On an early spring afternoon three beautiful and accomplished Hofstra alumnae gathered to talk about their unique collaboration. When Your Child Is Cutting: A Parent’s Guide to Helping Children Overcome Self-Injury is the first handbook for parents ever written on the subject of self-injury.
Though the authors, Dr. Merry McVey ’95, ’00; Dr. Sony Khemlani ’95, ’01; and Dr. Fugen Neziroglu ’74, ’76, often deal with the darkest of topics in their practice, the energy in the room is light and full of smiles and laughter. “We’re very close,” says Dr. Neziroglu.
“We take our work very seriously, but we don’t take ourselves very seriously at all,” adds Dr. McVey.
The three are in residence together at the Bio-Behavioral Institute in Great Neck, New York, which specializes in behavioral illnesses, such as obsessive-compulsive disorder, eating disorders, compulsive hoarding (which Dr. Neziroglu has also written about), social phobias, body dysmorphic disorder, depression, attention deficit hyperactivity disorder, and a variety of other conditions.
Drs. Neziroglu and McVey both teach in the Department of Psychology at Hofstra. Dr. Neziroglu teaches psychopharmacology to graduate students, and Dr. McVey teaches psychological aspects of human sexual behavior in the undergraduate program.
It was prior to the publication of When Your Child Is Cutting that they spoke about their work with children who self-injure and how they guide parents whose children are suffering from this addictive behavior.
What was the genesis of the book?
Dr. Merry McVey: We’ve been seeing a significant and rising sample of adolescents and children with self-injury issues.
Dr. Fugen Neziroglu: The school districts are actually referring patients to us because they have seen such a rise in self-injury among children and adolescents.
Dr. McVey: School social workers and school psychologists are seeing kids who are younger and younger. This was originally considered a problem among high school students. Now it’s also an issue among middle school students.
In terms of the general population we see self-injury occurring in between 12 to 14 percent of non-clinical community samples of high school to college students [non-clinical samples refers to people with no previous psychiatric diagnosis]. This is pretty significant. And in clinical samples the rates are much higher – this is a behavior seen among 80 percent of individuals with borderline personalities.
Why a handbook for parents?
Dr. Sony Khemlani: We actually first had the idea to do a handbook for adolescents but then it turned into a parent guide. There’s nothing like this out there, and we constantly get questions from parents on how to handle this issue.
Dr. Neziroglu: It’s a step-by-step guide on how to talk to a child who self-injures and how to recognize symptoms of self-injury.
Is cutting a more common behavior today than it was years ago?
Dr. McVey: I think self-injury has existed since the dawn of time but in different forms. It existed prehistorically in tribal scarification rites that occurred at puberty. We see it in primitive cultures today, and I think it’s always been around but been kept hush-hush.
In talking to kids, they tell us that media figures are coming out about their own self-injury. Once something becomes mainstream, people are more comfortable talking about it.
However, now that more people are discussing self-injury, there are those individuals who learn about it and have a predisposition for it. The idea of it resonates with them.
Dr. Khemlani: I actually had a patient who was in the same hospital room with her [referring to Dr. McVey] patient. She never had the idea to self-injure until she met Merry’s patient.
Dr. McVey: [Sarcastically] Oh, great.
Dr. Neziroglu: I think in the schools it’s the same thing. The kids see someone else doing it and then imitate the behavior.
Dr. McVey: That’s why the schools are getting so panicked about it. Copycat-cutting seems to be a big phenomenon.
There are kids who will try it and it doesn’t feel good to them; they’re not biologically set up for it. Then there are the kids who try it and it feels a little too good, and by the 20th or 30th cut they are addicted, because it’s tapping into the pleasure center of their brain. They’re feeling relief, and they’re feeling emotional release. And it becomes extremely problematic.
Once it becomes a habitual behavior, it’s harder to stop.
What are some of the signs of self-injury that parents should watch out for?
Dr. Khemlani: How to recognize if your child is cutting? It’s not usually one symptom but a cluster. Watch for a change in the pattern of their behavior. Lots of the symptoms individually are normal for adolescents.
So watch for changes in their mood – they may be more isolative and begin socializing with a different group of friends. Look for changes in their clothing – wearing items that camouflage parts of their body, like big bracelets. They may quit sports and other activities in which they used to be very engaged. Not going swimming, refusing to go to the pediatrician …
Dr. Neziroglu: You’ll see a lot of avoidance behaviors. These kids feel alone and isolated. They may appear to have lots of friends and have popularity among their peers, but they don’t feel connected to anyone.
Dr. McVey: Watch if your child is showing impaired judgment, increased impulsivity and engaging in high-risk behaviors, like risky sex, alcohol or drug use, driving too fast – those are risk factors.
Also, when we see children with a history of eating disorders or sexual abuse, we immediately evaluate for self-injury. Kids with an eating disorder are at 35 percent more risk for self-injury. If they have been sexually abused, they are seven times more likely to engage in self-injury as adolescents.
What are some other factors that may alert parents that something is wrong?
Dr. McVey: Children who are very dissatisfied with their body – that seems to be one of the most common variables. There is the feeling that the body is the enemy. Kids who have
extremely high anxiety about their appearance may be at risk.
Dr. Khemlani: Kids who are perfectionists – they’re the straight A students, the best of the best. But they feel that nothing is ever good enough.
Dr. Neziroglu: What is most important for parents to know is that cutting does not involve just one type of kid, and it may not be for any one specific reason.
Is there a particular age range where cutting is most prevalent?
Dr. McVey: Ages 14 to 16. But there are people who cut through their life span. Particularly women with borderline personalities may self-injure into their 50s and older.
