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Teens
& self-injury Why
do people self-harm? Self
Injury A common form of self-injury
involves making shallow cuts to the skin of the
arms or legs. This is casually referred to as
"cutting"; a person who routinely does this may be
colloquially called "a cutter". Localized multiple
cuts, especially those similar in appearance, are
sometimes characteristic of cutting, but are not
reliable indicators of self-injury. Less
frequently, this behavior may involve cutting other
parts of the body, including the breasts and sexual
organs. Other examples of self-injury
include: A popular misconception of
self-injury is that it is an attention seeking
behavior. In truth, many people who self-injure are
very self-conscious of their wounds and scars and
go to great lengths to conceal their behavior from
others. They may offer alternative explanations for
their injuries or conceal their scars with
clothing. In the strictest terms,
self-harm is a general term for self-damaging
activities (which could include alcohol abuse and
bulimia), whereas self-injury refers more
specifically to the practice of cutting, bruising,
poisoning, overdosing (without suicidal intent),
burning or otherwise directly injuring the body.
Many people, including healthcare workers, define
self-harm based around the act of damaging one's
own body. It may be more accurate to define
self-harm based around the intent, and the
emotional distress that the person wishes to deal
with. An example of this form of definition is
provided by the self-injury awareness charity,
LifeSIGNS. Neither the DSM-IV-TV nor the
ICD-10 provide diagnostic criteria for self-injury.
It is often seen as only a symptom of an underlying
disorder, though many people who self-injure would
like this to be addressed. Accurate statistics on
self-injury are hard to come by since most
self-injurers conceal their injuries Recorded
figures tend to be based on hospital admissions,
though more recently researchers have attempted to
document the topography and correlates of the
behavior in the general population. Studies based
only on hospital admissions may hide the larger
group of self-injurers who do not need or seek
hospital treatment for their injuries. Many of
these statistics show that more women seem to
self-injure than men, and that it is more common
among young people. One of the earliest studies
into self-injury was carried out in 1986 by
Conterio and Favazza, who estimated that 0.75% of
the population exhibit self-injurious behavior.
Half the sample had been hospitalized for the
problem, and 97% of were female. It should be noted
that more recent studies show the numbers of
self-injurers to be more evenly split between
female and male. A study of self-injurious
behavior in college students published by Cornell
University researchers in 2006 found that the most
common methods of self-injury reported by both male
and female subjects were scratching or pinching
with fingernails or other objects to the point that
bleeding occurred or marks remained on the skin
(51.6%), banging or punching objects to the point
of bruising or bleeding (37.6%), cutting (33.7%),
and punching or banging oneself to the point of
bruising or bleeding (24.5%). Female subjects were
2.3 times more likely to scratch or pinch and 2.4
times more likely to cut. Male subjects were 2.8
times more likely than female subjects to punch an
object with the intention of injuring themselves.
Male subjects were 1.8 times more likely to injure
their hands, whereas female subjects were 2.3 times
more likely to injure their wrists and 2.4 times
more likely to injure their thighs. Self-injury is
popularly assumed to represent a female phenomenon,
and although there is some disputed support to this
claim, the authors of the study believe that the
popular association of self-injury with cutting may
account for this belief. The WHO/EURO Multicentre
Study of Suicide estimated that the average
European rate of self-injury for persons over 15
years is 0.14% for males and 0.193% for females.
For each age group the female rate exceeded that of
the males, with the highest rate among females in
the 15-24 age group and the highest rate among
males in the 12-34 age group. Recently, however, it
has been found that the female to male ratio,
previously thought to be around 2:1, is diminishing
– in Ireland it has been close to parity for a
number of years. The Mental Health Foundation
estimates the rate in the UK to be 0.77% , and that
the majority of people who self-harm are aged
between 11 and 25 years, with between 1 in 12 and 1
in 15 young people self-harming . A 2003 study commissioned by
Samaritans found that more than 1 in 10 15-16 year
olds in the UK have deliberately harmed themselves,
and that girls of this age were nearly four times
more likely to have self-harmed than
boys. In a study of undergraduate
students in the United States, 9.8% of the students
surveyed indicated that they had purposefully cut
or burned themselves on at least one occasion in
the past. When the definition of self-injury was
expanded to include head-banging, scratching
oneself, and hitting oneself along with cutting and
burning, 32% of the sample said they had done this.
This suggests that this problem is not associated
only with severely disturbed psychiatric patients
but is not uncommon among young adults. In a study of psychiatric
morbidity carried out in the UK, respondents were
asked the question: "Have you ever harmed yourself
in any way, but not with the intention of killing
yourself?" This survey found an overall lifetime
prevalence of 2.4%, this being 2.0% of males and
2.7% of females. About 10% of admissions to
medical wards in the UK are as a result of
self-harm, however the majority of these are for
drug overdoses, with only 5 to 15% of this number
being caused by cutting. In New Zealand, more females
are hospitalized for intentional self-harm than
males. Females more commonly choose methods such as
self-poisoning that generally are not fatal, but
still serious enough to require
hospitalization. A number of social or
psychological factors can be seen to have a
positive statistical correlation with self-injury
or its repetition. People experiencing various
forms of mental ill-health can be considered to be
at higher risk of self-injuring. Key issues are
depression, phobias, conduct disorders. Substance
abuse is also considered a risk factor as are some
personal characteristics such as poor problem
resolution skills, impulsivity, hopelessness and
aggression. Many self-injurers grew up in an
environment that discourages expression of anger.
Abuse during childhood is accepted as a primary
social factor, also losing a parent or loved one,
along with troubled parental or partner
relationships. Factors such as war, poverty, and
unemployment may also contribute. However, some people who
self-injure have no experience of these
factors. Attempts to understand
self-injury fall broadly into either attempts to
interpret motives, or application of psychological
models. Motives for self-injury are
often personal, often do not fit into medicalised
models of behavior and may seem incomprehensible to
others, as demonstrated by this quote: "My motivations for
self-harming were diverse, but included examining
the interior of my arms for hydraulic lines. This
may sound strange." Assessment of motives in a
medical setting is usually based on precursors to
the incident, circumstances and information from
the patient however the limited studies comparing
professional and personal assessments show that
these differ with professionals suggesting more
manipulative or punitive motives. The UK ONS study reported
only two motives: “to draw attention” and
“because of anger”. Many people who
self-injure state that it allows them to "go away"
or dissociate, separating the mind from feelings
that are causing anguish. This may be achieved by
tricking the mind into believing the pain felt at
the time is caused by self-injury instead of the
issues they were facing before: the physical pain
therefore acts as a distraction from emotional
pain. The sexual organs may be deliberately hurt as
a way to deal with unwanted feelings of sexuality,
or as a means of punishing sexual organs that may
be perceived as having responded in contravention
to the persons well being.(e.g., responses to child
sexual abuse). To complement this theory,
one can consider the need to 'stop' feeling
emotional pain and mental agitation. "A person may
be hypersensitive and overwhelmed; a great many
thoughts may be revolving within their mind, and
they may either become triggered or could make a
decision to stop the overwhelming
feelings." Alternatively self-injury may
be a means of feeling something, even if the
sensation is unpleasant and painful. Those who
self-injure sometimes describe feelings of
emptiness or numbness (anhedonia), and physical
pain may be a relief from these feelings. "A person
may be detached from himself or herself, detached
from life, numb and unfeeling. They may then
recognize the need to function more, or have a
desire to feel real again, and a decision is made
to create sensation and ‘wake up’." A
flow diagram of these two theories accompanies this
section. It is also important to note
that some self-injurers report feeling very little
to no pain while self-harming. Those who engage in
self-injury face the contradictory reality of
harming themselves whilst at the same time
obtaining relief from this act. It may even be hard
for some to actually initiate cutting, but they
often do because they know the relief that will
follow. For some self-injurers this relief is
primarily psychological whilst for others this
feeling of relief comes from the beta endorphins
released in the brain (the same chemicals
responsible for the "runner's high"). These act to
reduce tension and emotional distress and may lead
to a feeling of calm. As a coping mechanism,
self-injury can become psychologically addictive
because, to the self-injurer, it works; it enables
him/her to deal with intense stress in the current
moment. The patterns sometimes created by it, such
as specific time intervals between acts of
self-injury, can also create a behavioral pattern
that can result in a wanting or craving to fulfill
thoughts of self-injury. Another possible source of
self-injury can be self-loathing, often as a means
of punishment for having strong feelings that they
were expected to suppress when they were children,
or because they feel bad and undeserving, having
previously been physically or emotionally abused
and feeling that they were deserving of the
abuse. Another often overlooked area
that can result in self-injurious behavior is
processing disorders. Autistic-spectrum disorders,
especially when undiagnosed, or misdiagnosed, can
result in severe depression, anxiety and
fluctuating behavior. The rising depression rates
in the UK teenage population could be accounted for
by the fact that there is no testing being carried
out on the NHS for such disorders. If a person is
diagnosed with depression and anxiety, the help
available is most often medication and (arguably
pre-scientific) therapy (such as psychodynamic
therapy). This could mean that a large proportion
of people with various processing disorders are
unable to be diagnosed as such. It is arguable that
the stress resulting from living with no support
for an undiagnosed disorder, or being given
inappropriate therapy, could lead to self-injurious
behavior. Often, people with disorders
such as autism are unable to feel certain
stimulation, such as temperature, hunger and pain,
in the same way as someone without a processing
disorder usually would. In his book The Ultimate
Stranger: The Autistic Child, Carl Delacato (1974)
classified each sensory channel as being either
hyper (too much stimulation gets in through the
sensory channel for the brain to cope with) hypo
(too little stimulation gets in through the sensory
channel causing the brain to be deprived) and
"white noise" (the faulty channel creates its own
stimulus). A person with autism often
displays behaviors to balance their sensory
dysfunction. If, for example, a person was
hypo-tactile, they may attempt to stimulate
themselves by using methods that could be
categorized as self-injury. There are many movements
among the general self-injury community to make
self-injury itself and treatment better known to
mental health professionals as well as the general
public. SIAD (Self Injury Awareness Day) which is
set for March 1 of every year, is one such
movement. On this day some people choose to be more
open about their own self-injury, and awareness
organizations make special efforts to raise
awareness about self-injury. Some people wear
ribbons to show awareness; commonly orange ribbons
are used for this. Sometimes a red and black ribbon
is also used, generally signifying a person who
self-injures. Sometimes orange is used to represent
those who self-injure, white for those who don't
injure but show support and white and orange
together show someone who is trying to stop or has
stopped self-injury. A single white bead on an
orange bracelet may sometimes be used for those who
want to stop and several mixed white and orange
beads is for those who have stopped. Self-injury may be an
indicator of depression and / or other
psychological problems. Therapy and skills training
can be very useful for those who self-injure. The
therapy module used will vary depending on the
person's diagnosis and their individual
needs. DBT, or Dialectical
behavioral therapy can be very successful for those
with a personality disorder, and could potentially
be used for those with other mental illnesses who
exhibit self-injurious behavior. Cognitive
Behavioral Therapy is generally used to assist
those with axis 1 diagnoses, such as depression,
schizophrenia, and bipolar disorder. Diagnosis and
treatment of the causes is thought by many to be
the best approach to self-injury; but in some
cases, particularly in clients with a personality
disorder, this is not very effective, which is why
more clinicians are starting to take a DBT approach
in order to reduce the behavior itself. A person
who is injuring themselves may be advised to use
coping skills, such as journaling or taking a walk,
when they have the urge to harm themselves. They
may also be told to avoid having the objects they
use to harm themselves within easy reach. People
who rely on habitual self-injury are sometimes
psychiatrically hospitalized, based on their
stability, and their ability and especially their
willingness to get help. Understanding
Self-Injury/Self-Harm When someone self-injures,
they do not intend to die. Young people who
self-injure may do so as a method to cope with
stress– hurting themselves is often seen as a
way to control their upsetting feelings. Others do
so to dissociate from their problems (e.g. to
distract themselves from emotional pain). Research
suggests that self-injury can activate different
chemicals in the brain which relieve emotional
turmoil for a short period of time. Other motivations for why
teens may self-injure include: What are the symptoms of
self-injury? There are many ways in which
a young person can engage in self-injury
behaviours, but the most common is cutting the skin
with razor blades or pieces of glass. Injuries can
range from moderate to severe. Other forms of self-injury
include: Who is at risk for
self-injury behaviors? Self-injury has become more
common than most people suspect. People who
self-injure often begin in early adolescence,
although they can be any age, ethnicity, or
socioeconomic status. Young people who have
symptoms of Depression, Anxiety, or low self-esteem
are more likely to self-injure. There isn’t
one absolute predictor of self- injury, but the
following predictors increase someone’s risk
for self- injury. Information about the
prevalence of young people who self-injure varies.
