An Interview with Jacob Christenson, PhD, LMFT

For years cutting has been considered a female problem. Girls were said to internalize their feelings more than boys and struggle with such intense emotions that cutting seemed like the only solution.

In recent years, experts have seen more cases of teenage boys engaging in self-harm, often in different ways and for different reasons than their female counterparts.

“Three years ago, none of our male students were cutting,” explains Jacob Christenson, PhD, LMFT, a field therapist at Aspen Achievement Academy, a renowned wilderness therapy program for troubled teens. “But in the past year, I’d estimate that half of the boys had tried cutting, sometimes to experiment and sometimes in more serious ways.”

Why Are Teenage Boys Cutting?

Like teen girls, teenage boys generally turn to cutting as a way to deal with their problems. As “emo” culture (which has been associated with self-injury) gains more exposure and acceptance in the media, more boys are trying self-harm as a way to express painful emotions.

“Self-harm is becoming more prominent in young adult culture,” explains Christenson. “When teens see cutting  as socially acceptable, they are more likely to try it. Some will find that it helps them cope with difficult feelings and fall into a pattern.”

Boys typically engage in self-harm to express feelings of rage or depression, notes Christenson, and as a result, may make many cuts in a short period of time. Unlike teen girls, who are more likely to begin cutting on their own, boys usually hear about it from a friend or in the media. While some boys turn their pain inward and hide their self-injurious behavior, others turn their pain outward and use cutting to draw attention from their parents or other people in their lives.

In his work as a field therapist, Christenson has observed two main categories of male cutters: those with no history of cutting, who hear about self-injury from a friend and want to try it to see what effect it has or to get attention, and those who find that cutting gives them genuine relief. While most boys experiment with cutting and find that it doesn’t do much for them, Christenson estimates that about 25 percent find that cutting relieves distress and develop a pattern of self-injurious behavior.

>What to Do if Your Teen Is Cutting

Cutting is a clear sign that a teen is in distress. “Regardless of how often or how much, any time a child is cutting, burning or branding themselves, it is a strong indication that parents need to get help right away,” advises Christenson.

Because cutting is historically a “girl’s issue,” parents don’t know how to react when their teenage boys are hurting themselves. As a first step, Christenson recommends that parents take their teen to a doctor for a full physical exam to determine the extent of the damage. The most serious cutters hide their behaviors (often cutting on their thighs and upper arms) so parents need an accurate assessment of the severity of the problem.

In most cases, cutting isn’t a sign that an adolescent is trying to commit suicide, but that is a natural fear many parents have. And there is always the risk that a teen might cut in the wrong place or cut too deep so intervention is usually necessary.

There is a great deal of shame and secrecy that goes along with cutting. For this reason, parents have to be cautious with how they respond to their child’s behavior.

“Cutting is naturally seen as a reprehensible act,” says Christenson. “Parents struggle to understand why their children would intentionally hurt themselves. But try not to act with disgust even though it is frightening and difficult to see. Teens who cut already feel ashamed and misunderstood – you don’t want to make them feel even more alienated.”

Teenagers engage in self-harm for a variety of reasons. For teen girls, there is often a history of abuse, assault or rape. For teen boys, there is often a disconnect or lack of attachment with their parents, notes Christenson. Most often, parents fall into one of two traps: failing to provide enough structure (and losing their authority), or failing to provide enough nurturance and affection (often because teens break rules and push boundaries until parents find themselves punishing and belittling their kids).

In either case, the best approach for parents and therapists is to show the adolescent that they are not put off by the self-injurious behaviors, says Christenson. “Teens need attachment desperately but they’re also deeply afraid of it. They need a stable figure in their lives who can prove they aren’t going to turn on the teen or be pushed away by their behaviors,” he says.

Treatment for Self-Harm

Most therapists are intimidated by adolescents who cut and prefer to avoid the issue. “Self-injury is a terrifying thing, and the adolescent knows it’s terrifying and that other people think they’re crazy,” says Christenson. “The therapist’s job is to let them know they aren’t crazy, sending the message that we can handle this and keep you safe.”

Wilderness therapy provides a safe, supervised environment for teens who are cutting to work through the issues underlying their behaviors. While the act of cutting alienates teens from others and turns them inward, wilderness therapy programs teach communication skills and coping strategies to help teens deal with their emotions in healthier ways.

“In the wilderness, if a teen wants to cut or isolate, they simply can’t get away with it,” says Christenson. “As part of a tight-knit community of adolescents and field instructors who spend 24 hours a day together, teens open up quickly about what they’re going through and find that the urge to cut subsides as they express emotion in other ways.”

The field instructors, therapists and staff at Aspen Achievement Academy are trained in working with teens who self-injure and serve as dependable role models who show teens that they can handle their emotions no matter what they are or how they are expressed. With guidance from their therapist, parents learn how to re-establish a nurturing relationship with their teen rather than arguing, controlling or punishing them. Parents work on establishing structure and enforcing consequences and receive ongoing support.

There is much that is unknown about teenage boys who engage in self-harm. As a relatively recent trend, additional research and awareness are necessary to fully understand the problem. If you suspect that your teen is cutting, know that treatment can help and that without it, the behaviors will not disappear on their own. Your teen is reaching out for help and is counting on you to answer the call.