When you ask an adolescent why he or she cuts, or you talk to them about cutting, you need to be able to put it into a context so they can understand what it is they are doing.

It is more complex, and simpler than the mysterious action it seems.

Our skin is our largest sensory organ. Stimulating the skin can be a form of self-soothing that can be achieved by touching, rubbing, massaging, and piercing. Some of our children have discovered that scratching and cutting are stimulating.

This stimulation creates an external and an internal response. The internal response can be mediated by endorphins, and have a physical representation in the brain.

The rush of endorphins from the physical side is what people tend to focus on, but often we don’t take the next step, which is “Why is it necessary for a child to seek that response in order to change their mood?”

Typifying self-stimulation as an act of self-harm can cause us to miss the underlying meaning and purpose of the behaviour.

Whether the behaviour is in the context of the child themselves without any reference to the outside world, or whether the behaviour is an action that causes a response from the outside world are two separate things.

There is an internal psychological response to a physical action that affects the child’s mood, and an external response in relationship to how other people respond to the child’s action. The action was done in private, and the later observation of the effect of that action results in the response.

Often the person who is self-soothing in that way will be at pains to demonstrate that they have done it.

The internal soothing behaviour then becomes an external attempt to have others notice us and attend to us.

We can see this as part of the attachment configuration, both attachment to self and attachment to others.