How do parents react when you tell them that their child is cutting?
Dr. Neziroglu: They don’t want to hear it. They’re in denial. They minimize it sometimes.
Dr. McVey: Parents don’t want to believe that it’s true. We try to emphasize, though, that it’s a real problem, but there’s real help.
Some parents assume their child is suicidal and should be hospitalized. That’s not always the case. It does put the child at increased risk for suicidal behavior, but many report not being suicidal at all.
Many parents put their children on a pedestal. It must be so hard for them to know that their children are hurting themselves.
Dr. Neziroglu: Especially those parents whose children are perfectionists and have excelled in every area of their life.
Dr. McVey: Part of the purpose of the book is to help parents manage their own emotional responses so they don’t damage their relationship with their children by focusing on their own frustration and disbelief. They need to focus on the child.
Dr. Khemlani: We also have a chapter in the book on what to do when your child approaches you in the middle of an urge to cut – that’s probably the most desperate hour.
What are some major dos and don’ts for parents in this situation?
Dr. McVey: Please don’t start screaming at your child, telling them they’ve disappointed you – that you thought they were great and now they’re not. Don’t devalue them the way they are probably devaluing themselves.
Dr. Khemlani: Don’t say, “How could you to this to me!” Don’t focus on yourself.
Dr. McVey: Do validate your child. Do let them know you understand that they are in pain and feeling numb. You may not understand the behavior but let them know you understand the feelings leading up to the behavior.
Another major do is to encourage them and to let them know there is help.
Dr. Neziroglu: And that they can learn to deal with their feelings in a much different way. You want to emphasize the feeling component.
Like some other addictions and self-destructive behaviors, do people who have self-injured in the past feel urges to do so throughout their life?
Dr. McVey: It depends on the reasons that drove them to do it in the first place. Some people may always have the urges, although a significant proportion of individuals, once ample time has passed since the last self-injurious episode, report significantly diminished urges.
I’m thinking of a patient who has now been abstinent from cutting for 5 ½ years, and she recalls one urge to cut this year, and she didn’t respond to it. So that would be an individual you would say going forward would have fewer and fewer urges like that.
It’s like people who smoke. Some people report always having a craving and others say they haven’t done it in so long it’s repugnant to them. It’s very individual.
Dr. Khemlani: It also depends on the other illnesses they may be suffering from – like bipolar disorder, post-traumatic stress syndrome or borderline personality. If those issues are not resolved properly, the urge to cut may never subside.
Dr. Neziroglu: That’s a major component. If it’s a high school student who is experimenting, the likelihood is that it will go away and it won’t come back. But if you have other co-morbid conditions, those may propel it.
That’s why professional help is very important. Even if a family goes for just one visit, they need a professional’s assessment. If your child is cutting, find out if it’s copycat-cutting or if something else is going on. Assess the reasons why it’s happening.
Dr. McVey: Parents can get so wrapped up in the fact that their child is cutting that they think that in itself is the disorder. But usually it isn’t. It’s a peripheral symptom of a greater issue. We look at cutting as a behavioral expression of something else that is going on. We never see cutting in isolation; the person feels great, is doing great in life but begins cutting because they like it. That never happens.
All three of you graduated from Hofstra. What did you get out of the doctoral program in the Psychology Department?
Dr. Khemlani: I think the program for me – one of its strongest components – was its training in cognitive behavioral therapy because so few programs have that specialization.
Dr. Neziroglu: Hofstra was one of the first schools to teach cognitive behavioral treatment at a time when it was not accepted at all.
Dr. Khemlani: Dr. McVey and I were also in the clinical school program and developed a solid foundation in working with the school districts.
Dr. Neziroglu: Since the day I graduated from Hofstra, I’ve been teaching there.
Dr. McVey: [Laughing] She’s the Hofstra poster child.
Dr. Neziroglu: I would say most of our staff here at Bio is from Hofstra. In fact, with the exception of one staff member, everyone here is a Hofstra graduate.
Are all your patients from Long Island?
Dr. Neziroglu: Our patients are from all over the country and all over the world.
Dr. Khemlani: What’s unique about our program is that we offer intensive treatment for people who don’t want to be hospitalized but who need to be seen several times a week for many hours at a time.
With work as intensive and emotional as yours, how do you keep from becoming overwhelmed?
Dr. Khemlani: Our secret is to laugh and act stupid.
Dr. McVey: Sony and I hang out with our little boys and roll around on the floor with them.
It is impossible to leave what we do at the office. Many times there are middle-of-the-night phone calls from patients, but you have to separate work from your personal life. There are times when I need a weekend off and I tell them and they’ll cover for me and vice versa.
We need to do the things that enrich us because we can’t do this if we’re not replenishing our souls.
When Your Child Is Cutting: A Parent’s Guide to Helping Children Overcome Self-Injury, published by New Harbinger Press, is currently available at Amazon.com.
Drs. Neziroglu and Khemlani will be presenting at the Second Annual Body Dysmorphic Disorder Conference, on October 21 and 22, 2006, at Hofstra University, sponsored by The Neysa Jane Body Dysmophic Disorder Fund. The fund was created in memory of Neysa Jane Powley, who suffered from BDD and ended her life at the age of 26. BDD is a condition that involves an intense preoccupation with a particular aspect or aspects of physical appearance in a normal appearing person. It is one of the conditions currently treated at the Bio-Behavioral Institute that may lead to self-injury. For more information on this conference, which is for mental health professionals, patients, family members and friends, e-mail firstname.lastname@example.org. For more information on the services offered by the Bio-Behavioral Institute, visit www.bio-behavioral.com.