attempt to meet him where he is. Mom noticed that Mickey had long cuts on his arm and he refused to tell her how they happen. She also noticed burn marks on his wrist and found he was using a battery in some way to burn himself. (It was kind of MacGuyveresque.) I contact Children's Mental Health Crisis, Mickey was hospitalized because of his continued lack of functioning and because of his increased threat to himself. He was eventually approved for Residential Treatment, something that is hard to get approved in MN. (He graduated last month and is back at home, and at school. He is much more active, some good stuff!)

Minnie is an extrovert and very high functioning in a household that the people are very low-functioning. She is a 13 year old mixed race girl. She was bullied at her old school, but since coming to a new school she is making better friends and connections with teachers. She is getting the supports she needs, but continues to struggle with some of the fight or flight behaviors she had to develop. Currently she has an in-home CTSS worker meeting with her twice a week to work on social skills, organization and processing. (I think she could do outpatient, but I don't think that Mom is capable of getting her their with the intensity she needs.) A friend of the family notice that Minnie had cut marks and told Mom, Mom found a razor in Minnie's room and learned that she was cutting. I, Mom and the CTSS worker spoke. We discussed the issue with Minnie and the dangers that cutting represented. We let the issue "drop", but checked into medication, educated mom on warning signs, and the CTSS worker focused on coping strategies revolving around anxiety and depressive thoughts. I am currently helping Mom stay organized enough that I can get Minnie involved in after school activities to help her gain feelings of success in social circles to help her raise a sense of worth. Minnie has gone 6 months without cutting.

These are two stories of events that have occurred on my case load, I shared them to show how approaches are different once the the background is revealed. The problem is that lay people are very good at being empathetic, but they don't have the resources to do all these things. Also, we don't want clinical relationships being the primary relationship people have, a lay person taking this on is forcing that kind of relationship and is depriving the person in crisis the opportunity to have a social relationship with someone. It is best to spread these burdens of the relationship around, one rope makes for a cruddy safety net. (I hate the term "lay" person in this case, so I apologize, in crunch time it was hard to come up with a better word.)

My goal in this thread was to provide information. (I really don't like to speak about work on the internet, because quite frankly it is where I come to decompress, but this is a serious concern and I wanted to make sure appropriate information was brought to bear.) One thing that everyone must remember is that people's paths through development and attaining happiness can be very different from what someone else experienced. While there are similarities, to the individual they are quite personal, because of that it is easy to get into heated debates and to address people in an improper way, it is one of the side effects of caring. Losing one's temper or patience is not helpful, if a situation is a crisis, or your are interacting with someone in crisis, when you lose your temper or escalate the situation are then becoming apart of the crisis and ramping it up. It is then very important to maintain respect with those that you are addressing, because by bringing calmness, reason, and empathy to the situation you bring a sense of safety which helps everyone engage in those healing steps. Luckily we are just posting on a message board, but it is still a good habit to be in as then it becomes second nature.

edited a poor turn of phrase.

[Balefont]

Amazing post, Guy. Thank you so much. As a mother of a teen girl going through a lot of her own issues (thankfully not self mutilation thus far) and enlisting the help of professionals both in and out of school, I completely agree with everything you said.

Also, kudos for your role in the example cases you've shared. I've been told with official training, I'd be good at social work but I don't have the soul to take it on as a career. Thank you thank you thank you for working so hard to make a positive difference in people's lives!

[Sci-2]

Good stuff Guy, I think you're right that controlling temper is good thing to work on.

Definitely apologize if anything I said caused stress to anyone trying to work on this or similar situations in their own lives.

[Elder Sister]

Well, I'm pretty sure that Jen stated many pages ago what she was going to do, and since I know for a fact that you people arguing on both sides are all extremely kind hearted, decent people (because I pay attention to what you say, thank you very much. :)), maybe we can just chill and read the awkward moments thread???

Poor Kay has had more than her fair share and deserves a break just for having to deal with some strange characters, and I shared a fascinating story about emu eggs.

Come on, walk with me...you know you want to go...come on....

[Gillio]

The last 5 posts are amazing, thank you all, as usual I'm out of likes.

(No surprise there - just look at these great posts, whats not to like?)

[Angalin]

Wrapping this up now. For the record, advice threads are for advice on that particular situation; if you want to wrangle about the principles involved, start a new thread to do so. And keep it civil.