This is because not everyone who self-injures seeks
help or treatment and because some jurisdictions
combine data on self-injury with data on suicide,
which makes it difficult to obtain an accurate
picture of either concern. A Canadian study
conducted in 2002 found that 13.9% of high school
students reported having self-injured. Females are
more likely to self-injure than males. How do you know if someone
you love self-injures? It's often difficult to know
if someone you love self-injures because many
people are very secretive about the behaviour. The
person may go to great lengths to hide any evidence
and cover up any physical injuries. Keep an eye out
for: Emotional warning signs are
important to consider as well. Some indicators may
include difficulty handling emotions or problems
with relationships. It is critical to recognize the
signs and get help early so that the person’s
behaviour does not escalate or lead to other
serious injuries. How can you tell the
difference between suicide and non-suicidal
self-injury? It is common for those
unfamiliar with self- injury to assume that self-
injury is a suicide attempt that didn’t work
– but that is incorrect. Self- injury is not
an attempt to die. Young people often say that they
self-injure so that they don’t attempt
suicide. This can be confusing to onlookers because
self- injury and suicide often involve the same
behaviours, but the key difference is the
motivation behind the behaviour. Individuals who
self-injure engage in these behaviours so that they
can feel better, not so that they can end their
life. Although self- injury is
different than suicide, many teens who self-injure
may be depressed and may indicate that life is not
worth living. They may have thoughts of death but
no actual intention to die. People who self-injure have a
hard time dealing with their feelings. Self- injury
is used to reduce, manage or escape from intense
emotions. If someone you know self-injures, listen
to what he or she is saying, talk about his or her
emotions, and encourage the person to get help. If
the young person is at immediate risk of hurting
him- or herself in a life-threatening way, he or
she should be taken to the hospital. What are the criteria for
diagnosis of non-suicidal
self-injury? It is important to note that
NSSI, or self-harm, is not a diagnosable mental
disorder. More research is required to help mental
health professionals better understand self- injury
in young people. The following criteria are
suggested as an area for further research in the
5th edition of the Diagnostic and Statistical
Manual of Mental Health Disorders
(DSM-V): 1. In the last year, the
individual has, on 5 or more days, engaged in
intentional self-inflicted damage to the surface of
his or her body of a sort likely to induce
bleeding, bruising, or pain (e.g., cutting,
burning, stabbing, hitting, excessive rubbing),
with the expectation that the injury will lead to
only minor or moderate physical harm (i.e., there
is no suicidal intent). Note: The absence of suicidal
intent has either been stated by the individual or
can be inferred by the individual’s repeated
engagement in a behavior that the individual knows,
or has learned, is not likely to result in
death. 2. The individual engages in
the self-injurious behavior with one or more of the
following expectations: 3. Note: The desired relief
or response is experienced during or shortly after
the self-injury, and the individual may display
patterns of behavior suggesting a dependence on
repeatedly engaging in it.The intentional
self-injury is associated with at least one of the
following: Prior to engaging in the
act, a period of preoccupation with the intended
behavior that is difficult to
control. Thinking about self-injury
that occurs frequently, even when it is not
acted upon. 4. The behavior is not
socially sanctioned (e.g., body piercing,
tattooing, part of a religious or cultural ritual)
and is not restricted to picking a scab or nail
biting. 5. The behavior or its
consequences cause clinically significant distress
or interference in interpersonal, academic, or
other important areas of functioning. 6. The behavior does not
occur exclusively during psychotic episodes,
delirium, substance intoxication, or substance
withdrawal. In individuals with a
neurodevelopmental disorder, the behavior is not
part of a pattern of repetitive stereotypies. The
behavior is not better explained by another mental
disorder or medical condition (e.g., psychotic
disorder, autism spectrum disorder, intellectual
disability, Lesch-Nyhan syndrome, stereotypic
movement disorder with self-injury,
trichotillomania [hair-pulling disorder],
excoriation [skin-picking]
disorder). What can you do if someone
in your life self-injures? It is important to encourage
someone who self-injures to seek help. Although he
or she may want to avoid discussing the issue,
understanding the feelings and emotions that make
him or her want to self-injure is an essential
component of treatment. In addition to better
understanding what causes someone to self-injure,
treatment also focuses on learning more adaptive
ways of coping, so that the individual can find
healthier and safer ways to solve his or her
problems. Although it’s important
to encourage the young person to seek help, he or
she must be ready and committed to change. Trying
to force someone to change his or her behaviour
before he or she is ready will only make the person
increasingly resistant to treatment and cause
frustration for you. Express your concern to the
young person, but don’t be overly dramatic or
cause a scene. The young person needs you to be
part of his or her support system now and when he
or she is in treatment. Self- injury can become
addictive and a habit, so it is important to be
patient during recovery. Don’t expect the
person to change his or her behaviour right away.
Remember that the person needs to have healthier
coping strategies in place before completely
relinquishing his or her self-injurious
behaviour. Being a positive influence
while the young person is seeking professional help
is important. Encourage him or her to avoid things
that can be used to hurt him- or herself. Remind
the person to do things that make him or her happy.
Help him or her connect with other people. Even
just spending time with him or her and listening to
what he or she has to say can make a difference.
Remember not to blame yourself and know that you
should not handle someone’s problems with
self- injury alone. What treatment options
exist for young people who
self-injure? A variety of treatment
options exist for youth who self-injure.
Determining which course of action is appropriate
for each individual should be done with the
guidance of a trained health
professional. Treatment options for youth
who self-injure may include one (or a combination)
of the following: Cognitive Behavior
Therapy (CBT), a type of therapy which helps
people understand, problem solve, and change
the relationship between their thoughts,
emotions, and behaviours Medication: Medication may
be used for young people who have symptoms of
Depression and/or Anxiety along with their
self-injury behaviours. Rather than treating the
self-injury directly, medication helps with the
underlying issues that are contributing to why
someone chooses to self-injure. For more
information on how to properly use medications,
check out MedEd. School supports: Sometimes
certain adaptations can be made by the school to
assist a student in coping with and managing his
or her self-injury. Regular Routine:
Maintaining a healthy, regular daily routine is
very important for someone who is struggling
with mental health issues. For help maintaining
the kind of healthy lifestyle that should
accompany professional treatment, check out
Taking
Charge of Your Health. Contagion and
self-injury For someone who uses healthy
coping strategies to deal with emotion, knowing
that someone else self-injures is unlikely to make
them start. If, however, someone has difficulty
coping with intense emotions, he or she may be more
likely to self-injure after finding out that
someone he or she knows self-injures. It’s
important to be aware that for some young people,
but not all, media portrayal and peer awareness of
self-injury may act as a trigger for their own
self- injury. Be attentive to what the young person
watches and hears, and talk to him or her about how
he or she is feeling. Related
disorders It’s important to note
that many young people who self-injure do not have
a mental illness; although it is more common for
someone who self-injures to have a mental illness
than someone who does not self-injure. Most often,
young people who self-injure are looking for a way
to deal with their emotions, and they will continue
to self-injure until they learn more effective
coping strategies. Why
do people self-harm? People who hurt themselves
most often start as teens or young adults. Because
people who self-injure frequently hide their
injuries from others, it can be difficult to
identify. There are many different
types of self-harm, which cause varying degrees of
damage. All forms should be taken
seriously. Why Do People
Self-Harm? People self-harm for a
variety of reasons. Understanding the reason
someone is hurting themselves is often an important
step to supporting them. Examples of reasons
include: Risks of
Self-Injury Self-harm has physical,
emotional, and social effects. Physical Effects Emotional Effects Social Effects The risk of accidental death
by self-injury is very real, and varies based on
the method. Treatment and Recovery:
How Do You Stop Self-Harming? It's normal to want to quit
self-harming, but feel unable to. Even knowing the
risks, many struggle to break themselves away from
the cycle. But it is possible. Here are some of the
key steps: 17 Quotes You Need if
You're Struggling with Self Harm According to Mental Health
America, 17-35% of college students engage in
self-harm. Part of the reason we don’t know
the exact numbers for sure is because of the
intense stigma around the topic. Many people
interpret self-harm as an way of “acting
out” or “looking for attention." However,
it’s important that we don’t stereotype--
pain does not discriminate and people of all ages
and backgrounds can be at risk for
self-harm. We’ve compiled a list of
quotes that we hope will help you overcome pain and
learn to love yourself. If you’re struggling
with self-harm, text SOS to 741741 to talk with a
trained Crisis Counselor. On Overcoming
Pain On Forgiving
Yourself On Loving
Yourself “Loving
yourself…does not mean being self-absorbed or
narcissistic, or disregarding others. Rather it
means welcoming yourself as the most honored guest
in your own heart, a guest worthy of respect, a
lovable companion.” Margo Anand Self-Injury:
The Secret Language of Pain for Teenagers Self-injury has not been a
topic discussed over family dinner. Although self-injury has been
plaguing lives for quite some time, with increasing
incidences being cited in middle school and high
school, it was not until 1996, when Princess Diana
admitted to bouts with self-injury, that article,
books, and television documentaries began to
appear. Now, conversations about self-injury are
appearing at the dinner table, despite its
remaining distastefulness. Today, researchers are
describing the phenomenon of self-injury among
teenagers as "the deliberate, direct, non-suicidal
destruction or alteration of one's body tissue"
(Favazza, 1996), and quantifying it under three
major categories: a) Major Self-Injury (the most
rare form which usually results in permanent
disfiguration), b) Stereotypic Self-Injury (which
consists of head banging and biting), and c)
Superficial Self-Injury (the most common which
involves cutting, burning, and hair pulling)
(Anonymous, 1999). Why would students purposely
hurt themselves? Our personal research indicates
that most students self-injure themselves because
they are unable to handle intense feelings, and so
they turn to self-injury as a way to express their
feelings and emotions. We tell audiences, "Pain
that is self-inflicted is pain over which a person
has control. Just enough pain will cause a person
to divert their attention away from the outside
pain over which they have no control to the known
pain they self-inflict." We like what psychologist
Scott Lines so eloquently said, "The skin becomes a
battlefield as a demonstration of internal chaos.
The place where the self meets the world is a
canvas or tabula rosa on which is displayed exactly
how bad one feels inside." Research indicates that
cutting is the most common method of adolescent
elf-injury, and is usually done with razor blades,
knives, or matches. In the following excerpt,
note the priority system involved in cutting, and
how this priority system centers on victim
convenience (i.e., the ability to hide the injury
the easiest). In the 1999 docudrama movie titled,
Secret Cutting it was revealed that the most common
parts of the body injured include (in ranked order)
"the forearms and wrists, upper arms, thighs,
abdomen, and occasionally, breasts and calves. The
reason for the variation in the ranked locations is
that those most concealed by clothing are the most
preferred areas." Crucially important to the
victim is concealment of the injury. By keeping
self-injuries away from peering eyes, the
adolescent can increase the ability to do it more
often without interruption. The fact that
self-injury has been so little documented until
recently is due in part to the "almost expert
awareness" on the part of the victim to be able to
avoid detection. It is common to associate a
great number of ancillary activities with
self-mutilation, but differentiate between what is,
and what is not harmful self-injury needs to be
made. Adolescent activities such as
skin piercing, tattoos, and group rituals fall into
the category of simple adolescent trends. Although
these activities fit the description of
self-injury, the motivation to engage in these
actions differs greater from intention physical
self-injury. For instance, teens want a tattoo, and
they do it for the tattoo or from peer pressure,
and not the pain that is involved in the procedure.
When a self-injurer cuts his or her skin it is to
feel the pain, and not for the decorative results
(Levenkron, 1998). We tell high school students
that self-injury is a self-inflicted act most often
used as a coping mechanism for relieving an
unwanted emotion, or as Jimmy Buffet (1999) said in
a song, "It's a permanent reminder of a temporary
feeling." Basically, it is a way to alter a mood
state by focusing pain in a controllable area of
the body. Think of a child who is riding his or her
bike right after a heated argument with a sibling.
That child would still be feeling angry or upset
about the argument. But if that child falls off the
bike and skins a knee, the primary concern
instantly becomes focused on the knee, not on the
anger. Falling off the bike made the child focus on
the feeling of physical pain, or the skinned knee.
The emotional anger that the child was feeling on
the inside has now seemed to vanish. Teens seek physical pain to
distract themselves from emotional pain. In popular
culture we see ... Self-Injury
and Cutting What Is
Self-Injury? Self-injury involves
self-inflicted bodily harm that is severe enough to
either cause tissue damage or to leave marks that
last several hours. Cutting is the most common form
of SI, but burning, head banging and scratching are
also common. Other forms include biting,
skin-picking, hair-pulling, hitting the body with
objects or hitting objects with the
body. Other Names Self-injury, self-harm,
self-mutilation, cutting, burning, SI. Why Do People Do
It? Although suicidal feelings
may accompany SI, it does not necessarily indicate
a suicide attempt. Most often it is simply a
mechanism for coping with emotional distress.
People who select this emotional outlet may use it
to express feelings, to deal with feelings of
unreality or numbness, to stop flashbacks, to
punish themselves, or to relieve
tension. Who
Self-Injures? Although SI is recognized as
a common problem among the teenage population, it
is not limited to adolescents. People of all sexes,
nationalities, socioeconomic groups and ages can be
self-injurers. Warning
Signs People who self-injure become
very adept at hiding scars or explaining them away.
Look for signs such as a preference for wearing
concealing clothing at all times (e.g. long sleeves
in hot weather), an avoidance of situations where
more revealing clothing might be expected (e.g.
unexplained refusal to go to a party), or unusually
frequent complaints of accidental injury (e.g. a
cat owner who frequently has scratches on their
arms). Treatments Medications such as
antidepressants, mood stabilizers and anxiolytics
may alleviate the underlying feelings that the
patient is attempting to cope with via SI. The
patient must also be taught coping mechanisms to
replace the SI. Once the patient is stable,
therapeutic work should be done to help the patient
cope with the underlying problems that are causing
their distress. Some experts say that
hospitalization or forced stopping of the SI is not
a helpful treatment. It may make the doctor and
involved friends and family feel more comfortable,
but does nothing to help the underlying problems.
Further, the patient is generally neither psychotic
nor actively suicidal and will benefit more from
working with a doctor who is compassionate to the
reasons that they are hurting themselves. Patient
desire to cooperate and get well is a major factor
in recovery. Signs
and symptoms of self-injury It’s more common amongst
girls to have these types of addictions but has
been seen as boys as well. Children who self-injure
will often battle with an eating disorder as well.
They might also have a history of sexual, physical
and/or emotional abuse or it may be a sign of or
low self-esteem. It begins as a defense of what is
going on in their personal lives and within their
family. They may feel they have failed in one area
of their lives and are looking for a way of taking
back control. Self-injury as a Sign for
other Issues Self-mutilation is a
severe impulse control disorder that can often be
associated with other psychiatric disorders. These
include: On the other hand, there are
“regular kids” going through the
adolescent struggle for self-identity and use
self-injury is a form of experimentation, similar
to alcohol or drugs that are also common around
this age range. Physical Signs and
Symptoms of Self-injury Because self-harm addiction
is often kept secret, it may be difficult to spot
signs and symptoms. Physical self-injury symptoms
may include: Situational Signs and
Symptoms of Self-injury Aside from physical examples
that are indicative of self-injury, there are
circumstantial evidences that loved ones can be
suspicious of. These warning signs that an
individual might be engaging in self-injury
include: How to Begin
Treatment In order for healing to take
place, the user must cease the form of self-injury
and allow the feelings they are avoiding to
surface. It is only then that they can begin a form
of counseling and therapy to start processing those
feelings. Self-mutilation treatment is most
beneficial with one-to-one counseling, group
therapy and a daily program of recovery is
implemented. Self-injury
Help If you or someone you know is
struggling with self-injury addiction, we can help.
