Q.My 16-year-old daughter cuts and pierces her body and insists that she is a typical -- and normal -- teenager.
Cutting is not the best "coping mechanism," she says, but body piercing "is no big deal." She doesn't want to stop either one, however, any more than she wants to quit smoking.
Her first ear piercing was professionally done and then she pierced three or four more holes in each ear herself, one in cartilage. She put two studs in her tongue and one ring in each nipple. I let her get her bellybutton pierced for her 16th birthday after she promised not to pierce herself again, but she later did two eyebrow piercings and one in her upper arm.
Also, my daughter was diagnosed with depression 18 months ago and spent three days in a facility after she tried to commit suicide.
She is sexually active -- she has a steady boyfriend -- and is on birth control but says that she doesn't drink or do drugs. She has lied to me in the past, however, so I'm not sure I believe her.
We see a therapist together to work on trust issues, freedom of expression and other relationship problems, but she won't go alone anymore because she says she doesn't like therapists, doesn't trust them and doesn't think they do any good. She does see the psychiatrist who prescribes her medication. He has some sessions with her and some with the two of us, and I see a therapist of my own (or I'd be in the loony bin by now).
My daughter thinks her behavior is fine but I see a risk at every turn. She said it was a mistake to tell me about her depression, that she doesn't want or need medication or therapy and she will get rid of some piercings one day, if only to get a job. All this leaves me depressed, sad, upset, frustrated and very scared. I feel as if I am going slowly insane.
A.Piercing and cutting and other tribal rites have been around for centuries. Today, though, they've become teenage fads, each satisfying markedly different needs.
Piercing is a sign of independence and perhaps rebellion for a teenager and it's a fashion statement, too -- much as she might make by dyeing her hair bright blue.
Cutting, though, is a serious psychological problem, which is becoming almost as common with teenagers as anorexia and bulimia.
Statistically, about 90 percent of the self-injurers today are white, middle-class females, and 61 percent have had an eating disorder; 56 percent have had problems with alcohol, and 30 percent have used drugs.
They often start cutting themselves in adolescence, because they feel unappreciated or think they've been treated unfairly or perhaps because puberty began before their brains and their emotions had caught up with their hormones. These teens may keep harming themselves for years unless someone insists that they get help. The sooner a self-injurer is treated, the easier it will be for her to correct her problem.
Scars aren't the only sign of self-injury.
Typically, a cutter -- or a burner or a scraper -- has low self-esteem, bouts of depression and a great need for love and acceptance. She also doesn't relate well to people or develop intimate relationships easily; she doesn't know how to comfort herself and she may not even think she deserves any comfort.
It is this inability to soothe herself that makes her cut the first time, and then she finds that the quick flow of blood gets rid of her pain and tension, gives her an immediate high and leaves her calm and in control of her anxieties and emotions for a day or even a week. That's why most therapists believe that people who injure themselves are really looking for emotional peace.
Cutting is always a problem, but piercing is only a problem if it becomes habitual and compulsive or if someone makes 15 to 20 holes in her body to attach her metal trinkets, as your daughter has done, instead of four or five. It can also spell trouble if these holes are made in her nipples or other sensitive places, because they could be a health risk, or in her tongue, because the metal could damage her teeth.
Do take your daughter to the doctor, to make sure she hasn't hurt her body, and to see if she needs shots to prevent hepatitis or tetanus. Make her stick with psychotherapy too, because she truly needs it -- and her medicine -- to prevent another bout of depression and both of you need help to strengthen your relationship.
Also read "Bodily Harm" by Karen Conterio and Wendy Lader, with Jennifer Kingson Bloom (Hyperion; $16). It distinguishes between self-injury and piercing quite well.
Questions? Send them to firstname.lastname@example.org or Box 15310, Washington, D.C. 20003.