Jan sat on my couch and looked at me with distrust. "Don't think you can help me, because you can't. I'm not talking to a shrink, so leave me alone." "OK, but there is one condition," I replied. "You have to stop cutting on your body. Once that stops, I'll leave you alone." "You wouldn't understand," Jan fired back. "Try me," I replied. "You aren't the first young woman I've seen with arms and legs that look like you've been through barbed wire. I know those cuts have something to do with feeling out of control and releasing feelings of anxiety and depression. Am I right so far?" "Maybe." For the first time, Jan made eye contact. "My parents are putting a lot of pressure on me. We never spend time together. I guess they are too stressed out with their lives. And I'm having trouble keeping up with all that's required of me. "At home, my parents fight about money, bosses and our family. My mom looks depressed and my dad is angry most of the time. "One night when things were really bad, I took a small kitchen knife and began to cut on my upper thigh. It was kind of awesome. I could focus on the blood running down my leg and not think about what was happening in my house. I stopped cutting when it hurt too much and I couldn't control the pain. But for a moment, I stopped feeling bad." Jan is one of many teen girls who self-harms as a way of coping with the emotional distress in her life. As bizarre as it might sound, Jan cuts herself to relieve the stress and emotional pain she feels. Stress from school, peers and her family combined with a media-driven culture have thrown Jan into such turmoil that harming her body is one way she finds momentary relief from it all. The momentary "high" Jan feels when she cuts her thigh comes from a release of endorphins that are secreted into her bloodstream. This provides a quick numbing or pleasurable sensation and temporarily distracts her from the stress she feels. Girls like Jan who self-harm often do so because they feel emotionally distant from or invalidated by their parents. Some are rewarded for this behavior by a peer group that also engages in self-harm as a coping mechanism. Others describe feeling "dead" inside or invisible to parents, and feel alive or confirmed in their existence when they cut. For many, cutting is a way to manage overly demanding parents. Cutting usually takes place on the arms, thighs, legs or abdomen. The evidence of it is often hidden under clothing, but a sibling might notice the marks, or a parent might find a razor or other sharp object in the adolescent's room. If a teen has a habit of becoming highly distressed and locking herself in her bedroom, she may be inflicting harm on herself. This is often the case with the girls I have treated for eating disorders. They would rather harm themselves than deal with a conflict or challenge from a parent. Obviously, self-harm requires intervention by a mental-health professional. The best treatment is family therapy with a skilled and trained family therapist. Therapy usually focuses on improving family communication, lessening expectations and demands, teaching conflict resolution and problem-solving, and developing closer and more meaningful relationships with parents and siblings. In addition to participating in family therapy, girls who self-harm have to learn to (1) identify the triggers that lead to cutting; (2) control their thoughts; and (3) solve problems. They need to be taught that harming themselves is not an appropriate way to feel alive or cope with emotional pain. Finally, they need to discover that developing intimacy with God is the best way to feel validated and alive. Understanding that God unconditionally accepts them regardless of their failures, promises peace in the middle of their emotional storms, and is always present and willing to help can be life-changing. The momentary high that comes from cutting can be replaced with God's peace and transforming power when they learn to bring all their burdens to the cross of Christ. * Let's Get Real BY LINDA S. MINTLE, PH.D. Girls who self-harm often feel emotionally distant from their parents. Linda S. Mintle, Ph.D., is a Virginia-based licensed clinical social worker and author of the new Breaking Free Series (Charisma House), available at www.charismahouse.com. She invites your questions about the tough issues of life at www.drlindahelps.com.

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