Advice From the Trenches

Advice from the Trenches: Scratching

Dear C and Dr. B; 

My 16-year-old daughter, Carolyn, scratches herself. She isn’t tearing her skin open or leaving large raised welts, but even though she tries to hide it with her hair, it is noticeable. We took her to a therapist, but this was less than helpful. The woman suggested a lot of things my daughter could do instead of scratching herself, but she didn’t address what I suspect is the underlying reason for the behavior. My daughter is really stubborn and will not ask for help. In her need to do it all herself, she ends up feeling alone and anxious. She believes no one is on her side.  She is refusing to go back to therapy. She refused to try any of the therapist’s suggestions and won’t talk about it with us. I am at a loss as to what to do. 

Poison Ivy

Dr. B says: Although it is developmentally normal for a teenager to want to do everything on their own, it still can be painful for all involved. It’s a very similar stage to when they were toddlers and all you heard was, “I do it myself!” What a toddler’s wants can be out of sync with their abilities, leading to tantrums. Given our culture, a teen’s expectations and capabilities can be out of sync, too. They often want 100% control over their lives, yet don’t have the skills to find ways to express these desires appropriately. This can lead to self harm behaviors. 

Not all therapy is useless. The technique of motivational interviewing would be helpful here. It addresses motivation for change before it addresses the dysfunctional behavior itself. Studies show that teenage support groups are effective as well. If teens can be motivated to do something on their own, such as a job or volunteer work, that can also be helpful. If her anxiety doesn’t resolve, an evaluation and appropriate medication might be in order.  

C says: I don’t mean to change the subject, but isn’t everyone missing something here? If this scratching is localized on Carolyn’s neck, where her hair can hide it, isn’t it possible that she’s become allergic to one of her hair products? An allergy can develop at any time in a person’s life, and stress is a factor that can bring it on. If you don’t see marks anywhere else, this could be a clue – dermatitis causes constant scratching. You mentioned that your daughter has an underlying issue, but the scratching is a symptom that can easily be caused by purely medical issues as well, and may need to be dealt with as a separate issue. I’d at least look into it.

In the meantime, you can’t force Carolyn to participate in therapy she doesn’t want, but what you can do is listen and respond as a parent. She feels no one is on her side? I’m curious as to what “her side” is. There is an unspoken argument going on here and you’ve given us no clue as to what it is. But think about this – scratching is a bit like silent screaming. Screaming is what people do when they feel no one is listening. Stop trying to control the situation and just listen for a change. It’s not like you have to stop this behavior or she will DIE. When teens are torn up inside, they often do things that are far worse to cope with the unbearable tension. They destroy their health and brain cells with drugs, act out with inappropriate sexual behavior that ruins their lives, or run away from home. Your daughter scratches herself? So does my dog. She’s not on heroin. Be patient and be loving. It’s not time to panic yet. 

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