“My Teen Uses Depression and Self Injury to Manipulate

eggsFrom time-to-time, I hear some variation of, “My child is so manipulative.  She’s only cutting herself and saying she is depressed for attention.  She’s not really that depressed.”

When manipulation is suggested, there are several points I typically make to parents:

1) First: Your feelings are valid.  Just like your child’s.   It is understandable that you assume that something you have not experienced (depression itself, gratification from self-injury, etc.) is not in fact occurring.  Our brains are wired to efficiently make sense of the world, and sometimes that means categorical thinking and making assumptions based on our own feelings and experiences.  So I can see how you would project your own internal experience (not really depressed) onto your child.  Also, you see your child as someone who is really craving attention, and your child’s social group puts a lot of emphasis on “being depressed,” so your assumption is not coming from left field. You are not a horrible parent, just a reasonable person making inferences from the information that you have. Now. Take what I just said as a model of “validation,” because I encourage you to get in the habit of making your child feel as if her feelings are understandable, even when you don’t see their situation the same way.

2)  Let’s reframe “manipulation.”  “Manipulation” has an incredibly negative connotation.  But, in reality, manipulation is a tactic used to meet an unmet need when the “manipulator” is ill-equipped to meet the need in a constructive way (and/or ill-equipped to tolerate times when that need cannot be met).  Let’s say, for the sake of argument, that your child is at times “dramatizing and exaggerating” symptoms in order to satisfy her need for consideration and attention.  If someone goes to such measures (that they actually harm themselves in some cases), wouldn’t you say they have a very REAL internal distress surrounding her sense of being cared-about and being considered/attended-to?   And this feeling of being unloved, ignored, and alone (even when she is not) is likely a raw sensitivity for her, as is typical with depression.  So there you have it.  She may not be handling her unmet needs constructively (aka she may be “manipulating”) BECAUSE she is depressed.  This is why treatment addresses the child’s faulty assumptions, helps your child appropriately advocate for her needs, and helps your child tolerate times when life cannot reasonably satisfy her sensitivity to that need.

Now what if she is using her mental health to “manipulate” you into satisfying her “need” for socializing or freedom or money (as opposed to an actual psychological need)? What if your teen says, “If you don’t let me go to the party, you are going to make me so upset I am going to cut myself!”??

In such a situation:

a) Be empathic to her situation (don’t you remember how much it sucked when your parents wouldn’t let you do something you wanted to do, something that all your friends were doing?). Also, remember that her mood disorder causes her to have legitimate sensitivities to being unloved and being an “outsider.” To her, she IS defending what feels like a legitimate psychological need (the distorted thinking is something like “my sense of belonging DEPENDS on me going to the party!”) As part of her depression, she may also lack emotional buffers (the ability to naturally tolerate and minimize disappointment and upset). While she is accountable for practicing using her “buffers” (cognitive skills, self-soothing, and distress tolerance learned in therapy), you are responsible for delivering the opportunity to practice such skills with empathy.

b) Supervise her closely (yes, sometimes kids actually do self injure in these situations, both in an effort to manage intense emotions, and sometimes to elicit a sense of regret from the parent).

c) DO NOT give-in if you think you made the right parenting call.  If you give-in, you will positively reinforce her saying, “You are going to make me cut” as opposed to constructively communicating her feelings and using her self-soothing, healthy thinking, and distress-tolerance skills.

d)  If you legitimately feel that your child is so distressed that she may hurt herself (remember, she may actually feel for the moment that life is not livable because she cannot go to the party.  That catastrophic thinking is the nature of depression.), please seek immediate professional help.  If you don’t believe she can maintain her safety, of course, bring her to the emergency room. (But just make sure you are not using the emergency room as your own manipulation tactic.  The ER is not a “punishment” tool, but should only be used if you legitimately need it to ensure your child’s safety.)

3)  Connect with your child.  I know you just want to pinpoint a simple cause (She is being manipulative and/or succumbing to peer pressure) so that your child will get better, but depression is a complicated condition that has biological, social, and psychological causes.  Just because a child has love and nice clothes and fun vacations and  “a good life,” does not mean she is immune to depression.  And well-meaning statements such as “you shouldn’t be depressed because you have no reason to be depressed” are heard as, “there is something very wrong with you, and the feelings that you have are not worthy of my acceptance.”  Ironically, trying to talk a child out of her feelings will make her feel worse, while seeking to understand and empathize will make her feel loved and accepted.  With empathy, ask questions such as “what does your depression feel like?” or  “Is there anything I can do to help?”

If you are confused about why your child self-harms, ask her openly, and listen non-judgmentally.  Here are a bunch of reasons that people self-harm, cut and pasted directly from this helpful article:

1. To reduce unwanted emotions
2. To provide distraction from emotions, including anxiety, depression, racing/obsessive thoughts, guilt/shame, rejection, sexual preoccupation, eating disordered thoughts or activities
3. To increase feelings of control
4. To self-punish
5. To ward off numbness/to feel something (this is common in trauma victims and in those who report lack of feelings or “emptiness”.)
6. As a cry for help/to express feelings to others

4)  A little part of you can relate, I’m sure.  Compulsive self-harm as a way to release inner turmoil (#2 above) is the type of self-injury I see most often.  Therefore, in an attempt to elicit your parental powers of empathy, I ask, “Have you ever eaten a whole bag of chips of smoked a cigarette or bitten your nails in an effort to compulsively resist undesirable feelings (even boredom is an undesirable feeling)?”  No doubt every one of us has engaged in a form of offering an intense physical stimulation (the taste of salt, the surge of nicotine, the tactile sensation of breaking nails) in order to detract-from and minimize the emotion at-hand.  It may be helpful to think of compulsive self-harm as a more-intense behavior to detract-from and minimize a more-intense emotion.

Also, have you ever told your husband, “I have a killer headache,” only to have him look at you and say, “Take a Tylenol.  Anyway, what’s for dinner?”  (If this has never happened, immediately send your husband a text professing your appreciation for his empathic nature.)  If this has happened to you, recall how your instinct was to explain to him that your temples felt like they were being smashed repeatedly with a hammer and nudge your back into his shoulder, attempting to elicit some sort of affectionate gesture.  And if your husband then simply stared blankly and said, “that reminds me, I’m kinda in the mood for mashed potatoes,” surely you immediately announced that you had an explosive migraine that calls for your sympathy and consideration, goddammit See where I’m going with this? In this metaphor, a headache is the thing that is easy for others to dismiss since they  are not the ones feeling the drill to the head.  And when others dismiss the pain, a natural response is to lay it on oh-so-thick until others GET IT.  With your child, the thing others easily dismiss because they don’t feel it, is the depression. And, you guessed it, the thing that they may naturally want to showcase in an effort to legitimize and scream for the world to notice, is the depression.

So, parents, I hope this gives you some food for thought in a manner that does not make you feel judged for your assumptions.  Because, misjudging instead of empathizing with others just makes any stressful situation (even your teen’s depression) infinitely worse.

-Angelica Shiels, Psy.D.

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