Please call our toll free number at (877) 259-5635.
We are available 24 hours a day, seven days a week
to answer your questions on self-injury treatment
and addiction. Does
someone who cuts herself want to die? Perhaps you know someone who
cuts herself and wonder if she really wants to die?
The answer is that it depends. The very act of cutting is
not necessarily a suicidal gesture, however, those
who engage in self-harmful gestures such as cutting
may be struggling with suicidal thoughts.
Additionally, self-injurious acts can be life
threatening as they may accidentally go too far and
result in unintentional suicide. Why do people cut
themselves? People who cut themselves or
injure themselves in other ways report a sense of
relief after the act. Cutting, for them, is a way
of mitigating deep emotional pain or distracting
themselves from something they want to keep their
mind off. It can help people express feelings that
they are unable to articulate with words, and can
help people feel alive when otherwise they report
feeling numb. Cutting is a way of
coping. Interestingly, a 2003 study
headed by Naomi Eisenberger indicates that the
brain encodes physical pain and social emotional
pain in the same regions, namely the dorsal
anterior cingulate cortex and the anterior insula.
The fact that the brain handles emotional social
pain and physical pain in the same area may make
some sense of why someone might turn to physical
pain to help cope with emotional pain. Is it true that people who
cut themselves only do it for attention? While there are some people
who might cut or act in certain ways that call out
for attention, the vast majority of people who cut
are doing so because it is the best way they know
how to cope with deeply painful
feelings. Many people cut or engage in
self-harmful behaviors actually do so in secret.
People who cut often wrestle with a great deal of
shame and therefore hide this behavior. People
generally do not cut themselves for
attention. If people keep cutting a
secret, how can I tell if someone is
cutting? If you suspect that a friend
is cutting, the best way to find out is to ask them
from a non-judgmental and caring place. People can be scared of
bringing up difficult issues such as cutting or
suicide with people they are concerned about, but
talking about it is one of the ways to help a
suicidal friend or someone who cuts. Signs to look
out for may include unexplained injuries or wounds,
isolation, irritability, and other secretive
behaviors. Someone who seems to be especially
accident prone or wears long sleeves when the
weather is warm may also be hiding the fact that
they are injuring themselves while
alone. How can I help my friend
who is cutting? If you know someone who may
be cutting or engaging in some other kind of
self-injurious behavior, it might feel awkward to
bring it up in conversation. If you do try to talk
about it, your friend may deny that she or he cuts
or refuse to speak about it. Even so, it is worth
making the effort to talk about it It is important that you
refrain from judging your friend or belittling what
she or he is doing. Telling her or him to stop
probably will not help either. It is important to understand
why your friend is cutting, which likely has to do
with coping with difficult emotions. You can offer
your support and encourage your friend to talk
about his or her problems. The best thing is for your
friend to get appropriate mental health treatment.
You can encourage your friend to get help, and if
it makes sense for you, you can offer assistance on
how to find a psychotherapist. It is important that
the psychotherapist has experience working with
people who engage in self-harming
behaviors. Your friend who cuts
hopefully does not wish to die but is coping in a
way that is ineffective in the long run. Discussing
this problem in the open is often the first step
toward healing. Sources Eisenberger, N, Lieberman, M,
Williams, K. (2003). Does rejection hurt? An fMRI
study of social exclusion. Science, vol. 302, pp.
218-226. How
Are Self-Injury and Suicide Related? This is an excerpt from
Healing
Self-Injury: A Compassionate Guide for Parents and
Other Loved Ones, by
Janis Whitlock, PhD, and Elizabeth
Lloyd-Richardson, PhD. It’s not unusual for
young people who are struggling with painful
feelings to engage in self-injury
— things such as cutting, burning or
scratching themselves until they bleed. Knowing
that a child is intent on harming herself is very
upsetting to parents, and many worry that
self-injury is a sign that their child is
suicidal. Self-injury and suicidal
behaviors — imagining, planning or attempting
suicide — are related, but the relationship
between the two is confusing. Because they can look
similar, it can be very difficult to tell the
difference between them. But there are important
differences in the intention as well as the danger:
Self-injury is virtually always used to feel better
rather than to end one’s life. Indeed, some
people who self-injure are clear that it helps them
to avoid suicide. In fact, the technical term for
self-injury is non-suicidal self-injury, or
NSSI. Differences Self-injury and suicide
differ in multiple ways, including: The intent: The intent
of self-injury is almost always to feel better,
whereas for suicide it is to end feeling (and,
hence, life) altogether. The method used:
Methods for self-injury typically cause damage to
the surface of the body only. Suicide-related
behaviors are much more lethal. Notably, it is very
uncommon for individuals who practice self-injury
and who are also suicidal to identify the same
methods for each purpose. Level of damage and
lethality: Self-injury is often carried out
using methods designed to damage the body but not
to injure the body badly enough to require
treatment or to end life. Suicide attempts are
typically more lethal than standard NSSI
methods. Frequency: Self-injury
is often used regularly or off-and-on to
manage
stress and other emotions.
Suicide-related behaviors are much more
rare. Level of psychological
pain: The level of psychological distress
experienced in self-injury is often significantly
lower than that which gives rise to suicidal
thoughts and behaviors. Moreover, self-injury tends
to reduce arousal for many of those who use it and,
for many individuals who have considered suicide,
is used as a way to avoid attempting
suicide. Presence of cognitive
constriction: Cognitive constriction is
black-and-white thinking — seeing things as
all or nothing, good or bad, one way or the other.
It allows for very little ambiguity. Individuals
who are suicidal often experience high cognitive
constriction. The intensity of cognitive
constriction is less severe in individuals who use
self-injury as a coping mechanism. Aftermath: Although
unintentional death does occur with self-injury, it
is not common. The aftermath of a typical
self-injury incident is short-term improvement in
sense of well-being and functioning. The aftermath
of a suicide-related gesture or attempt is
precisely the opposite. Common risk
factors Despite differences and
intention, suicidal thoughts and behaviors and
self-injury do share common risk factors. Some of
these include: Because of these common
risk
factors, it is
important for you to know that youth who
self-injure are also at increased risk for
suicidality. Our work shows that about 65 percent
of youth who self-injure will also be suicidal at
some point (though many will not go beyond having
suicidal thoughts). For many, self-injury is used
alone or in combination with other behaviors as a
way to keep emotional distress or disconnectedness
at a manageable level. Although suicidal thoughts
and behaviors can occur before self-injury is used,
in most cases, suicidal thoughts and behaviors
coincide with or come after self-injury starts. It
is also important to note that only 36 percent of
adults who self-injure in the United States
reported having ever felt suicidal while engaging
in self-injury, meaning that the majority of
individuals who injure have never felt suicidal
while engaging in self-injury. Reducing inhibition to
suicidal behavior Although self-injury does not
cause suicide, the other important thing to know
about the relationship between self-injury and
suicide is that the very act of engaging in
self-injury reduces inhibition to suicidal behavior
if someone becomes suicidal. In other words, having
“practiced” injuring the body repeatedly
makes it easier to actually injure the body with
suicidal intent. Other factors that can place
someone at greater risk of moving from self-injury
to suicide include: These risk factors may be
present individually or in clusters. The more of
these your child has, the higher his or her risk is
of at least having suicidal thoughts (this is
called “suicidal ideation”). What is especially important
for you to know is that one of the most powerful
protective factors against moving from self-injury
to suicide is a feeling of connectedness to
parents. Indeed, the consistency with which parents
show up in our studies as important sources of
support for their children is one of the reasons we
wrote this book! Janis Whitlock, PhD, is the
founder and director of the Cornell Research
Program on Self-Injury and Recovery. Elizabeth E.
Lloyd-Richardson, PhD, is an associate professor of
psychology at the University of Massachusetts,
Dartmouth. This piece is an excerpt from
Healing
Self-Injury: A Compassionate Guide for Parents and
Other Loved Ones,
from Oxford University Press. This
researcher who studies self-injury explains why
people do it. And why he did it. You probably think of a
middle-class, teenage girl cutting herself to get
attention. That's the cliché, and it's all
kinds of wrong. Meet Dr. Stephen
Lewis. He's been researching
self-injury — we're most familiar with it as
cutting or burning — for over 10
years. A quick definition:
Self-injury is intentional damage to body tissue
(that doesn't include body modifications like
piercings, tattoos, and scarification) without
suicidal intent. And far more people are doing it
than you'd think. What he and other experts
found might surprise you: Self-injury happens
equally across gender, ethnicity, and socioeconomic
lines. It's not just an issue in the
U.S. either. Self-injury has emerged as a major
global mental health concern. Here's something else that
might surprise you: Lewis isn't just an academic
expert. He's a life expert. He lived
it. He used to self-injure, and
he shared his experience with the world in his talk
for TEDxGuelphU. It took some soul-searching
before Lewis decided to tell his story publicly. In
the end, he told me, "I wanted to convey a sense of
hope to those who presently struggle. I wanted them
to know they are not alone and that recovery is
possible." Like Lewis (and myself), 1 in
5 adolescents has engaged in self-injurious
behavior at least once, and a quarter of them have
done it repeatedly. It can start as young as age
12. As Lewis put it, "Self-injury
provided needed relief from that emotional turmoil
I was feeling inside. It conveyed the words I could
not." It's an attempt to relieve
overwhelming feelings of sadness, distress, or
self-loathing. Most often, people do it to
externalize inner pain, to make it tangible, or to
stop feeling numb. The relief that self-injury
provides is only temporary, though, and it can
develop an addictive quality: The longer it's used,
the harder it is to stop (or to find another way to
quell the pain). There's also a tolerance
factor: The more you self-injure, the shorter the
period of relief. It makes for a cycle that's
incredibly difficult to break. So, how can we help stop
the cycle of self-injury? Whether you're someone who
has self-injured or not, one of the most important
things we can do is educate ourselves: The false
cliches and stereotypes we carry around about
self-injury affect those who do it, too. When we characterize people
who hurt themselves as crazy, manipulative, or
attention-seeking, they're more inclined to feel
ashamed and isolated. They live in fear of
judgment, and that fear creates silence. This silence means that many
people feel hopeless and alone. While self-injury
isn't, by definition, a suicidal behavior, it does
elevate risk for suicide. Without help, that silence
and that hopelessness can be deadly. Self-injury is a habit that's
hard to break. One of the first steps toward ending
the cycle is for us to allow the conversation to
happen. Four little words are all
we need: "How can I help?" That's what turned things
around for Lewis: "For me, this involved a
willingness to not just ask for help, but to accept
it —something I was not accustomed to. This
help, for me, came from professionals. It came from
friends, and it came from my family." His story ends well. My
story — as a fellow self-injurer — ends
well, too. All of these stories can end
well. "Recovery is a process," said
Lewis. "And not a linear one. I had good days and
bad days, and on some bad days, I self injured
again. But those bad days became fewer and farther
between." Nobody should suffer alone.
We all have baggage, but we each bear the weight of
our burdens differently. We can help each other
bear that weight if we're brave enough to listen
and brave enough to start conversations that
matter. This is how we find better
ways to heal. This is how we create hope for those
who need it the most. Want more information on
self-injury? Take a look at the Self-Injury
Outreach and Support
website. Why
Teens Cut Themselves What Cutting
Is Cutting is a type of
self-harm in which teens deliberately cut or
scratch themselves with knives, razor blades, or
other sharp objects, but not with any intention of
trying to commit suicide. Other self-harm behaviors can
include head-banging, branding or burning their
skin, overdosing on medications, and
strangulation. These behaviors are more
common than you might think and affect up to 16
percent of teenagers and young adults. Why Teens Cut
Themselves Parents and pediatricians
often have a hard time understanding why teens
would cut or do other things to harm themselves.
Not surprisingly, cutting is a complex behavioral
problem and is often associated with a variety of
psychiatric disorders, including depression,
anxiety, and eating disorders. Teens who cut
themselves are more likely to have friends who cut
themselves, low self-esteem, a history of abuse,
and/or thoughts of committing suicide. While it is sometimes seen as
an attention-seeking behavior, cutting is a way for
kids to release tension, relieve feelings of
sadness or anger, or distract themselves from their
problems. Of course, any relief is only
temporary. While some teens who cut may
have a friend who cuts or may have read about it or
seen it on TV, most kids who start cutting say that
they were not influenced by anyone or anything else
and came up with the idea themselves. Signs of
Cutting Cutting is most common in
teens and young adults—especially among teen
girls—and often starts around age 14 or 15,
during the early high school years. Teens who cut themselves are
usually described as being impulsive. Some are also
described as being overachievers. In terms of warning signs and
red flags, your teen may be cutting if she:
If you think that your child
is cutting, ask her about it gently. If the answer
is yes, it's important not to get mad or overreact.
You don't want to make her feel bad for doing it.
Keep in mind that cutting is often a symptom of a
larger problem, and you, as a parent, can help your
child figure out the underlying cause by seeking
professional help (more on that below). Treatments for
Cutting It is critical to seek
treatment for your teen right away if she is
cutting, both to help treat any underlying
psychiatric problems, like depression or anxiety,
and to prevent cutting from becoming a bad
habit. The longer a teen cuts
herself, the harder it becomes to break the
habit. And cutting can lead to more
problems later in life. In fact, the S.A.F.E.
Alternatives (Self Abuse Finally Ends) treatment
program describes cutting as 'ultimately a
dangerous and futile coping strategy which
interferes with intimacy, productivity and
happiness.' These are some forms of
treatment that may help your teen quit cutting and
learn healthier coping strategies. Treatment
for cutting
Sources: American Academy of Child and
Adolescent Psychiatry. Facts for Families.
