Cutting for attention?

For me, this has become a relatively new topic. With social media, cutting “parties,” graphic Tumblr pages, and Demi Lovato, I find more cases of attention-seeking cutting every day. But is there a difference between cutting for attention and the more clinically recognized rage-based cutting? The long answer is yes. The short answer is no.

Rage-based cutters usually do everything possible to keep what they’re doing hidden. They wear sweaters in summer. They make up stories about “accidents.” They spend a lot of time alone. They keep secrets. A rage-based cutter has a very difficult time expressing emotion. They avoid interpersonal conflict at all costs, and instead resolve conflicts privately by self-harming in some way. I have found that a rage-based cutter is not what gets glamourized in the movies—they’re not typically your gothed-out, emo, druggie high school dropout. They’re actually the opposite (usually). They get good grades. They’re committee chairs, star athletes, or presidents of social clubs. They maintain a high level of social functioning. They’re usually hidden from the world in plain site. We find that a rage-based cutter needs to be freed from rigid and inflexible rule structures about emotional expression. They need to be able to get angry without facing unfair consequences.

With attention-seeking cutters, I see a different picture altogether. Their mood is different. Their actions are different. Their personalities are different. Even the way they think about the world is different. They aren’t trying to hide the way a rage-based cutter is; on the contrary, a hiding place is the last thing they want. They tend to either brandish their wounds to their friends, or manipulate circumstances that will “accidentally” reveal their behavior to an unsuspecting bystander. They are not shy about expressing their emotions. They’re on social media sites all day long. They’re more interested in peer relationships than school, grades, or extracurricular activities. In truth, they are far hungrier for attention than the rage-based cutter, and have figured out how to turn the spotlight.

That’s the long answer. Yes, there is a difference—in motivation. But the short answer is there is no difference. And what I mean by that is that within the familial context, a repair needs to be made, no matter what the reason behind the self-harm really is. For the attention seeker, this may mean asking families to spend more time together, maybe adjusting the way a family defines “special,” perhaps even adding some good old after-school activities to teens with way too much time on their hands. For the rage-based cutter, this may mean relaxing family rules around communication, confronting a family about inappropriate secrets, sometimes simply educating parents about normal developmental milestones.

Family is everything to us here at KISI and we believe family therapy is vital for teens struggling with the need to self-harm. You can’t send a cutter—attention-seeking, rage-based, or otherwise—to their own shrink and expect any real results. From our standpoint, the problem isn’t the cutting, it’s the family dynamic. Family therapy is about learning to communicate effectively. It’s about realigning relationships. It’s about resolving conflict. And yes, sometimes it’s about confronting attention-seekers and holding parents accountable. We’ve found that our work brings real change; attention-seekers get a voice and space to grapple with adolescence, and their families are better equipped to support the turbulent journey through the teenage years.

-Brad Horne is a Fellow and the Training Coordinator at the Kahn Institute for Self-Injury