I’m 16, and I’ve been diagnosed with depression, GAD, and gender dysphoria- I’m FtM- all of which I’ve struggled with for years. For a time during my most recent episode, I used cutting to cope. I was working hard in treatment before and during the episode, and I continue to fight as hard as I can. I’ll be two months clean at the end of March, and I’m proud of my progress since I began this journey a year and a half ago.

Lately I’ve been under more stress with school, the college search, and increased gender dysphoria. I’ve noticed that in the face of my active refusal to cut, I’ve subconsciously come up with smaller ways of being self-destructive. I bite the top layer of skin of my bottom lip so that it bleeds, and pick at pimples for the same purpose- I’ve taken to keeping my nails short so I can’t do that. I will also occasionally skip or delay meals when I’m quite hungry, not because of my weight, but because I feel more in control somehow.

Is this typical when first recovering from cutting? Also, while the decision not to eat is conscious and deliberate, I don’t always realize I’m biting my lip or picking my skin. How can I be more aware? Should I even be that worried?

Thanks for the input!

A. Your stress level has increased and thus you needed something to relax. You gave up cutting and needed something else. As you have noted, you resorted to a new set of self-destructive mechanisms to cope. You’ve been diagnosed with a number of mental health disorders, but you didn’t mention anything about treatment. Had you been in treatment, it’s unlikely that your cutting behavior would have shifted to some other form of self-destructive behavior.

You asked about whether or not it is typical to trade one self-destructive behavior for another. For some people, especially those of whom are not in treatment, the answer is yes. Had you been in treatment, you may have had a more favorable outcome.

The solution to this problem isn’t necessarily becoming more aware of your behavior but rather finding healthy replacements for unhealthy behavior. There are adaptive ways to deal with stress and there are maladaptive ways to deal with stress. Currently, you are utilizing the latter; consult a therapist who can help you develop healthy ways to deal with stress. Please take care.

Dr. Kristina Randle