Self-Injury In Adolescents. Nonsuicidal self-harm in
youth: a population-based survey. Nixon MK - CMAJ -
29-JAN-2008; 178(3): 306-12 Source:
www.verywell.com/teen-cutting-and-self-harm-behaviors-2633862
Talk
with your kids about cutting
Injuring yourself on purpose
by making scratches or cuts on your body with a
sharp object, enough to break the skin and make it
bleed. The latest aggregated research has found
generally similar rates of self-harm between girls
and boys. People may cut themselves on
their wrists, arms, legs, or bellies. Some people
self-injure by burning their skin with the end of a
cigarette or lighted match. Cutting is a way some people
try to cope with the pain of strong emotions,
intense pressure, or upsetting relationship
problems. They may be dealing with feelings that
seem too difficult to bear, or bad situations they
think can't change. This practice has long
existed in secrecy. When cuts or burns heal, they
often leave scars or marks. Cuts can be easily
hidden under long sleeves. But in recent years,
movies and TV shows have drawn attention to it --
prompting greater numbers of teens and tweens (ages
9 to 14) to try it. Go to any school and ask, 'Do
you know anyone who cuts?' Yeah, everybody knows
someone. That might be a great way to start a
conversation What Parents Should
Do When parents suspect a
problem, they are usually at a loss of how to
approach their child. Be direct with your child.
Don't act out of anger or let yourself become
hysterical. But express concern. Say, 'We're going
to get help for you.' It's better to err on the
side of open communication. The kids may not talk
until they're ready. It's better to open up the
door, let them know you're aware of this. That
you're not going to punish them, that you're just
concerned. And if they don't come to you, go to
someone. Some parents mistake cutting
for suicidal behavior so the kid gets dragged into
the ER which often is a hostile environment for the
cutter. Many kids who are not suicidal at all are
being evaluated and even hospitalized as
suicidal. Psychotherapy should be the
first step in treatment. Ask if the therapist has
any expertise working with self-injurers. Some
therapists have a fear reaction to it. The
therapist needs to be comfortable with
it. The ultimate lynch pin is --
the child has to decide they're not going to do
this anymore. Any ultimatum, bribery, or putting
them in a hospital is not going to do it. They need
a good support system. They need treatment for
underlying disorders like depression. They need to
learn better coping mechanisms. Parents can help by providing
emotional support, helping identify early warning
signs, helping kids distract themselves, lowering
the child's stress level, and providing supervision
at critical times. But a parent can't do it for
them. It takes a certain level of resource to be
able to stop cutting, and many kids don't have
those resources. They need to stay in therapy until
they get to that point. Kids who develop this
behavior have fewer resources for dealing with
stress, fewer coping mechanisms. As they develop
better ways of coping, as they get better at
self-monitoring, it's easier to eventually give up
this behavior. But it's much more complicated than
something they will outgrow. What is
cutting?
Emma's friends had noticed
something strange as well. Even when the weather
was hot, Emma wore long-sleeved shirts. She had
become secretive, too, like something was bothering
her. But Emma couldn't seem to find the words to
tell her mom or her friends that the marks on her
arms were from something that she had done. She was
cutting herself with a razor when she felt sad or
upset. Injuring yourself on purpose
by making scratches or cuts on your body with a
sharp object — enough to break the skin and
make it bleed — is called cutting. Cutting is
a type of self-injury, or SI. Most people who cut
are girls, but guys self-injure, too. People who
cut usually start cutting in their young teens.
Some continue to cut into adulthood. People may cut themselves on
their wrists, arms, legs, or bellies. Some people
self-injure by burning their skin with the end of a
cigarette or lighted match. When cuts or burns heal, they
often leave scars or marks. People who injure
themselves usually hide the cuts and marks and
sometimes no one else knows. Why Do People Cut
Themselves? It can be hard to understand
why people cut themselves on purpose. Cutting is a
way some people try to cope with the pain of strong
emotions, intense pressure, or upsetting
relationship problems. They may be dealing with
feelings that seem too difficult to bear, or bad
situations they think can't change. Some people cut because they
feel desperate for relief from bad feelings. People
who cut may not know better ways to get relief from
emotional pain or pressure. Some people cut to
express strong feelings of rage, sorrow, rejection,
desperation, longing, or emptiness. There are other ways to cope
with difficulties, even big problems and terrible
emotional pain. The help of a mental health
professional might be needed for major life
troubles or overwhelming emotions. For other tough
situations or strong emotions, it can help put
things in perspective to talk problems over with
parents, other adults, or friends. Getting plenty
of exercise can also help put problems in
perspective and help balance emotions. But people who cut may not
have developed ways to cope. Or their coping skills
may be overpowered by emotions that are too
intense. When emotions don't get expressed in a
healthy way, tension can build up — sometimes
to a point where it seems almost unbearable.
Cutting may be an attempt to relieve that extreme
tension. For some, it seems like a way of feeling
in control. The urge to cut might be
triggered by strong feelings the person can't
express — such as anger, hurt, shame,
frustration, or alienation. People who cut
sometimes say they feel they don't fit in or that
no one understands them. A person might cut because
of losing someone close or to escape a sense of
emptiness. Cutting might seem like the only way to
find relief or express personal pain over
relationships or rejection. People who cut or self-injure
sometimes have other mental health problems that
contribute to their emotional tension. Cutting is
sometimes (but not always) associated with
depression, bipolar disorder, eating disorders,
obsessive thinking, or compulsive behaviors. It can
also be a sign of mental health problems that cause
people to have trouble controlling their impulses
or to take unnecessary risks. Some people who cut
themselves have problems with drug or alcohol
abuse. Some people who cut have had
a traumatic experience, such as living through
abuse, violence, or a disaster. Self-injury may
feel like a way of "waking up" from a sense of
numbness after a traumatic experience. Or it may be
a way of reinflicting the pain they went through,
expressing anger over it, or trying to get control
of it. What Can Happen to People
Who Cut? Although cutting may provide
some temporary relief from a terrible feeling, even
people who cut agree that it isn't a good way to
get that relief. For one thing, the relief doesn't
last. The troubles that triggered the cutting
remain — they're just masked over. People don't usually intend
to hurt themselves permanently when they cut. And
they don't usually mean to keep cutting once they
start. But both can happen. It's possible to
misjudge the depth of a cut, making it so deep that
it requires stitches (or, in extreme cases,
hospitalization). Cuts can become infected if a
person uses nonsterile or dirty cutting instruments
— razors, scissors, pins, or even the sharp
edge of the tab on a can of soda. Most people who cut aren't
attempting suicide. Cutting is usually a person's
attempt at feeling better, not ending it all.
Although some people who cut do attempt suicide,
it's usually because of the emotional problems and
pain that lie behind their desire to self-harm, not
the cutting itself. Cutting can be habit forming.
It can become a compulsive behavior — meaning
that the more a person does it, the more he or she
feels the need to do it. The brain starts to
connect the false sense of relief from bad feelings
to the act of cutting, and it craves this relief
the next time tension builds. When cutting becomes
a compulsive behavior, it can seem impossible to
stop. So cutting can seem almost like an addiction,
where the urge to cut can seem too hard to resist.
A behavior that starts as an attempt to feel more
in control can end up controlling you. How Does Cutting
Start? Cutting often begins on an
impulse. It's not something the person thinks about
ahead of time. Shauna says, "It starts when
something's really upsetting and you don't know how
to talk about it or what to do. But you can't get
your mind off feeling upset, and your body has this
knot of emotional pain. Before you know it, you're
cutting yourself. And then somehow, you're in
another place. Then, the next time you feel awful
about something, you try it again — and slowly
it becomes a habit." Natalie, a high-school junior
who started cutting in middle school, explains that
it was a way to distract herself from feelings of
rejection and helplessness she felt she couldn't
bear. "I never looked at it as anything that bad at
first — just my way of getting my mind off
something I felt really awful about. I guess part
of me must have known it was a bad thing to do,
though, because I always hid it. Once a friend
asked me if I was cutting myself and I even lied
and said 'no.' I was embarrassed." Sometimes self-injury affects
a person's body image. Jen says, "I actually liked
how the cuts looked. I felt kind of bad when they
started to heal — and so I would 'freshen them
up' by cutting again. Now I can see how crazy that
sounds, but at the time, it seemed perfectly
reasonable to me. I was all about those cuts —
like they were something about me that only I knew.
They were like my own way of controlling things. I
don't cut myself anymore, but now I have to deal
with the scars." You can't force someone who
self-injures to stop. It doesn't help to get mad at
a friend who cuts, reject that person, lecture her,
or beg him to stop. Instead, let your friend know
that you care, that he or she deserves to be
healthy and happy, and that no one needs to bear
their troubles alone. Pressured to
Cut? Girls and guys who
self-injure are often dealing with some heavy
troubles. Many work hard to overcome difficult
problems. So they find it hard to believe that some
kids cut just because they think it's a way to seem
tough and rebellious. Tia tried cutting because a
couple of the girls at her school were doing it.
"It seemed like if I didn't do it, they would think
I was afraid or something. So I did it once. But
then I thought about how lame it was to do
something like that to myself for no good reason.
Next time they asked I just said, 'no, thanks
— it's not for me.' " If you have a friend who
suggests you try cutting, say what you think. Why
get pulled into something you know isn't good for
you? There are plenty of other ways to express who
you are. Lindsay had been cutting
herself for 3 years because of abuse she suffered
as a child. She's 16 now and hasn't cut herself in
more than a year. "I feel proud of that," Lindsay
says. "So when I hear girls talk about it like it's
the thing to do, it really gets to me." Getting
Help There are better ways to deal
with troubles than cutting — healthier,
long-lasting ways that don't leave a person with
emotional and physical scars. The first step is to
get help with the troubles that led to the cutting
in the first place. Here are some ideas for doing
that: Tell someone. People
who have stopped cutting often say the first step
is the hardest — admitting to or talking about
cutting. But they also say that after they open up
about it, they often feel a great sense of relief.
Choose someone you trust to talk to at first (a
parent, school counselor, teacher, coach, doctor,
or nurse). If it's too difficult to bring up the
topic in person, write a note. Identify the trouble
that's triggering the cutting. Cutting is a way
of reacting to emotional tension or pain. Try to
figure out what feelings or situations are causing
you to cut. Is it anger? Pressure to be perfect?
Relationship trouble? A painful loss or trauma?
Mean criticism or mistreatment? Identify the
trouble you're having, then tell someone about it.
Many people have trouble figuring this part out on
their own. This is where a mental health
professional can be helpful. Ask for help. Tell
someone that you want help dealing with your
troubles and the cutting. If the person you ask
doesn't help you get the assistance you need, ask
someone else. Sometimes adults try to downplay the
problems teens have or think they're just a phase.
If you get the feeling this is happening to you,
find another adult (such as a school counselor or
nurse) who can make your case for you. Work on it. Most
people with deep emotional pain or distress need to
work with a counselor or mental health professional
to sort through strong feelings, heal past hurts,
and to learn better ways to cope with life's
stresses. One way to find a therapist or counselor
is to ask at your doctor's office, at school, or at
a mental health clinic in your
community. Although cutting can be a
difficult pattern to break, it is possible. Getting
professional help to overcome the problem doesn't
mean that a person is weak or crazy. Therapists and
counselors are trained to help people discover
inner strengths that help them heal. These inner
strengths can then be used to cope with life's
other problems in a healthy way. Teenage
Cutting: A Trend on the Rise
Wendy Lader, PhD, clinical
director of S.A.F.E Alternatives and co-author of
Bodily Harm, says self-harm is more prevalent than
most people think. “Studies on adolescents in
community samples report a lifetime prevalence
between 15 and 20 percent,” she
says. So, why would kids
purposefully cut themselves? The most common reason
is control of emotions, according to Lader.
“For kids experiencing intense emotions, it
can be used to deaden the intensity. For those
feeling a sense of numbness, it serves the opposite
effect, helping them feel something,” Lader
says. Experts say for some
adolescents, self-injury indicates other mental
health concerns, such as depression. Others use is
as a way to fit in with peers. And this behavior can become
addictive, according to Susan Bowman, licensed
counselor and author of See My Pain: Creative
Strategies and Activities for Helping Young People
Who Self-Injure. “When kids cut themselves, it
releases endorphins and they get a high from
it,” she says. “It becomes a control
issue: This is the way I release the
pressure.” There are clues that parents
can watch for when it comes to self-injury. In
addition to unexplained cuts and bruises, a change
in communication, eating or sleeping patterns can
be red flags. Though parents are understandably
appalled at the thought of their child
self-injuring, Bowman says this is exactly the
reaction to avoid. “If you are shocked by a
cut on their wrist, they may not trust you to
accept and deal with what’s really bothering
them,” she says. “They need caring and
nurturing.” So, how should you react?
Here's some advice from the experts: •Communication is key.
“Listen. Speak calmly, without judging, while
expressing your love and concern,” Lader says.
“Don’t try to offer your opinion or fix
the problem. The goal is to foster open
communication,” •Ask the right
questions. Bowman says parents should use
“what” and “how” questions,
like “What makes you want to hurt
yourself?” • Positive attention is
a valuable part of the healing process. “Kids
need attention when they are using positive coping
skills and talking about their problems,”
Bowman says. • Consider therapy.
“A therapist can help determine if the child
is experiencing some underlying issue that they
don’t know how to identify or talk
about,” says Lader. If you aren't sure how to
choose a therapist, the school counselor might be a
good place to start. Bowman also advises looking
for someone experienced in adolescent issues, and
specifically self-injury. “A combination of
therapy techniques, such as cognitive, behavioral
and creative arts therapy usually works best,”
Bowman says. Self-injury is a cry for
help. Kids engaging in these behaviors desperately
need parents to provide understanding and a
willingness to listen. Cutting
and Self-Harm: Warning Signs and Treatment
Cutting. It's a practice that
is foreign, frightening, to parents. It is not a
suicide attempt, though it may look and seem that
way. Cutting is a form of self-injury -- the person
is literally making small cuts on his or her body,
usually the arms and legs. It's difficult for many
people to understand. But for kids, cutting helps
them control their emotional pain, psychologists
say. This practice has long
existed in secrecy. Cuts can be easily hidden under
long sleeves. But in recent years, movies and TV
shows have drawn attention to it -- prompting
greater numbers of teens and tweens (ages 9 to 14)
to try it. It's clear that estrogen is
closely linked with women's emotional well-being.
Depression and anxiety affect women in their
estrogen-producing years more often than men or
postmenopausal women. Estrogen is also linked to
mood disruptions that occur only in women --
premenstrual syndrome, premenstrual dysphoric
disorder, and postpartum depression. Exactly how
estrogen affects emotion is much less
straightforward. Is it too much estrogen? Not
enough? It turns out estrogen's emotional
effects... "We can go to any school and
ask, 'Do you know anyone who cuts?' Yeah, everybody
knows someone," says Karen Conterio, author of the
book, Bodily Harm. Twenty years ago, Conterio
founded a treatment program for self-injurers
called SAFE (Self Abuse Finally Ends) Alternatives
at Linden Oak Hospital in Naperville, Ill., outside
of Chicago. Picture of an Unhappy
Kid Her patients are getting
younger and younger, Conterio tells WebMD.
