SELF-INJURY: UNDERSTANDING AND HELPING ADOLESCENTS WHO CUT

Sarah Walters, MA, LPC-Intern/Counselor Youth Service Specialist II

TERMS Self Mutilation (past term)  Self-Inflicted Violence (SIV)  Self-Injury Behavior (SIB)  Non-Suicidal Self-Injury (NSSI)  Self-Harm (SH)  Deliberate Self-Harm (DSH) 

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Self-Injury (SI)

WHAT IS SELF-INJURY? •

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Self-injury is generally defined as the purposeful act of hurting one’s body, without suicidal intent, in a non-lethal, socially unacceptable manner, in order to reduce psychological distress (Suyemoto & MacDonald, 1995; Walsh, 2006). Includes cutting, burning, “embedding”, scratching, and carving the skin; overdosing, breaking bones, swallowing poisons; purposeful bruising, ripping of the skin and hair; etc. (Strong, 1999).

“Self-injury is often a strangely effective coping behavior, albeit a self-destructive one.” (Walsh 2006)

MYTHS ABOUT SELF-INJURY •

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The wound isn't "that bad", therefore the problem isn't that serious. People who self-injure are crazy and should be checked into a psych hospital. People who self-injure just want attention. Self-injurers are just trying to manipulate others. Self-harmers pose a danger to others. People who self-harm do not feel the pain. People who self-harm could stop if they wanted to. Self-injury is a suicide attempt gone wrong. People self-harm to fit in or be cool. Only teenage girls self-injure.

WHO SELF-INJURES? SI can occur in anyone who experiences overwhelming emotion and uses the behavior as a coping mechanism. There is no one “person type” who self-injures (Strong, 1998).  Testimony from a 15 year old high school student: 

“If you met me, you’d never know I’m a cutter. If I were to list my mental problems on one side- eating disorder, self-mutilation, major depression, two suicide attemptsand my credentials on the other side- honors student, first place in the school poetry contest, and award for most school spirit- it doesn’t look like it could be the same person. But it’s me. I’m a good actress… I’m scared and sad and all alone.” (Strong, 1998)

RESEARCH FINDINGS 

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SI was once only found in severe mentally ill patients, but has now grown to epidemic proportions in adolescents (Walsh, 2006). Although research may vary, up to 35% of adolescents have or are currently engaging in a type of self-injurious behavior (Muehlenkamp, 2006). In 2003, nearly 70% of American counseling center directors reported increases in cases of self-injury (Milne, 2004). Research shows that over half of self-injurers have been abused or neglected in some form and 71% of self-injurers believe they are addicted to self-injury (Turner, 2002). The United States healthcare system spends over $150 million a year for SIB in adolescents (Crowell et al., 2008). The most common form of self-injury is cutting.

WHAT WOULD CAUSE SOMEONE TO SELF-INJURE?  

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SI has not been narrowed down to one universal cause. Self-injury serves as a coping mechanism for dealing with life stressors, even if only temporarily (Wester & Trepal, 2005). The pain of self-injury replaces internal pain and people self-injure to put an end to emotional suffering. Some research suggests it does physically reduce tension by increasing enkephalin levels in the brain (Strong, 1998). Too much emotion v. Too little emotion Emotions that can trigger self-injurious episodes are depression, shame, sadness, anger, worry, and anxiety (Walsh, 2006).

MOST COMMON REASONS WHY TEENS SAY THE SELF-HARM “It’s like a friend.”  “It alleviates the tension.”  “It makes me feel alive inside.”  “I have control.”  “It helps me numb the pain.”  “I like the rush.”  “It helps me stop bad thoughts.”  “It helps me purge bad feelings.” 

SIGNS OF SI BEHAVIOR Unexplained frequent injury including cuts or burns (usually on the arms or legs)  Wearing long pants/sleeves in warm weather  Low self-esteem  Difficulty handling feelings  Relationship problems  Poor functioning at school or home  Signs of depression or withdrawal  Finding sharp objects in unusual places  Typical onset of SI is around the age of puberty 

HOW SHOULD I RESPOND?  Remain

calm.  Ask questions that are non-judgmental. Be curious about their SI behavior and what emotions make them feel the need to injure themselves. The behavior is just a symptom of the real problem.  Talk with the school counselor as well as the individuals parents.  Guide them to seek outside help.  Provide them with resources as extra support.

RESOURCES 

Self-injury support community for self-injurers and their family. Information on self-injury and recovery, as well as listings of related media. http://self-injury.net/

 Online

Support Groups:

http://www.recoveryourlife.com/  http://www.sisupport.org/  http://www.selfinjury.com/  http://gabrielle.self-injury.net/ 

TREATMENT FOR SELF-INJURY 

Dialectical Behavior Therapy targets SI behavior through teaching distress tolerance skills.       

Radical Acceptance Distraction techniques Coping statements Relaxation techniques Improving the moment Mindfulness Substitution

DISCUSSION

REFERENCES •

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Crowell, S.E., Beauchaine, T.P., McCauley, E., Smith, C.J., Vasilev, C.A., & Stevens, A.L. (2008). Parent child interactions, peripheral serotonin, and self-inflicted injury in adolescents. Journal of Consulting and Clinical Psychology, 78 (1), 15-21. Fox, C; Hawton, K (2004), Deliberate Self-Harm in Adolescence, London: Jessica Kingsley, ISBN 978-1-84310-237-3 Milne, Celia. "Cutting through the pain." Medical Post 21 Sep 2004: 40. :25. Curriculum Edition. eLibrary. Stelly's Library. 28 Nov 2005 Muehlenkamp, J.J.(2006). Empirically supported treatments and general therapy guidelines for non-suicidal self-injury. Journal of Mental Health Counseling, 28 (2), 166185 Strong, M. (1999), A Bright Red Scream: Self-Mutilation and the Language of Pain, Penguin (non-classics), ISBN 978-0-14028-053-1 Suyemoto, K.L., & MacDonald, M.L. (1995). Self-cutting in female adolescents. Psychotherapy, 32(1), 162-171 Turner, V. J. Secret scars : uncovering and understanding the addiction of self-injury. Center City: Hazelden, 2002 Walsh, B.W. (2006). Treating self-injury: A practical guide. New York: Guilford Press. Wester, K.L. & Trepal, H.C. (2005). Working with clients who self-injure: providing alternatives. Journal of College Counseling, 8, 180-188