There are few things more disturbing for moms and dads than finding out that your child is intentionally hurting herself. Unfortunately, it’s very common, especially among girls. Experts call it “self-injury,” and as many as a quarter of all teenagers do it.

The most common form of self-injury is cutting or scratching the skin with anything that can draw blood, such as razors or even paperclips and pen caps, but people also self-injure by burning themselves, picking at skin and wounds, or hitting themselves. They often start around puberty.

When a girl develops a habit of cutting her arms it might look like suicidal behavior, but it actually isn’t. People who self-injure aren’t trying to kill themselves, they are trying to alleviate some emotional distress they are feeling. However, the behavior indicates a depth of psychic pain that could lead to a suicide attempt. The behavior is also inherently dangerous because people who self-injure may hurt themselves more seriously than intended or develop infections or other medical complications.

Understanding the drive

It’s hard to understand why anyone would want to intentionally hurt herself, why people cut themselves or why that injury would come as a relief, as many self-injurers describe it. Some people report that it serves as a distraction from some other intense emotional pain, says Ron Steingard, MD, a psychiatrist at the Child Mind Institute.

Others self-harm because they feel deadened inside. “They’ve locked down so tightly because of whatever’s going on in their lives that they feel they’re incapable of feeling anything at all,” says Dr. Steingard. “So they hurt themselves in order to feel something.”

In some cases, self-injury can also become a way of communicating. When a girl is found to be cutting, it’s likely to elicit empathy and concern from parents and other adults. Next time she is feeling desperate, she might use self-mutilation as a way to communicate her feelings.

Related: How to Help Your Depressed Teenager

A way to cope

But self-injury isn’t always a form of communication. Some kids are very secretive about the habit and are focused only on ameliorating their own pain, not sharing it. It’s what clinicians call a maladaptive coping tool: Even though self-injury isn’t the best way to manage a problem, it might bring temporary relief.

Unfortunately, that relief makes self-injurious behavior very reinforcing, so kids come to rely upon it as a way to deal with their painful feelings. And the longer they practice self-injury the more reinforcing it becomes.

Red flags for cutting

If you suspect that your daughter may be hurting herself but you’re not sure, look for these signs:

• Talking about self-injury
• Suspicious-looking scars
• Wounds that don’t heal or get worse
• Cuts on the same place
• Increased isolation
• Collecting sharp tools such as shards of glass, safety pins, nail scissors, etc.
• Wearing long-sleeved shirts in warm weather
• Avoiding social activities
• Wearing a lot of band-aids
• Refusing to go into the locker room or change clothes in school

Triggers

The impulse a teenager feels to harm herself is almost always triggered by a specific event in her life. The most common “trigger” for cutting is feeling rejected: by a boyfriend, her close friends, or by a general feeling of being left out or criticized.

Getting self-harm help

If you discover that a child has been hurting herself, even if she says it was a one-time thing, it’s important to get help. It’s true that kids might experiment with self-injury, especially if they have friends who are doing it, but it’s a serious and dangerous behavior, and you don’t want to ignore what might be a real mental health issue.

• Evaluation: To begin with, you should have your daughter evaluated by an experienced mental health professional to find out what her reasons for hurting herself are and what emotional difficulties she’s experiencing.

• Dialectical behavior therapy (DBT): One highly recommended treatment is DBT, in which a psychologist works with your child to help her learn how to tolerate uncomfortable feelings anger, anxiety, and rejection without resorting to cutting.

• Cognitive Behavioral Therapy (CBT): In CBT, a psychologist teaches your child to challenge negative, distressing thoughts, to recognize the pattern and train herself to think outside it. In many cases, particularly with teenagers, this treatment is very successful.

• Family Therapy: If there are things going on at home-fighting, job loss, a death that could be the source of your daughter’s emotional troubles, family therapy is a good way to begin treatment.

• Medication: Often if there is another disorder involved, a doctor will prescribe medication to treat that condition. The combination of medication and psychotherapy is very successful in treating kids who self-harm.

Finally, Dr. Steingard recommends that families try to be open and supportive. “This is a behavior that’s very hard for people to get inside and empathize with. But it isn’t something that a person can just stop; it’s something that needs to be understood.”