"Self-harm typically starts at about age 14. But in
recent years we've been seeing kids as young as 11
or 12. As more and more kids become aware of it,
more kids are trying it." She's also treated plenty
of 30-year-olds, Conterio adds. "People keep doing
it for years and years, and don't really know how
to quit." The problem is particularly
common among girls. But boys do it, too. It is an
accepted part of the "Goth" culture, says Wendy
Lader, PhD, clinical director for SAFE
Alternatives. Being part of Goth culture
may not necessarily mean a kid is
unhappy. Lader says "I think kids in
the Goth movement are looking for something, some
acceptance in an alternative culture. And
self-injury is definitely a coping strategy for
unhappy kids." Very often, kids who
self-harm have an eating disorder. "They may have a
history of sexual, physical, or verbal abuse,"
Lader adds. "Many are sensitive, perfectionists,
overachievers. The self-injury begins as a defense
against what's going on in their family, in their
lives. They have failed in one area of their lives,
so this is a way to get control." Self-injury can also be a
symptom for psychiatric problems like borderline
personality disorder, anxiety disorder, bipolar
disorder, schizophrenia, she says. Yet many kids who self-injure
are simply "regular kids" going through the
adolescent struggle for self-identity, Lader adds.
They're experimenting. "I hate to call it a phase,
because I don't want to minimize it. It's kind of
like kids who start using drugs, doing dangerous
things." Blunting Emotional
Pain Psychiatrists believe that,
for kids with emotional problems, self-injury has
an effect similar to cocaine and other drugs that
release endorphins to create a feel-good
feeling. "Yet self-harm is different
from taking drugs," Conterio explains. "Anybody can
take drugs and feel good. With self-injury, if it
works for you, that's an indication that an
underlying issue needs be dealt with -- possibly
significant psychiatric issues. If you're a healthy
person, you might try it, but you won't
continue." Self-harm may start with the
breakup of a relationship, as an impulsive
reaction. It may start simply out of curiosity. For
many kids, it's the result of a repressive home
environment, where negative emotions are swept
under the carpet, where feelings aren't discussed.
"A lot of families give the message that you don't
express sadness," says Conterio. It's a myth that this
behavior is simply an attention-getter, adds Lader.
"There's a [painkiller] effect that these
kids get from self-harm. When they are in emotional
pain, they literally won't feel that pain as much
when they do this to themselves." What It Looks
Like David Rosen, MD, MPH, is
professor of pediatrics at the University of
Michigan and director of the Section for Teenage
and Young Adult Health at the University of
Michigan Health Systems in Ann Arbor. He offers parents tips on
what to watch for: Small, linear cuts. "The most
typical cuts are very linear, straight line, often
parallel like railroad ties carved into forearm,
the upper arm, sometimes the legs," Rosen tells
WebMD. "Some people cut words into themselves. If
they're having body image issues, they may cut the
word 'fat.' If they're having trouble at school, it
may be 'stupid,' 'loser,' 'failure,' or a big 'L.'
Those are the things we see pretty
regularly." Unexplained cuts and
scratches, particularly when they appear regularly.
"I wish I had a nickel for every time someone says,
'The cat did it,'" says Rosen. Mood changes like depression
or anxiety, out-of-control behavior, changes in
relationships, communication, and school
performance. Kids who are unable to manage
day-to-day stresses of life are vulnerable to
cutting, says Rosen. Over time, the cutting
typically escalates -- occurring more often, with
more and more cuts each time, Rosen tells WebMD.
"It takes less provocation for them to cut. It
takes more cutting to get the same relief -- much
like drug addiction. And, for reasons I can't
explain but have heard often enough, the more blood
the better. Most of the cutting I see is quite
superficial, and looks more like scratches than
cuts. It's the sort that when you put pressure on
it, it stops the bleeding." What Parents Should
Do When parents suspect a
problem, "they are at a loss of how to approach
their child," Conterio says. "We tell parents it's
better to err on the side of open communication.
The kids may talk when they're ready. It's better
to open up the door, let them know you're aware of
this, and if they don't come to you, go to someone
else ... that you're not going to punish them, that
you're just concerned." Be direct with your child,
adds Lader. "Don't act out of anger or let yourself
become hysterical -- 'I'm going to watch you every
second, you can't go anywhere.' Be direct, express
concern. Say, 'We're going to get help for
you.'" Parents often mistake cutting
for suicidal behavior. "That's usually when they
have finally seen the cuts, and they don't know how
to interpret it," explains Rosen. "So the kid gets
dragged into the ER. But ER doctors aren't always
used to seeing this, and find it difficult to
understand whether it's suicidal or self-injurious
behavior. Many kids who are not suicidal at all are
being evaluated and even hospitalized as
suicidal." Unfortunately, "the attitude
in hospital emergency rooms can be very cavalier
and harsh about self-injurers," adds Lader.
"There's a lot of dislike, because it's a self-made
injury, so ER personnel can be very hostile. There
are all kinds of stories of girls getting stitched
without anesthetic. The thing is, after they've
self-injured, the girls are calmer -- so when
they're getting stitches, they feel the pain. Yet
the doctor is angry, wants to get this over
with." Psychotherapy should be the
first step in treatment, Lader adds. The SAFE web
site has a list of doctors who have been to her
lectures, who want to work with self-injurers. With
other therapists, ask if they have any expertise in
working with self-injurers. "Some therapists have a
fear reaction to it. The therapist needs to be
comfortable with it," she advises. However, the girl or boy must
be ready for treatment, says Rosen. "The ultimate lynch pin is --
the child has to decide they're not going to do
this anymore," he tells WebMD. "Any ultimatum,
bribery, or putting them in a hospital is not going
to do it. They need a good support system. They
need treatment for underlying disorders like
depression. They need to learn better coping
mechanisms." When An Inpatient Program
Is Necessary When kids just can't break
the cycle through therapy, an inpatient program
like SAFE Alternatives can help. In their 30-day program,
Lader and Conterio only treat patients who
voluntarily request admission. "Anybody who can't
perceive that they have a problem will be hard to
treat," says Conterio. Those who come to us have
recognized that they have a problem, that they need
to stop. We tell them in the acceptance letter we
send them, 'This is your first step toward
empowering yourself.'" When admitted to SAFE,
patients sign a contract that they won't
self-injure during that time. "We want to teach
them to operate in the real world," says Lader.
"That means making choices in response to emotional
conflict -- healthier choices, rather than just
self-injuring to feel better. We want them to
understand why they are angry, show them how to
handle their anger." Although self-harm is not
allowed, "we don't take away razors," Conterio
adds. "They can shave. We don't take belts or shoe
laces. The message we're sending is, 'We believe
you're capable of making better
choices.'" Turning Inward to
Heal Many kids haven't thought
about it at all -- exactly why they self-injure,
says Lader. "It's like any addiction, if I can take
a pill or self-medicate in some way, why deal with
the problem? We teach people that cutting only
works in the short term, and that it will only get
worse and worse." When kids learn to face their
problems, they will quit self-harming, she adds.
"Our goal is to get them to communicate what's
wrong. Babies don't have the capacity for language,
so they use behavior. These adolescents regress to
that preverbal state when they
self-harm." Individual and group therapy
are the hubs of this treatment program. If there is
underlying depression or anxiety, antidepressants
may be prescribed. The patients also write
regularly in their journals -- to learn to explore
and express their feelings. Helping them gain
self-respect and self-esteem is a critical
treatment goal, Conterio tells WebMD. "Many kids have difficulty
dealing with situations and people that make them
angry," Lader adds. "They don't have great role
models for that. Saying no, standing up to people
-- they don't really believe they're allowed to do
that, especially girls. But if you can't do that,
it's very difficult to maneuver the world, survive
in the world without someone stronger, more capable
than you to fight your battles." Circular negative thinking
keeps kids from developing self-esteem. "We help
them empower themselves, take risks in
confrontation, change how they view themselves,"
says Conterio. "If you can't set limits on someone
else's behavior, stand up to them -- you can't like
yourself. Once these girls learn to take care of
themselves, stand up for what they want, they will
like themselves better." "We want them to get to the
point where they believe, 'I am somebody, I do have
a voice, I can make changes, instead of, 'I'm
nobody,'" she says. Staying
Safe One study of the SAFE program
showed that, two years after participating, 75% of
patients had a decrease in symptoms of self-injury.
An ongoing study is indicating a decrease in
hospitalizations and emergency room
visits. "I've been doing this for 20
years, and the success rate is far greater than the
failure rate," says Conterio. "We truly believe
that if people can continue to make healthy
choices, they won't go back to self-harm. We get
emails that are a blast from the past. Some
patients do extremely well. Others regress. Others
have finally decided to do the work they learned
here. When they apply it, they do well. It all goes
back to choice." The bottom line: "When kids
decide they don't want to cut any more - and they
get stressed again -- they have to be able to
manage stress as it arises," Rosen says. "They
can't succumb to cutting. People who can figure out
some alternative way to manage stress will
eventually quit it." Parents can help by providing
emotional support, helping identify early warning
signs, helping kids distract themselves, lowering
the child's stress level, and providing supervision
at critical times, Rosen says. "But a parent can't
do it for them. It takes a certain level of
resource to be able to stop cutting, and many kids
don't have those resources. They need to stay in
therapy until they get to that point." Self-harm is not a problem
that kids simply outgrow, Rosen adds. "Kids who
develop this behavior have fewer resources for
dealing with stress, fewer coping mechanisms. As
they develop better ways of coping, as they get
better at self-monitoring, it's easier to
eventually give up this behavior. But it's much
more complicated than something they will
outgrow." Wound
Locations Other Quick
Facts on Self-Injury
A brief
overview of the signs of self-injury and how it's
treated in children and adolescents. Self-injury
is characterized by deliberately injuring oneself
to alleviate some kind of emotional distress. The
most common form of self-injury is cutting or
scratching the skin, but people also self-injure by
burning themselves, picking at skin and wounds, or
hitting themselves. Self-injury is more common in
girls than boys, and onset is often around
puberty. Signs Your
Child May Be Self-Harming: How to
Help If you
discover that a child has been hurting herself it's
important to have her evaluated by an experienced
mental health professional to find out why she is
self-injuring and what emotional difficulties she's
experiencing. Therapy: 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 at treating kids who self-harm. Cutting/Self
Harm
Self-harm (SH) or deliberate
self-harm (DSH) includes self-injury (SI) and
self-poisoning and is defined as the intentional,
direct injuring of body tissue without suicidal
intent. These terms are used in the more recent
literature in an attempt to reach a more neutral
terminology. The older literature, especially that
which predates the DSM-IV-TR, almost exclusively
refers to self-mutilation. The term is synonymous
with
"self-injury."[1][2][3] The
most common form of self-harm is skin-cutting but
self-harm also covers a wide range of behaviours
including, but not limited to, burning, scratching,
banging or hitting body parts, interfering with
wound healing, hair-pulling (trichotillomania
Self-harm in childhood is
relatively rare but the rate has been increasing
since the 1980s.[12] Self-harm is listed in
the Diagnostic
and Statistical Manual of Mental
Disorders Self-harm is most common in
adolescence and young adulthood, usually first
appearing between the ages of 12 and
24.[1][5][6][17][18]
However, self-harm can occur at any
age,[13] including in the elderly
population.[19] The risk of serious injury
and suicide is higher in older people who
self-harm.[18] Self-harm is not limited to
humans. Captive non-human animals are also known to
participate in self-mutilation, such as captive
birds and monkeys.[20][21]
If you notice any of these
warning signs in a friend or loved one, you should
talk to them and express your concerns; let them
know that help is available. Remember that the
person is already experiencing emotional pain, so
it’s important to be caring and compassionate.
Don’t judge them or make them feel bad about
their behavior. Gender
differences
Does
Cutting Mean That Someone Is Suicidal? Answer: While it might
seem like she is hurting herself because she wants
to commit suicide—after all, cutting the
wrists is one method that people use to kill
themselves—this isn't necessarily what her
intentions are. People who injure themselves by
cutting, scratching, burning and other methods of
self-harm are often doing it as a way to relieve
their emotional suffering. While it might seem
counterintuitive that causing oneself physical pain
could help emotional pain, many cutters report that
this is exactly what happens. Cutting causes the
release of chemicals called endorphins. Endorphins
are the body's own natural painkillers and they
help it to cope with the stress and pain associated
with injury. They can also help dampen emotional
pain. Other reasons that
self-injurers often give for cutting and self-harm
are: releasing anger, slowing down racing thoughts
and coping with dissociation or flashbacks. When
dissociation or flashbacks occur, the physical
sensations of pain are a way for the person to
ground themselves back in reality. While I can't say for certain
whether your daughter is experiencing any thoughts
of suicide, one thing I do feel fairly certain of
is that she is going through quite a bit of
emotional turmoil and needs your help and support.
You will need to do what you can to ensure that she
gets professional treatment with both medications
(to help quell the feelings that are driving her
urges to hurt herself) and therapy (to help teach
her better ways to deal with her
feelings). Please be aware that this is
not just a passing phase that she is going through
or a cry for attention. You should take this quite
seriously. Cutting can be very addictive and hard
to stop without assistance. There is also the risk
that she may accidentally hurt herself more
seriously than she intends to. Sources: Alderman, Tracy.
"Myths and Misconceptions of Self-Injury: Part II."
Psychology Today. Sussex Publishers, LLC.
Published: Ocobert 22, 2009. Accessed: June 28,
2015. Ferrales, Diana and
Sonja Koukel. "Teens and Self-Cutting (Self-Harm):
Information for Parents: Guide I-104." New Mexico
State University. New Mexico State University Board
of Regents. Accessed: June 28, 2015. Lohmann, Raychelle
Cassada. "Understanding Suicide and Self-Harm."
Psychology Today. Sussex Publishers, LLC.
