The Pain of Pain

Dear Mr. Dad: My son is a freshman in high school, and until the beginning of this school year, he was a happy kid, with lots of friends and plenty of extracurricular activities. But over the past few months, he’s changed. He’s lost a bunch of weight, is sullen most of the time, and has taken to wrapping himself up in an oversized, floppy hoodie that covers everything but his face. After school, he goes to his room, and barely communicates with me or my husband. He also seems to have lost all contact with his friends. We’re really worried that he’s doing something self-destructive, like cutting himself. What can we do?

A: I appreciate your email, but you really need to contact your son’s pediatrician or family doctor. Sudden weight loss, mood changes, secretive behavior—including major wardrobe changes—are huge red flags, and your doctor will be able to put you in touch with an appropriate mental health professional.

Your next call should be to your son’s school. You want to find out whether any of his teachers have noticed the same kinds of behavior changes as well as whether he’s being bullied.

Unfortunately, there’s not a lot of data on the percentage of kids who deliberately hurt themselves, largely because they tend not to tell anyone. But studies I’ve looked at estimate that between 10 and 25 percent of adolescents and teens engage in some kind of self-injury at least once. Girls are thought to be a little more likely than boys to self-injure, but that might be because some of what boys typically do (such as punching walls, getting drunk, and engaging in risky behavior) isn’t always seen as self-injury. But both boys and girls cut, bite, or burn themselves—and baggy clothes are a good way to hide the evidence.

How much do you know about your son’s social life? Did he recently break up with a girlfriend or have a major feud with friends? According to various surveys, many teens self-injure to get reactions from someone, to feel more in control, to express depression or anxiety, and to stop bad feelings.

Maybe the most horrifying part of this is that many kids who injure themselves learn how from websites that actually encourage self-harm and even suicide. What a revolting thought. The good news—if there is such a thing—is that, according to Dr. Mathilde Ross, a psychiatrist at Boston University, most self-injurers aren’t suicidal and generally outgrow the behavior in their 20s.

Whether your son is harming himself or not, though, he needs help right now. And again, even though you and your husband are clearly concerned, neither of you is the right person for the job.

While you’re waiting for an appointment with the pediatrician, spend some time reading some of the resources at At the same time, pay very close attention to the way you’re responding to your son. It’s not going to be easy, but try to stay calm. Showing concern is fine, but expressing shock or horror, making threats, or getting angry will only drive him further away than he already is. He needs to know that you love him and that he can trust you. Engaging him in even the smallest conversation is a good sign that you’re on the right track.
An important part of a teen’s development is pushing boundaries and making mistakes. If your son knows he has a safety net, he just might use it.

Helping teens overcome self-injury

Dear Mr. Dad: I’m really worried about my daughter. She’s a sophomore in high school and until the beginning of this year she was a happy, cheerful girl. Recently, though, she’s been losing a lot of weight and is always wearing big long sleeve shirts. She won’t show her mother or me her arms or her body. She’s also very secretive and spends a lot of time alone in her room. My wife and I are terrified that our daughter is cutting herself, and we’re both really scared for her safety. What can we do?

A: Okay, the very first thing you need to do is get a health professional involved. Unexplained weight loss, sudden changes in behavior, unexplained major mood changes and weight loss are all major red flags. Keep a detailed record of what you see your daughter eating over the course of a week, as well as any behavior that concerns you. Then, take your notes to your family doctor and get his or her advice.

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