Self-Injury: How, Why, and Help

Do you know any teenagers that intentionally self-inflict wounds to themselves? That cut their arms, stomachs, thighs; that burn themselves, that pull their own hair out, punch themselves in the face, or bang their heads off concrete walls with such force that they bleed. I do. I work with these girls, and sometimes guys every time I punch that time clock.

I didn't even know that such a thing existed until I became a mental health professional. Ten years ago I was in high school, and kids I knew would do no such thing, at least not that they shared with me. Not many of us would, even now. So what drives the urge for someone to hurt themselves? To partake in self-mutative behaviors. To scar themselves for life, years of explaining.

Experts argue the reasons. Questioning "cutters" themselves usually brings forth only abstract answers; if you get more than the typical teenage response of "I don't know." The general consensus is that people cut for various reasons. Really? Hmmm? But what are these reasons?Here are some of the more common motivating factors that I found researching and talking with those that use self-mutilation as a means to cope with stress.

• distracting themselves from a crisis, usually memories, as in post-traumatic stress; enabling a sense of dissociation from the stressor (usually the person's own mind).
• feeling so numb that they have to hurt themselves as a means to feel something, anything, even pain
• physiologically cutting releases endorphins enabling a person to feel good for a short time
• using physical pain to distract from emotional pain

These are the most commonly accepted motivating factors for cutting, and I agree that they all contribute to the growing population of "cutters." My professional experience puts a slightly different spin on things. I don't often see cutters actually hurt themselves more than superficially; not enough, anyways, to cause a real sensation of pain. They perceive the real and intense emotional pain they are experiencing as physical pain resulting from the wound, thus enabling their mind to deal with what they are experiencing. Similar to a mother who doesn't understand why her child is throwing a temper tantrum and states "if you don't quit with that, I'm going to give you something to cry about." In other words, "I don't know why I'm hurting so much or I don't know how to deal with why I am hurting so much, so I am going to give myself a reason for hurting that I do know how to deal with."

It is important to realize that "cutting" and other forms of self-mutative behaviors are not typically indicative of suicidal ideation. Self-injury is a coping skill for dealing with intense, painful emotions. I will discuss teenage suicide in a later post, but understanding the difference is vital. If you forbid a child (or adult) and prevent cutting as a coping skill you may be taking away the only one they have at the time. You may increase the likelihood that they will attempt to make a suicidal gesture. You cannot take away one coping skill, without supplementing another. This is how these kids are dealing with their issues. Instead we need to offer alternative means of help and be aware that there is a problem; one that needs fixed.

These behaviors are often associated with symptoms of mental illness and/or personality disorders. There is a strong correlation between mental illness, personality disorders and childhood abuse. Any kind of abuse. Throwing self-harm into the mix increases the probability that the abuse was sexual. What can we do? How can we help?

Awareness. I am unclear on if self-harm is on the rise or if we are becoming more aware of the problem. However, we need to be even more aware of this ever growing trend with teenagers. Someone suffering so greatly as to feel the need to hurt themselves are also be likely to turn to drugs, alcohol, promiscuity, aggression, run-away behaviors and most scary, suicide to cope with their problems and ease their pain.

Do not ignore someone who is reaching out for help. Do not assume that they are just "attention-seeking." Maybe they are, but they are asking in the only way they know how for help. So what if you get manipulated a time or two, we all do.

Watch for these signs: many "cutters" try to hide the behaviors.

• Scars, especially in a pattern or tattoo like semblance (engraving); most common on the abdomen, forearms and wrists, chest, and thighs
• Fresh superficial cuts or constantly keeping old wounds open and "picking" at them
• Bruises in unusual places without likely explanations
• Broken bones without a verifiable accident
• Keeping sharp objects available; hoarding razors, knifes, pieces of glass and hiding them in their room, backpack, or on person
• Spending a great deal of time alone, especially in bedrooms and bathrooms
• Wearing long sleeves or long pants even in hot weather
• Claiming to have frequent accidents or mishaps without anyone else around to have seen

Watch for emotional changes that may indicate depression and thus a risk to hurt themselves:

• Isolating from friends and family
• Avoiding activities and sports; especially ones requiring minimal clothing like swimming
• Increase irritability
• Lashing out at family and friends in anger

If you know someone who is hurting themselves seek help. It is not a problem you can conquer on your own. Treatments vary with medications, behavioral modification programs, and therapy. It is a process of trial and error and it takes months and years to reprogram someone into being capable of dealing with their emotions in a productive manner. It also takes lots of support and patience. Links and resources are available at the end of this article.