Published: October 28, 2012. Accessed: June 28,
2015. It concerns me that
you are, probably unintentionally, aiding the
concept that girls are the only ones that
self-harm. While you do use the word "people" at
times, I have yet to find a comment from you that
says that boys self-harm at about the same rate as
girls, though their self harm is more around
burning and scratching. With headings like "Does
someone who cuts herself want to die?" makes it
look like victomology and does not address the real
issue that it's not just a girl's issue by any
means. How different would that article and others
you write, to acknowledge the surprising statistic
that self-harm is about equally practiced by girls
and boys. Wouldn't your readers be shocked by that
information? Changing the title of that
article to "Does someone who cuts themselves want
to die?" would give you a chance to talk about
the issue of equality and differenecs and bring
this hidden fact to light.
depression.about.com/od/selfinjury/
How do
I knows if my friend is self-injuring? This secrecy itself may be a
signal that something is wrong – especially if
this is out of the ordinary for your friend (e.g.,
you notice your friend doesn’t want to hang
out with anyone any more). Another important sign to
look for is a significant change in your
friend’s mood or behavior. If you notice that
your friend is withdrawing from you or others and
feeling down for a prolonged period of time, there
may be something going on. As a friend, checking in
to see what might be going on for your friend and
expressing your concern is okay (we provide a few
steps on how to bring up self-injury with your
friend, below). Often, when people
self-injure, they experience more negative moods
(e.g., sadness, stress, anxiety, frustration); they
may also become more distant. Here are a few other
possible signs of non-suicidal self-injury that are
important to be aware of: 2. Finding razors, knives
or other items that may be used to
self-injure. 3. Noticing that your
friend is spending less time with you, other
friends, or family members, and there is no real
reason for this. They may spend much more time
alone, may not answer your calls, or may not
respond to your texts like they used
to. 4. Noticing that your
friend is wearing clothing that doesn’t
quite match the weather (e.g., wearing a
long-sleeved shirt and pants on hot summer
days). Your friend may be hiding scars, wounds,
or bruises by wearing clothing or bracelets that
cover body parts where he or she
self-injures. These signs do not mean that
your friend is definitely self-injuring, just that
he/she might be. You should talk with your friend
if you suspect self-injury, as something else
besides self-injury could be going on. How
do I talk to my friend about self-injury? 2. Be honest with your
friend about how worried you are. 3. Be aware of how you
feel. If you feel really upset, it may not be a
good time to have the conversation and you may
need to take some time for yourself first. It is
important to remain calm and avoid reacting
strongly because it was probably very difficult
for your friend to tell you in the first
place. 4. Focus the conversation
on your friend’s feelings and emotions,
rather than his/her self-injury. 5. Do not judge your
friend or make threats (e.g., they have to stop
or else you won’t talk to them anymore).
Your friend has come to you because they trust
that you will be supportive during this
difficult time. 6. Do not promise your
friend that you can keep his/her self-injury a
secret. Make sure your friend knows that you are
worried, you care about him/her, and that it is
important to you that they stay safe and get
help. You cannot stop someone from
self-injuring, but you can help them find
someone who can provide the professional support
they need. 7. Don’t be afraid to
ask your friend questions about his/her
self-injury but don’t put the pressure on.
Some people have difficulty talking about it.
Expressing your support and helping your friend
find someone they feel comfortable talking to is
most important. 8. Understand that people
do not self-injure just for attention or
“drama”, if they are doing this they
need to be taken seriously and supported. This
can be difficult at times, but it is important
to not dismiss your friend’s self-injury as
unimportant, manipulative or
attention-seeking If your friend does not want
to talk about it, that’s okay. It can be
difficult at first. Continue to let your friend
know that he/she is not alone and that you are
there to support him/her. Let your friend know that
you are concerned and that you will be there to
listen when they are ready. Six types:
2. religious –
self-flagellants and others. 3. puberty rites – hymen
removal, circumcision or clitoral
alteration. 4 .psychotic – eye or
ear removal, genital self-mutilation and extreme
amputation 5. organic brain diseases
– which allow repetitive head-banging,
hand-biting, finger-fracturing or eye
removal. Classification Examples of
Behavior Degree of Physical
Damage Psychological
State Social Acceptability
I Ear-piercing,
nail-biting, small tattoos, cosmetic
surgery (not considered self-harm by the
majority of the population) Superficial to
mild Benign Mostly accepted
II Piercings, saber
scars, ritualistic clan scarring, sailor
and gang tattoos Mild to
moderate Benign to
agitated Subculture
acceptance III Wrist- or
body-cutting, self-inflicted cigarette
burns and tattoos,
wound-excoriation Mild to
moderate Psychic
crisis Accepted by some
subgroups but not by the general
population IV Auto-castration,
self-enucleation, amputation Severe Psychotic
decompensation Unacceptable Many of us have been to
therapy, whether by choice or by force. We’ve
sat in a chair week after week talking—or not
talking—about our problems. However, we often
don’t really understand the purpose of
therapy. We’ve come up with our own
definitions for our therapists: “That crazy
lady who asks all the questions,” or,
“That man who’s always in my
business.” At Represent, many of us
writers wanted to know how therapy is supposed to
work and how a relationship with a therapist can be
healing. So last year a group of us interviewed
therapist Carrie King, director of the
Children’s Psychotherapy Project in Brooklyn,
NY, to sort out all of the ideas we have about
therapy. Working Out the
Past King was short and slim,
empathetic but with a sharp tongue. She told us
that most kids in care have been through traumatic
experiences and that spending time in a safe place
thinking about what has happened to you is
important, because traumas can have a lasting
impact. Even if years have passed, your mind and
body may still be working out an understanding of a
traumatic event that happened to you when you were
much younger. Your feelings might come out
through harmful behaviors like self-mutilation
(hurting yourself) or eating disorders (bulimia,
anorexia or binge eating). These are all signs that
your mind and body are trying to work out what
happened to you. If you were physically or
sexually abused, you might never have fully allowed
yourself to experience the feelings associated with
what happened. Those feelings can come back in ways
that may feel strange to you. For instance, some
people develop panic attacks (a sudden feeling of
intense anxiety, shortness of breath, sweating and
trembling), or hypervigilance (an unusually high
awareness of surroundings), or dissociation (a
feeling of being separate from yourself and away
from your body). “Kids who are molested
grow up wondering if they’re good,” King
told us. “They ask questions like: ‘Is
who I am good enough? Am I good enough in
relationships? Am I good enough as a
friend?’” Her message was clear: although
the abuse many of us endured was not our fault, it
often leaves us feeling tainted, unworthy, or like
we’re bad inside. The Risk of Getting Hurt
Again King told us that if you
don’t come to an understanding of what
happened to you in the past, you might put yourself
at a greater risk of being abused again. Many
times, people who have suffered a trauma seek out
experiences that feel similar to those that led to
the painful experience. Just as you may replay the
trauma in your head, trying to understand what
happened or why, you may unconsciously replay the
trauma in your life. King researched factors that
affect whether adult women who had been sexually
abused in the past were sexually abused again. She
found two things: First, because it feels so bad to
be abused, some women got depressed and started
drinking or doing drugs. “Anyone on drugs or
drinking is at a higher risk of being sexually
assaulted,” King said, because they are not
always aware of their surroundings or what’s
happening to them. Second, some women feel so
badly about themselves because of their past abuse
that their vision of who they are and what their
body means to them changes. “They lose an
attachment to or respect for their bodies,”
King said. So when there were danger signs, these
women didn’t take action to protect their
bodies from harm. “A repetition of the
trauma (being abused in a similar way as in the
past) shows you there’s still something you
need to understand about how you think about what
happened, or what it means to you, and how you
approach your body and your life as a result,”
she said. Why We Build Walls. .
. Because of betrayals
we’ve experienced in past relationships, many
of us feel unsure about getting into new
relationships. To protect ourselves from harm, we
may build boundaries and walls inside to shield
ourselves from people or situations that we fear
may hurt us. But those walls—like
reacting to other people with distrust or
hostility—can also make us feel isolated or
misunderstood. We asked if it’s possible to
loosen our boundaries so we can truly become close
to others, and how we could go about doing that
without making ourselves unsafe. “You built that boundary
because you love yourself and you had the will to
survive,” King said. “But when the danger
is not there anymore, you have to let go of those
boundaries.” King told us that you can take
certain steps to help you rethink how you approach
others. . . .And How to Take Them
Down The first step is to
acknowledge that you built those walls for a
reason: you needed to protect yourself from
danger. The second is asking
yourself, “Why did I build this?” Looking
back at what you didn’t have as a child (like
protection or consistent love) and figuring out if
you have it now or not is a lot of work. It means
considering your past and seeing how many things in
your life have changed, investigating your mind and
environment consciously and seeing how safe you
really are now. The third step is to begin to
take the boundary down. That’s a huge thing to
do because you’re making yourself vulnerable
and leaving the familiar. Say one of your former
foster parents abused you by constantly cutting you
down. You might have become hostile and untrusting
of people, fearing that they will do the same
thing. But once you become aware of this pattern
you decide to try to let go of your hostility and
distrust and connect to positive, caring friends
and adults. That’s a great goal, but scary.
You are leaving the ways of acting that you are
familiar with and trying out a new way of relating
to people that you hope will be better. But acting
more openly might lead to getting hurt
again. When taking any risk,
it’s best to have someone safe to return to
for support and to reflect on the feelings that
risk-taking raises inside of you. That’s where
a therapist can be more helpful than a friend or
even a mentor. “It’s very hard for a
friend to help you feel safe enough to take such
enormous risks. In most cases, it takes someone who
is trained,” King said. Seeing the Big
Picture King told us that therapists
can often help their clients hear themselves. She
gave us an example of a girl who says she wants to
settle down, but is constantly going from guy to
guy. “I would try to get her to figure out why
she’s going from guy to guy if she wants to be
connected to one person,” she said. A therapist can help you
think about your experiences in new ways.
“Sometimes you spend so much time in your own
head, you lose the creativity of thinking about
your problems in a different way. Telling someone
else and hearing their ideas on your problems can
be good,” she told us. Many of us believed that our
therapists’ main job is to give advice on the
day-to-day goings-on in our lives. But King told us
that she is not there to give advice and solve
problems; she’s there to observe and notice
her clients’ behaviors and to pay attention to
the larger themes in their lives, such as the main
emotions they feel, experiences they seek out and
patterns of their behavior. She said therapists are
trained to see the big picture. “We try to
look for what’s behind all the details of a
story: the rage, or the fear of being left again,
or the worry about what’s going to become of
you. Those are the bigger things, the big umbrella
sort of piece behind many of your stories,”
she said. We thought therapists must
become bored listening to their clients for hours,
but King said even boredom can be useful.
“When someone is telling a big long boring
story, I use it to think, ‘What’s
happening here? Why am I feeling bored’?”
Sometimes people go on and on about something
unimportant to avoid talking about something real
or important. If the therapist points that out,
they can at least talk about why the client is
avoiding a more important conversation. Speaking with Dr. King made
therapy seem less scary and threatening. She helped
us see that with the right person, therapy is a
place where you have the freedom and safety to
think and talk about painful experiences in your
past, and to get help changing harmful patterns of
thinking or acting, so you don’t get hurt
again. Self-mutilation
rampant at 2 Ivy League schools
Sarah Rodey, 20, a University
of Illinois student began self-injuring by cutting
herself, a disturbing phenomenon that counselors
say is happening at colleges, high schools and
middle schools nationwide. Nearly 1 in 5 students at two
Ivy League schools say they have purposely injured
themselves by cutting, burning or other methods, a
disturbing phenomenon that psychologists say they
are hearing about more often. For some young people,
self-abuse is an extreme coping mechanism that
seems to help relieve stress; for others it’s
a way to make deep emotional wounds more
visible. The results of the survey at
Cornell and Princeton are similar to other
estimates on this frightening behavior. Counselors
say it’s happening at colleges, high schools
and middle schools across the country. Separate research found more
than 400 Web sites devoted to subject, including
many that glorify self-injury. Some worry that many
sites serve as an online subculture that fuels the
behavior — although whether there has been an
increase in the practice or just more awareness is
unclear. Sarah Rodey, 20, a University
of Illinois student who started cutting herself at
age 16, said some online sites help socially
isolated kids feel like they belong. One of her
favorites includes graphic photographs that the
site warns might be
“triggering.” “I saw myself in some of
those pictures, in the poems. And because I saw
myself there, I wanted to connect to it
better” by self-injuring, Rodey
said. The Web sites, recent books
and media coverage are pulling back the curtain on
the secretive practice and helping researchers
better understand why some as young as
grade-schoolers do it. “You’re trying to
get people to know that you’re hurting, and at
the same time, it pushes them away” because
the behavior is so distressing, said Rodey, who has
been diagnosed with bipolar disorder. The latest prevalence
estimate comes from an analysis of responses from
2,875 randomly selected male and female
undergraduates and graduate students at Cornell and
Princeton who completed an Internet-based mental
health survey. Seventeen percent said they
had purposely injured themselves; among those, 70
percent had done so multiple times. The estimate is
comparable to previous reports on U.S. adolescents
and young adults, but slightly higher than studies
of high school students in Australia and the United
Kingdom. 'An increasing
phenomenon' The study appears in this
month’s issue of Pediatrics, released Monday.
Cornell psychologist Janis Whitlock, the
study’s main author, also led the Web site
research, published in April in Developmental
Psychology. Among the Ivy League students
who harmed themselves, about half said they’d
experienced sexual, emotional or physical abuse
that researchers think can trigger
self-abuse. Repeat self-abusers were more
likely than non-injurers to be female and to have
had eating disorders or suicidal tendencies,
although self-injuring is usually not considered a
suicide attempt. Greg Eels, director of
counseling and psychological services at Cornell,
said the study’s findings are not surprising.
