I have a 20-year-old daughter who has been burning and cutting herself for almost six months now. She refused to get help for any of this, although she was on Paxil for a month. She will not take it anymore, thinking it hadn't helped her, but it actually did. She is deeply involved with other self-harmers, and her boyfriend is into cutting and has attempted suicide numerous times. What can I, as a mother, do for her? I have begged her to get help, to no avail. I am so scared for her, and I don't know what to do about it.

B.C.M.

Self-mutilation is a serious behavior, and I can understand why you are so concerned about your daughter. Unfortunately if she refuses to get help (and is not endangering her life, which might call for involuntary hospitalization if necessary), there is little you can do directly to get her to stop.

What you CAN do, however -- and what I strongly recommend -- is see a therapist yourself ASAP for help in managing your distress. You might also benefit from reading about and thus better understanding self-injurious behavior. Tracy Alderman's book The Scarred Soul: Understanding and Ending Self-Inflicted Violence is a self-help guide for people who injure themselves, but it also contains a chapter written specifically for family and friends.

Most people who engage in self-injurious behavior have difficulty identifying and tolerating their emotions. They may cut, burn, scratch or otherwise hurt themselves when feeling overwhelmed. Although it may be hard for someone else to understand, self-mutilators may feel a sense of physical and emotional release -- and relief -- after the injury. They may dissociate the pain involved, or prefer focusing on physical pain instead of their emotional distress.

Psychotherapy with a professional experienced in working with people who self-mutilate can help the self-injurious person learn additional emotion management skills. Perhaps even if your daughter does not wish to take psychiatric medication, she might be willing to see a therapist who can help her work through whatever's bothering her. But again, engaging in therapy -- or not -- is ultimately her decision, just as she, not you, is ultimately responsible for her behavior. Good luck.