Tips for being the "support" person to a cutter. You need just as much support as they do, it is a very difficult role. One in which you will fail many times, there is no quick fix. The important thing is to keep trying and remember you are not alone.

• Stay strong, consistent and firm.
• Set ground rules and stick to them.
• Don't feel guilty.
• Limit access to sharp objects in your home
• Don't power struggle.
• Participate in therapy with your child.
• Validate your child's feelings.
• Incorporate virtues into your home.
• LISTEN when your kids talk to you.
• Be involved in each and every aspect of your kid's life.

It is especially important to provide an environment that is structured and where the rules are fixed. Expect the cutter to attempt manipulation of these rules by saying something like, "if you don't let me stay out an hour later, I'm going to cut myself." Reply to them something like, "if you are sure that's the only way you can deal with the disappointment of a fixed curfew, but here are some other ideas (stay tuned for upcoming post on coping skills) that you could try. I'll be here to help you."

It is equally important to validate these children and their feelings. Much research has been devoted to the theory that childhood invalidation is strongly linked to borderline personality disorder (cutting is a major symptom and is used as one of the diagnostic criteria for this disorder). Dr. Marsha Linehan has some invaluable research in this subspeciality and incorporates her work into a behavior modification approach called DBT or Dialectical Behavioral Therapy. DBT is widely renowned and accepted in most psychology communities. For more information on DBT go to http://depts.washington.edu/brtc/ or talk to your therapist. Let your kids know it is okay to be angry or sad or anxious or whatever they are feeling. Remember anger is usually a secondary emotion. Help them identify feelings of fear, embarrassment, loneliness that are usually translated to anger and self-destructive behaviors. Teach your kids how to recognize their emotions and then teach them appropriate means for dealing and coping with feelings.

Remember, there is no right or wrong solution. Only the one that works; and it will be different for each kid, each caregiver, and each family. Reach out to others and get help as well as give help when dealing with these issues.

Resources for help:

National Suicide Hotlines

• 1-800-784-2433 (1-800-SUICIDE)
• 1-800-273-8255 (1-800-273-TALK)
• click here to get the number for the suicide hotline in your state: http://www.suicide.org/suicide-hotlines.html

Self-Harm Resources

• 1-800-DONTCUT http://www.self-injury.com/
• http://www.sisupport.org/index.html
• http://www.self-injury.net/

References

• http://helpguide.org/mental/self_injury.htm#online
• http://www.psychiatric-disorders.com/articles/warning-signs/self-mutilation.php
• http://www.revolutionhealth.com/healthy-living/parenting/ages-stages/high-school/issues/cutting-self-injury
• http://en.wikipedia.org/wiki/Self-injury
• http://faculty.washington.edu/linehan/

Stress, An Addiction?

Everyone experiences stress throughout their lives, its normal right? Our jobs, our homes, our families, our finances, our vacations...stressful. It is a common standard of our society to measure success against stressful situations. We may even feel that our lives are inadequate when stress is at it's minimal levels. But what does living with stress really do to our bodies? What happens inside that makes it so addicting? Yes, that's right addicting.

When an excitable situation arises our bodies go into "fight or flight." It is our internal defense; a weapon, if you will, in our survival arsenal from the days of lore. Though we are still fighting our environment, the mode of the danger has changed dramatically. We aren't fighting bears anymore, but creditors. It isn't an every now and again occurrence, it's an every day one. We are reaching into our arsenal more and more, and with every use, there is a price to pay.

Ever hear of an "adrenaline junkie" who skydives, or bungee jumps, or swims with sharks to get that rush, that complete euphoria of the mind? Stress releases adrenaline into our bloodstream (along with some other chemicals) that prepare our body to either run for our life or fight for it. Our heart rate increases and digestion slows considerably so that blood can be rushed to muscles, our strongest defender. An extra reserve of energy and strength is released to help us survive. Remember the mother who lifted a car off of her toddler? For her, this was an appropriate response; one she would most likely use only once in her lifetime. Now, if the adrenal glands were able to differentiate between this stressful event and say, one where you are receiving a reprimand from your boss, life would be swell. It can't, however, and we have to counter the body's natural response with coping skills of our own. We live in a chronic state of stress and the effects of our innate responses are detrimental to our overall health.

This constant state of stress is reeking havoc on our internal functioning, and in some cases, external as well. Stress is related to physical and mental health problems, healing, and overall happiness. So why do we feel like failures if we don't rush from one stressful event to the next? Take a moment, slow down, give yourself a break. Ironically, your survival and health depend on not using your bodies natural defense at survival.