“We see it frequently and it seems to be an
increasing phenomenon.” While Eels said the
competitive, stressful college environment may be
particularly intense at Ivy League schools, he
thinks the results reflect a national
problem. Dr. Daniel Silverman, a study
co-author and Princeton’s director of health
services, said the study has raised consciousness
among his staff, who are now encouraged to
routinely ask about self-abuse when faced with
students “in acute distress.” “Unless we start talking
about it and making it more acceptable for people
to come forward, it will remain hidden,”
Silverman said. Some self-injurers have no
diagnosable illness but have not learned effective
ways to cope with life stresses, said Victoria
White Kress, an associate professor at Youngstown
State University in Ohio. She consults with high
schools and says demand for her services has risen
in recent years. Psychologists who work with
middle and high schools “are overwhelmed with
referrals for these kids,” said psychologist
Richard Lieberman, who coordinates a suicide
prevention program for Los Angeles public
schools. He said one school recently
reported several fourth-graders with burns on their
arms, and another seeking help for “15
hysterical seventh-grade girls in the office and
they all have cuts on their arms.” In those situations,
Lieberman said there’s usually one instigator
whose behavior is copied by sympathetic but
probably less troubled friends. Rodey, a college sophomore,
said cutting became part of her daily high school
routine. “It was part of waking
up, getting dressed, the last look in the mirror
and then the cut on the wrist. It got to be where I
couldn’t have a perfect day without it,”
Rodey said. “If I was apprehensive
about going to school, or I wasn’t feeling
great, I did that and I’d get a little
rush,” she said. Whitlock is among researchers
who believe that “rush” is feel-good
hormones called endorphins produced in response to
pain. But it is often followed by deep shame and
the injuries sometimes require medical
treatment. Vicki Duffy, 37, runs a
Morris County, N.J., support group and said when
she was in her 20s, she had skin graft surgery on
her arms after burning herself with cigarettes and
a fire-starter. After psychological and drug
treatment, she stopped the behavior 10 years
ago. Author of the 2004 book
“No More Pain: Breaking the Silence of
Self-Injury,” Duffy recalled being stopped on
the street by a 70-year-old woman who saw her
scarred arms and said, “’I used to do
that.”’ Rodey said she stopped
several months ago with the help of S.A.F.E.
(Self-Abuse Finally Ends) Alternatives treatment
program at a suburban Chicago hospital. Treatment
includes behavior therapy and keeping a written log
to track what triggers the behavior. Rodey said she feels
“healed” but not cured “because
it’s something I will struggle with the rest
of my life. Whenever I get really stressed out,
that’s the first thing I think
about.” I am only 14 and I am crying
out for help. What can I say or do to make them
stop? I feel like if I tell them, they'll feel
bad and cut more and I really don't know what to
do. I don't think they realize how much this hurts
not just them, but me. Please print this
soon. Frightened and Worried in
Minnesota: Dear
Frightened: You are right to be worried
about your friends. They are in serious trouble.
Strange as it may seem, people who cut themselves
do it to distract themselves from their emotional
pain. Cutting is usually a symptom of a serious
emotional problem, and often cutters need
professional intervention to stop their
compulsion. One would think that a
child's parents would recognize that something was
wrong when the young person habitually wears
clothing that is inappropriate for the season - but
apparently your friends' parents are too focused on
something else to notice. Your friends are sick, and
they're not likely to listen to you at this point.
That's why you must tell your parents what is going
on, so they can tell the other adults that their
children are in need of treatment - and the sooner
the better. Editor's Note: Another
option is to talk to your school's counselor. Too
often the emotional/physical/sexual abuse that
creates emotional pain comes from the parents of
the cutters. Even if this isn't so, it's not a bad
idea to guarantee outside sources are involved in
the situation. Feeling
misunderstood Feeling
judged Feeling
unaccepted Feeling
rejected Feeling
controlled Feeling
powerless Feeling
untrusted Feeling
trapped Feeling
imprisoned Feeling not listened
to Feeling
unheard Feeling
failful Feeling
confused Feeling
guilty Feeling
responsible Feeling
overwhelmed Feeling
unloved Feeling uncared
about Feeling
punished Feeling
hated Source:
http://eqi.org/cutting1.htm#Feeling
alone and
unsafe
Non-suicidal self-injury
(NSSI), also referred to as self-injury or
self-harm, is the deliberate and direct destruction
of one’s body tissue without suicidal intent
and not for body modification purposes. Therefore
this definition does not include tattooing or
piercing, or indirect injury such as substance
abuse and eating disorders. Also, this type of
self-injury is different than “self-injurious
behaviors” (SIB) which are commonly seen among
individuals with intellectual and developmental
disabilities. Self-injury
Methods The most common methods of
self-injury include cutting, burning, scratching,
and bruising. These injuries can range in severity
from minor to moderate. Self-injury can start at
any age, but most people who self-injure start when
they are teenagers. Many people who start
self-injuring in their teens continue into
adulthood, while others may start self-injuring as
adults. Although any one at any age may begin to
engage in self-injury, research shows that the most
common age of onset for self-injury is early
adolescence, more than half of young adults who
have engaged in self-injury recall starting at this
time, however slightly less than a quarter recall
starting before age 12. Rates Between 14 to 24% of youth
and young adults in the community report engaging
in self-injury at least once in their life. Some
studies have found even higher percentages if they
provide comprehensive checklists of the different
types of possible self-injury methods or if they
advertise their study as one about
self-injury. What
are common misconceptions about
NSSI? Self-injury is a failed
suicide attempt Self-injury is NOT an attempt
to die. Most people who self-injure say they do it
to feel better, to express their pain and/or to
stop feeling numb. In fact, some people who
self-injure even say they do it to stop themselves
from acting on urges and thoughts to kill
themselves. Although self-injury and suicide
attempts are different behaviors, many individuals
who self-injure also may struggle at times with
suicidal feelings. The injury isn’t very
bad, so it isn’t serious The seriousness of a
person’s distress is NOT related to the
severity of the self-injury. Research has shown
that self-injury is related to emotional
difficulties, distress and sometimes suicidal
feelings. Therefore, any degree of self-injury
needs to be taken seriously. Self-injury is just an
attempt to get attention Self-injury is NOT about
trying to get attention. Self-injury is often done
in private and many people keep it a secret from
others. Some people who self-injure never tell
anyone about it. If they tell someone, they may be
more inclined to tell a friend or to share their
self-injury experiences online. Because many individuals who
self-injure have difficulties telling others how
they feel some may use self-injury to show others
the distress they find hard to put into words. This
is not about trying to get attention but about an
attempt to communicate their pain or intense
emotions. People who self-injure
have a personality disorder Many people who self-injure
do NOT have a personality disorder. Sometimes
self-injury is a symptom of borderline personality
disorder (BPD)—a mental health illness
involving a long-term pattern of difficulties
dealing with emotions, impulsivity, and unstable
relationships—but a diagnosis of BPD cannot be
made based on self-injury alone. There are other
symptoms of BPD that must be present in order to
receive this diagnosis and many people who
self-injure do not have these other
symptoms. Self-injury is a sign that
someone has been abused Although self-injury is quite
prevalent amongst individuals with a history of
abuse, not everyone who has been abused will
self-injure and not everyone who self-injures has
been abused. It is very important not to assume
that self-injury is an indicator of
abuse. People who self-injure
don’t feel pain People who self-injure DO
feel pain. Sometimes when a person feels numb, or
like they are separated from their body, the
purpose of self-injury is to feel pain (that is,
the goal is to feel something, even if it is pain).
However, some individuals who self-injure say that
sometimes they do not feel the pain, that they feel
disconnected from their body during the self-injury
but this is not always the case. Self-injury is a phase or
a teen fad that people grow out of Self-injury is NOT a trend, a
fad, or a phase. Self-injury is an attempt to cope
with some very difficult feelings. It is often
referred to as a ‘maladaptive coping
strategy.’ Research shows that using
self-injury at any point in one’s life is a
sign that the person is struggling to cope. Most
people do not grow out of self-injury without
finding healthier ways to cope. This can be very
difficult and may require professional help.
Self-injury doesn’t get better on its
own. How
common is non-suicidal self-injury? By the
numbers Non-suicidal self-injury is
quite common, with about 14 to 24% of teens
reporting self-injuring at least once and about a
quarter of those having done it many times. Similar
rates of self-injury have been found amongst
college students. However, in later adulthood the
occurrence of self-injury seems to be somewhat
less, with about 1 in 20, or approximately 4%, of
adults indicating they have self-injured. Because
almost all the research on this has been done over
the last decade, it is unclear whether it is
increasing or if as youth and young adults mature
they learn healthier coping and the use of
self-injury decreases. Further research is needed
to understand why the prevalence is different
amongst older adults. In any case, non-suicidal
self-injury is not a rare or unusual occurrence
amongst youth and young adults. Who is at
risk for non-suicidal self-injury? One of the most commonly
found risk factors for non-suicidal self-injury is
having difficulties with regulating emotions. This
means individuals who experience intense negative
emotions that they find intolerable, which is often
combined with difficulty expressing emotions, are
more at risk for self-injury. There may be many
reasons for these difficulties, including past life
experiences and/or temperament Research has shown that in
adolescent samples females are more likely to
report having self-injured. However, by late
adolescence or young adulthood, males and females
report similar rates of self-injury. Research has
also shown that females may be more likely to seek
help or report their self-injury than males,
leading professionals and the general public to
mistakenly think of self-injury as a
“female” behavior. So, while many people
think females are more at risk for self-injury this
is not the case. In addition, some research
has indicated that being a member of a group that
is likely to experience social prejudice (i.e., a
group that is marginalized) may increase the risk
for self-injury. For example some research has
shown that people who are lesbian, gay, bisexual or
transgendered may be more likely to engage in
self-injury. With more stress in one’s life,
it can be more difficult to cope. People who self-injure
sometimes have mental health difficulties such as
depression, post-traumatic stress disorder (PTSD),
or eating disorders. However, many people who
self-injure do not have a mental illness. This is
not to say that self-injury is not serious though,
self-injury is a sign of significant
distress. As noted above, one of the
most common reasons for self-injuring is to deal
with intense negative emotions (like sadness,
stress and anger) and thoughts (such as negative
thoughts about oneself). These feelings or thoughts
are felt to be so intense and overwhelming that
they are intolerable. People who self-injure
frequently report that following the self-injury
they experience a “relief” from these
negative emotions/thoughts for a short
time. Sometimes people self-injure
to punish themselves for things they feel guilty
about, or when they are really hard on themselves
and feel they have not done well enough. Some people self-injure to
reconnect with themselves and others (that is, to
feel something, even if it is pain). Some people
use self-injury as a way to tell others about how
they feel. There are many other reasons
for self-injuring and someone may self-injure for
more than just one reason or the reason for the
self-injury may change over time as the self-injury
continues. As anyone who self-injures will tell
you, it is very hard to say “why” they
self-injure, it is a complex combination of things
– however they do know that they are doing
this to try to feel better in one way or
another. Self-Injury as maladaptive
coping People who self-injure have a
hard time dealing with their feelings. Instead of
being able to cope with an intense emotion (such as
sadness or anger), they use self-injury to reduce,
manage, or escape from these feelings. Because for
some people the self-injury brings relief, it is
tempting to keep using it to cope with these
difficult feelings. However, the more often
individuals use self-injury to cope, the more
likely they are to self-injure when they have
difficult feelings in the future. Many people who
self-injure report feeling that they
“can’t stop” or that they “are
addicted” to self-injury. It is important to
break the cycle early on as it becomes increasingly
difficult to stop. However, some people who
self-injure also experience depression. People who
are depressed have a lot of negative thoughts
(about themselves, others, the world around them,
and their future), they may feel hopeless and as if
they are a burden to others. These feelings CAN
lead to suicidal thoughts and actions. People who
self-injure are at a higher risk for suicide when
their distress is greater than their ability to
cope. Sometimes people may self-injure as a way to
cope, and to stop themselves from acting on these
thoughts and urges of suicide. In any case, because we know
that those who self-injure are also at greater risk
for attempting suicide at some point (even though
these are different behaviors), anyone who
self-injures should be evaluated for possible
suicide risk. Is
non-suicidal self-injury contagious? Self-injury is NOT
contagious. Self-injury is usually done in private
and differs from person to person (in terms of how,
where, and why it is done). People only self-injure
when the self-injury fills a need for that person.
People who already use healthy ways to cope with
distress and difficult emotions are unlikely to
start self-injuring after learning that someone
else self-injures. People who find it hard to cope
with difficult feelings may be more likely to try
out unhealthy ways of coping (such as self-injury)
after learning that a friend does it. Self-injury in the
media Self-injury is becoming more
popular as a subject in music, television shows,
and websites. Many celebrities talk about their own
self-injury. It is important that people know what
self-injury is and that there is help for it. These
media help to spread awareness about self-injury.
However, some depictions of self-injury can be
triggering for those who self-injure; sometimes
they can also make self-injury seem okay or even
glamorous. It is important to remember though that
people who self-injure report that once you start
it can be hard to stop and that they feel like
self-injury takes over their lives. Self-injury
needs to be taken seriously. Can
people stop self-injuring? Self-injury is not a
life-sentence. People CAN and DO STOP
self-injuring. However, the longer a person
self-injures, the more difficult it can be to stop.
It is important to remember that stopping a
behavior that has become a frequently used
maladaptive coping strategy will take time and
effort and having support in doing this would be
helpful. Many people who self-injure
do it in private and work very hard to keep it a
secret. In these cases, the self- injury may
sometimes be accidentally discovered. Some people
who self-injure will tell one or two close friends
or family members; often they will tell others who
self-injure when they’re online. Other people
who self-injure will talk to a professional (like a
counsellor, psychologist or a doctor) about their
self-injury. It is important that people
who self-injure are provided with helpful resources
and, if they are open to it, professionals who can
support them in their efforts to cope better.
Mental health professionals (such as counsellors,
social workers, psychologists and psychiatrists)
are trained to help people learn healthier ways to
cope, and can be helpful in supporting someone who
self-injures. This website has current best
practice information and resources that can be
shared with the professional (click here). Some
people who self-injure are not ready and/or willing
to seek professional help. It is possible to learn
healthier ways to cope without a professional but
it may be extremely difficult. Resources on this
website for those who self-injure can help in
efforts to recover (click here). People who self-injure cannot
be forced to stop. Sometimes people who self-injure
do not want to stop self-injuring. Remember that
self-injury serves a purpose and stopping can be
difficult. When people who self-injure start
learning healthy ways to cope, then they find
stopping self-injury easier. Where
can I find more information? These resources are
recommended for anyone wanting to learn more about
self-injury. This includes people who self-injure,
family, friends, and professionals. Books Conterio, K. & Lader, W.,
& Bloom, J. (1998). Bodily Harm: The
breakthrough healing program for self-injurers. New
York: Hyperion. Gratz, K.L., & Chapman,
A.L. (2009). Freedom from self-harm: Overcoming
self-injury with skills from DBT and other
treatments. Oakland: New Harbringer. Hollander, M. (2008). Helping
teens who cut: Understanding and ending selfinjury.
