Hello Dr. Greenberg,

My name is____ and I am having an issue with my younger cousin. She is 16 and lives with her father, step-mother and one year old baby sister. She recently revealed to me that she is very depressed, has suicidal thoughts and has been cutting off and on since middle school. I told her that she needed to talk to her dad (a very old school, can handle anything, busy, high demand business owner who does not have time for her) about going to see a therapist. She was fairly open to the idea, but scared to tell him and suggested maybe I tell him. I talked to her dad who seemed to dismiss the idea of taking her (he does not have time for her) to see a therapist. Her dad also dismissed the cutting as an attempt to divert attention away from the fact that she had been caught with a second facebook page and not friended her parents so as to not be "censored." I told him that regardless of that if she has been doing it off and on for several years it needs to be addressed. That was two days ago and neither of them have mentioned it to the other. I am very concerned.

She and I talk every day and I was hoping to get some advice on helping her stop and learn to cope with her emotions more productively. I would take her to a therapist myself if it was legal.

Please advise.Thank you.

A Worried Cousin

Dear Cousin,

You have lots of reasons to be worried about your cousin. The combination of severe depression, suicidal thoughts and self-mutilation is a dangerous one. Your cousin is lucky to have you on her team.

Self-mutilation or cutting as a single symptom is not uncommon among teen girls. One study even suggested that 1 in 12 teens deliberately harm themselves. They do this in an attempt to deal with overwhelming emotions that they neither know how to deal with or express. Teen girls are particularly vulnerable to cutting as they experience overwhelming emotions, immature brains, and hormonal changes. Most teens who cut do not commit suicide.

However, your cousin is dealing not only with cutting but with accompanying mood issues and suicidal thoughts. Perhaps, her father is unaware of how serious his daughter's problems are. Perhaps you can talk to the father and stepmother together. I would also suggest talking to the biological mother but I am not sure if she is involved in your cousin's life or not. You or your cousin can speak to the school psychologist or social worker who should then bring this problem to the attention of the family.

I am afraid that you are absolutely correct. Your cousin is in deep trouble. I am not sure what the laws of your state are but I would suggest that if you become extremely worried about your cousin then you take her to a hospital emergency room. The staff at the emergency room may then contact her father. I wish you luck and am so glad that your cousin has you for emotional support.

Please let me know what happens.

Dr. G.

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