New York, NY: Guilford Press. Websites Cornell
Research Program on Self-injurious
Behaviors
Research
Articles and Texts Klonsky, E.D.
(2007). The functions of deliberate self-injury: A
review of the evidence. Clinical Psychology Review,
27, 226-239. Nock, M.K. (2009)
Understanding non-suicidal self-injury: Origins,
assessment, and treatment. Washington, DC: American
Psychological Association. Nock, M.K. (2009).
Why do people hurt themselves? New insights into
the nature and functions of non-suicidal
self-injury. Current Directions in Psychological
Science, 18, 78-83. Whitlock, J.L,
Eckenrode, J. & Silverman, D. (2006).
Self-injurious behaviors in a college population.
Pediatrics, 117, 1939-1948. Adolescents
who self-harm more likely to commit violent
crime The study also found young
people who harm themselves and commit violent crime
-- "dual harmers" -- are more likely to have a
history of childhood maltreatment and lower
self-control than those who only self-harm. Thus,
programs aimed at preventing childhood maltreatment
or improving self-control among self-harmers could
help prevent violent crime, the authors
state. Rates of self-harm --
deliberately harming oneself, often by cutting or
burning -- have increased substantially among
adolescents in recent years both in the United
States and the United Kingdom. In the U.S., roughly
one in four teenage girls try to harm themselves
and one in 10 teenage boys. In the U.K., the yearly
incidence of self-injury among teenage girls has
risen by nearly 70 percent in three
years. "We know that some
individuals who self-harm also inflict harm on
others," said Leah Richmond-Rakerd, lead author of
the study. "What has not been clear is whether
there are early-life characteristics or experiences
that increase the risk of violent offending among
individuals who self-harm. Identifying these risk
factors could guide interventions that prevent and
reduce interpersonal violence." In the study, published in
The American Journal of Psychiatry, Richmond-Rakerd
and researchers from Duke and King's College London
compared young people who engage in "dual-harm"
behavior with those who only self-harm. Participants were from the
Environmental Risk (E-Risk) Longitudinal Twin
Study, a nationally representative U.K. cohort of
2,232 twins born in 1994 and 1995 who have been
followed across the first two decades of life.
Self-harm in adolescence was assessed through
interviews at age 18. Violent offenses were
assessed using a computer questionnaire at age 18
and police records through age 22. "By comparing twins who grew
up in the same family, we were able to test whether
self-harm and violent crime go together merely
because they come from the same genetic or family
risk factors," said Terrie E. Moffitt of Duke
University, founder of the E-Risk Study. "They did
not. This means that young people who self-harm may
see violence as a way of solving problems and begin
to use it against others as well as
themselves." Researchers also found that
those who committed violence against both
themselves and others were more likely to have
experienced victimization in adolescence. They also
had higher rates of psychotic symptoms and
substance dependence. "Our study suggests that
dual-harming adolescents have experienced
self-control difficulties and been victims of
violence from a young age," said Richmond-Rakerd.
"A treatment-oriented rather than
punishment-oriented approach is indicated to meet
these individuals' needs." Additional recommendations
include: Improving self-control
among self-harmers could help prevent violent
crime. Self-harming adolescents should be
provided with self-control training, which may
reduce further harmful behaviors. Self-harm and violent
crime have largely been studied separately
within the fields of psychology, psychiatry and
criminology. Interdisciplinary research should
be pursued, since it could yield new
insights. This research was supported
by the National Institute of Child Health and Human
Development (NICHD) (HD077482), the Jacobs
Foundation and the Avielle Foundation. Leah S.
Richmond-Rakerd was supported by a postdoctoral
fellowship provided by the NICHD (T32-HD007376)
through the Center for Developmental Science at the
University of North Carolina at Chapel Hill. The
E-Risk Longitudinal Twin Study is funded by the UK
Medical Research Council (grant G1002190). Do
Men Self-Injure? Male and female patterns of
self-harm. One of the problems with the
existing research is that it has been so heavily
based on inpatient hospital and clinic populations.
Yet sociological studies of health show that men
are much less likely than women to go to the
doctor, to go to the hospital, or to seek medical
care. First, it is certainly true
that women self-injure more than men. They
self-injure in larger numbers partly because their
gender role socialization inclines them toward it.
When women get upset, they are taught to turn their
feelings inward and take it out on themselves.
Connie (pseudonym), a 19-year-old college student
who had a lot of familial conflict, told us, "This
was the only thing that would calm me down when I
was just so angry. And I wanted to punch walls and
stuff like that but I didn't want to be so loud
about it. So, it was taking anger out on myself."
Penelope noted that, "Like with my dad, I feel,
like, all my anger at him but I can't take it out
on him 'cause he'll kick me out of the house, so I
just take it out on myself instead." Women are also socialized to
lodge their self-identify heavily within their
bodies, since so much of their value and self-worth
in the relationship marketplace resides in their
looks. Being a woman of any age in today's society
means struggling to meet cultural appearance norms
(i.e., be thin, be pretty, be fit but not too
muscular). For people who fail to live up to the
standards of fashion models, this may create
anxiety, depression, and feelings of failure. This
excessive focus on embodiment leads women to think
that if they can control their bodies, they can
control their selves. Injuring their bodies gives
them a feeling of control over their emotions. This
is the same sociological impulse that leads so many
of them to engage in eating disorders. So, although women still
self-injure more than men, the practice is
spreading into wider groups of men, and, over time,
we should expect to become aware of more boys and
men engaging in it. Third, our research suggests
that there are distinctly "feminine" and
"masculine" ways of self-injuring. Women tend to
make smaller cuts in hidden places with sharp
implements (such as exacto blades, straight-edge
blades, and broken razor cartridges) and to hide
their behavior. When men and women conform to
these gendered ways of injuring, they are
(relatively speaking) more accepted. Lisa told us
that she went inward toward self-destruction,
"Probably because I didn't want people to know. I
didn't want to ruin my future because I wanted to
show people that I could be okay, eventually, but I
wasn't at the time." Guys who follow their gender
norms seem able to self-injure more openly without
reprimand. Ben struggled with an abusive father,
and everyone knew that he was beaten regularly. So
when he made large, bold cuts on his arms and
didn't try to hide them, nobody asked him about
these; it was taken as an understood response. In
fact, committing violent acts upon one's body is a
more acceptable and manly behavior (like some
masculine rites of homo-social bonding behavior
such as getting drunk with a group of friends and
branding themselves), and many women noted that
male self-injurers whom they knew seemed to be able
to "pull it off better." Sam, the former Marine,
agreed, saying, "In a sense, the more you could
tolerate, the more 'manly' you were. I knew of a
sergeant who shot up Jack Daniels intravenously and
everyone thought that was 'hardcore." I don't
remember feeling like the Marines thought I was
unmasculine for SI." When people deviate from
these masculine and feminine ways of self-injuring,
however, they are more likely to be negatively
sanctioned. Penelope, quoted above, reflected that
she turned her anger inward precisely because she
feared the reaction of others if she (like guys)
turned it outward, or against others. Women who
flaunt their injuring too openly may also be
chastised as "posers," "emo cutters," or condemned
for "crying for help" (even if they need it). If
they make larger cuts or burns, or if they do these
to their faces, chests, or arms, they may be
considered unfeminine and be more highly
stigmatized. There is, thus, a highly
gendered component to the causes, population, and
manner of self-injuring that is shifting in some
ways and not in others. The
Changing Gender Ratio in Occurrence of Deliberate
Self-Harm Across the Lifecycle Abstract. Background: Overall
gender ratios are often quoted in studies of
deliberate self-harm (DSH) patients, almost always
with higher rates in females than males. Reporting
a ratio across all ages may conceal important
variations in the gender ratio across the life
cycle. Method: Analysis was done of the gender
ratio by age groups in rates of DSH in a
consecutive sample of DSH patients presenting to a
general hospital over a 10-year period. The
patients were identified through a well-established
monitoring system. Results: The study sample
included 2,189 female and 1,439 male patients.
While the overall gender rate ratio was 1.5 females
to each male, the ratio varied considerably by age
group: 8:1 in 10-14-year-olds, 3.1:1 in
15-19-year-olds, 1.6:1 in 20-24-year-olds,
approximately 1.3:1 in 25-49-year-olds, and 0.8:1
in people aged 50 years and over. Conclusion:
Statements about overall gender ratios for DSH
conceal important changes in the ratio across the
life cycle. These changes probably reflect
differences in development and problems faced in
adolescence, changes in motivation for DSH with
age, and the closer resemblance of DSH to suicide
in older age groups. The
Relationship of Digit Ratio (2D:4D) and Gender-Role
Orientation in Four National Samples The ratio of second to fourth
finger length (2D:4D ratio) is sexually dimorphic
with women having higher 2D:4D ratio than men.
Recent studies on the relationship between 2D:4D
ratio and gender-role orientation yielded rather
inconsistent results. The present study examines
the moderating influence of nationality on the
relationship between 2D:4D ratio and gender-role
orientation, as assessed with the Bem Sex-Role
Inventory, as a possible explanation for these
inconsistencies. Participants were 176 female and
171 male university students from Germany, Italy,
Spain, and Sweden ranging in age from 19 to 32
years. Left-hand 2D:4D ratio was significantly
lower in men than in women across all
nationalities. Right-hand 2D:4D ratio differed only
between Swedish males and females indicating that
nationality might effectively moderate the sexual
dimorphism of 2D:4D ratio. In none of the examined
nationalities was a reliable relationship between
2D:4D ratio and gender-role orientation obtained.
Thus, the assumption of nationality-related
between-population differences does not seem to
account for the inconsistent results on the
relationship between 2D:4D ratio and gender-role
orientation. More youth ar attempting
suicide and it's unclear
why Self-harm or self-injury, the
act of hurting oneself on purpose, affects nearly 1
in 4 teenage girls in the United States. That’s according to a
new
study recently
published in the American Journal of Public Health,
for which researchers at the University of Portland
in Oregon assessed the prevalence of non-suicidal
self-injury among adolescents through the
2015
Centers for Disease Control and Prevention Youth
Risk Behavior Surveillance
System. The YRBSS featured
information on 64,671 public high school students
ages 14-18 from 11 states via ongoing school-based
national, state, tribal and large urban school
district surveys representative of high school
students in America, plus one-time national and
special-population surveys. Participants in the 11 states
— Arizona, Connecticut, Delaware, Florida,
Idaho, Kentucky, Massachusetts, Nevada, New
Hampshire, New Mexico and Vermont — answered
at least 89 questions about demographics;
unintentional injuries and violence; tobacco use;
alcohol and drug use; sexual behaviors; body weight
and diet behaviors; physical activity and other
health-related topics. A sample question addressing
NSSI may read: “During the past 12 months, how
many times did you do something to purposely hurt
yourself without wanting to die, such as cutting or
burning yourself on purpose?” with choice
options of “0 times,” “1 time,”
“2 or 3 times,” “4 or 5 times”
and “6 or more times.” Questionnaires were
administered and collected during a single class
period, according to the study. What exactly is
self-harm? “Self-harm or
self-injury means hurting yourself on
purpose,” according to the National Alliance
on Mental Illness. “One common method is
cutting yourself with a knife. But any time someone
deliberately hurts herself is classified as
self-harm. Some people feel an impulse to burn
themselves, pull out hair or pick at wounds to
prevent healing. Extreme injuries can result in
broken bones.” It isn’t a mental
illness, “but a behavior that indicates a lack
of coping skills” that may be associated with
illnesses such as borderline personality disorder,
depression, eating disorders, anxiety or
posttraumatic distress disorder. Key
Findings Overall, 17.6 percent of
survey respondents in the University of Portland
study reported at least one NSSI act in the
previous year. “The numbers are very
disturbing,” study co-author Nick McRee told
BuzzFeed News. “They suggest that the behavior
is not concentrated among a small number of
disturbed youths, but in fact, it is a fairly
common type of behavior among adolescents in
general.” The rate of boys reporting
self-harm without wanting to die over the past year
ranged between 6.4 percent to 14.8 percent. The
rate for girls was twice as high. In fact, in some states, such
as Idaho, the rate of self-harm for teenage girls
was as high as 31 percent. They were also more likely
than boys to report experiencing most of the health
risks believed to be associated with NSSI, authors
wrote. Such health risks include depression,
suicidal thoughts, forced sex and cyber
bullying. Still, more than 1 in 10 high
school boys in the analyses reported
NSSI. Across the board, prevalence
of NSSI appeared to decline with age. Among
14-year-olds, 19.4 percent reported at least one
incident of NSSI. Among 18-year-olds, the rate
dropped to 14.7 percent. “No particular racial or
ethnic group is immune from NSSI, though rates were
higher among Native Americans, Hispanics, and
Whites than they were among Asians and
Blacks,” authors wrote. In fact, more than 20 percent
of adolescents identifying as Native American
reported NSSI, compared to just over 12 percent of
African-American youth. “Our findings indicate
that the scope of NSSI among adolescents is so
widespread that individual clinical and therapeutic
interventions may be insufficient to address this
public health problem,” report authors
wrote. The researchers hope
school-based and community health programs will
better address the identified risk factors.
Additionally, they wrote, because many factors
associated with NSSI can also be linked to other
mental health problems, “efforts to prevent
NSSI should be incorporated into broader efforts to
address mental health among children and
adolescents.” Study Some limitations the
scientists addressed include lack of insights about
the severity of injuries or how participants felt
about their behavior, suggesting the evidence lacks
in-depth analyses common in clinical
samples. Questionnaires also
didn’t include questions about other factors
associated with NSSI, such as family
dynamics. Future research should focus
on whether the high rates of NSSI reflect a trend
or just evidence of public recognition of the
phenomenon, authors wrote. Additionally,
researchers believe more investigation is needed to
understand whether the observed NSSI decline by age
continues beyond high school or has lasting
effects. Read the full study at
ajph.com Pain generated or sustained
by the mind One can paint a pretty
picture but this story has a twist. |
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