Focus on the Adolescent: Self- Injury

Julie Magee, M.S.W., Counselor

Self-injury, sometimes called self-mutilation, is a general term for a variety of forms of intentional self-harm without a coexisting wish to die from the self- inflicted wounds.

The most common patterns of self-mutilation include cutting skin with razors or knives, biting, hitting, or bruising oneself, burning, picking or pulling at skin or hair, or amputating parts of the body. It is not self-injury if the primary purpose of the behavior is for sexual gratification, body decoration, a spiritual enlightenment ritual, or an attempt to fit in with peers.

Approximately 1 percent of the U.S. population uses physical self-injury as a way of dealing with overwhelming feelings or situations. The incidence of self-harm is highest among teenage females, patients diagnosed with borderline personality disorder, and patients diagnosed with a dissociative disorder. The typical self-injurer is female, in her mid-20s to early 30s, and has been hurting herself since her teens. She tends to be middle- or upper-middle-class, intelligent, well educated, and reacting to trauma from a background of physical abuse, sexual abuse, and/or a home with at least one alcoholic parent.

Many researchers believe self-injury results from feelings of shame or a need to relieve tension, while suicide attempts reflect feelings of rejection or hopelessness. However, statistics show that nearly 50 percent of individuals who injure themselves also attempt suicide at some point in their lives.

Self-injury/self-mutilation is a maladaptive coping mechanism. Self-injurers come from all walks of life and all economic brackets. Some people who self-injure manage to function effectively in demanding jobs in fields such as education, medicine, law, and business, to name a few. The incidence of self-injury is about the same as that of eating disorders, but because it is highly stigmatized, most people hide their injuries carefully. Other maladaptive coping mechanisms ostensibly more acceptable in American society are alcoholism, drug abuse, overeating, anorexia, bulimia, workaholism, and smoking.

One significant historical element common to the majority of people who self-injure, is that they learned to mistrust their own interpretations of their surroundings; they were invalidated from an early age. As children they learned that certain feelings weren't allowed. They may have been punished for expressing certain thoughts and feelings, while at the same time they had no good role models for coping with distress.

Scientists think that problems in the serotonin system may predispose some people to self-injury by making them tend to be more aggressive and impulsive than most people. This trouble with neurotransmitters, combined with a belief that some feelings are bad or wrong, could lead to the aggression being turned on oneself. Self-injury, for some people, leads to the release of endorphins (the body's natural painkillers), which reduces the level of distress.

Self-injury is the act of attempting to alter a mood state by inflicting physical harm severe enough to cause tissue damage to one's body. Virtually all self-injurers are suffering in silence; they are discouraged from expressing emotions. Paradoxically, self-injury brings out many uncomfortable feelings in people who do not do it: revulsion, anger, fear, and disgust. These reactions to a person's behavior make it especially daunting to ask for support.

For those seeking professional help, initiate treatment from a therapist with some specialized training and experience. Most treatment is on an outpatient basis, although there are some inpatient programs. A number of different treatment approaches are used with self-injury, including psychodynamic psychotherapy, group therapy, journaling, and behavioral therapy.

Getting Help: The First Step

Making the decision to help yourself, a relative, or friend who self-injures is the first step to finding a healthier way to handle feelings such as anger, anxiety, depression, fear, guilt, and/or self-hatred. Many websites offer self-help ideas. It is possible for someone to learn to stop self-injuring on their own, without professional treatment, depending on the severity of their self-harm, but it will be quite complex.

Given that self-injury is a behavior that becomes compulsive and addictive, it is incredibly difficult to bring to a halt, even while realizing it is unhealthy. When attempts to develop improved ways of dealing with distress do not seem to work despite great effort, it is best to acknowledge the confusion and hurt, and seek professional support.

Teens and young adults who want expert assistance in overcoming self-injurious behavior yet do not want to broach the subject with their parents, guardians or friends may acknowledge depression and mourning as the initial focus, and once in therapy, can bring up the subject in confidence with a professional that will work to help build new coping strategies.

As stated earlier, the causes associated with the roots of this behavior are not always known, however, a prevalent theory is that some people are born with a biological predisposition to be very emotional. Subsequently, they experience an environment that does not meet their needs. When they are not soothed, negative feelings intensify for the their caregiver and themselves, and the efforts to reduce distress go amiss. The quandary begins when the child is unable to tolerate negative emotions without doing something impulsive to try to stop them; as a result they may have difficulty forming good relationships with others.

For people experiencing these established patterns of behavior to solicit help in learning to stop the cycle is an extraordinarily difficult task. Yet, the act of asking for help, in itself, generates hope that things can be better. The post-traumatic stress can be alleviated. To improve life a person who self-injures must make a commitment to stopping any form of self-injury. Each time it happens the belief that it is the only solution is strengthened. Many believe that they are terrible people and deserve pain for doing it, or letting it happen. A good life is implausible for those who deliberately harm themselves.

Family Relationships and Health: An Educational Journey

A good home life can increase the odds that children will avoid many hazards during adolescence. Children who experience a kind, warm, solid relationship with parents who demonstrate respect for their children, an interest in their activities, and set firm boundaries for those activities, may steer clear of illegal activity, drug and alcohol misuse, negative peer pressure, delinquency, sexual acting out, and low self-esteem.

In planning for successful parenting there are three major areas that are essential to the parent-child relationship: Connection; Supervision; and Psychological Independence.

Additionally, parents who expect that children will sometimes act in ways that are inappropriate, yet prepare for such behavior by involving their children in the formulation of rules and consequences, may discover the joy in the journey, and the success of their children along the way.

The combination of connection, monitoring, and psychological autonomy may sound simple in its brevity, however the guidelines can be frustrating to those who feel lost, and translating general ideas into specific behaviors and then into patterns of interaction can be challenging and complicated. When one or both parties are already ingrained in less productive patterns of interaction, the tasks seem impossible.

Assistance is available through books, tapes, and classes. Community health programs, public schools, and libraries, offer great resources. Counseling services are also available at mental health centers and through private practitioners. Without a little guidance some parents easily fall into the trap of concentrating on trying to control their child rather than trying to control their child's behavior. Parents who learn the difference and gain knowledge of new skills to practice will enjoy much more success and a lot less despair. Parents who ask for help and support in their community, neighborhood, school, and/or from professionals learn to be more successful and experience confidence and joy.

Resources:

Brigham Young University's Family Studies Center
(www.focusas.com/parenting.html)

1-2-3 Magic Parenting: Discipline without arguing, yelling or spanking.
(www.parentmagic.com)

Deb Martinson; Focus Adolescent Services
(www.focusas.com/selfinjury.html)

Center for Young Women's Health
(www.youngwomenshealth.org/si.html)

David Roberts, of Healthy Place
(www.healthyplace.com)

Dialectical Behavior Therapy (DBT) a type of psychotherapy used for reducing self-injury and suicidal behaviors
By Dr. Sarah Reynolds

The 7 Habits of Highly Effective People
By Steven Covey

The 7 Habits of Highly Effective Families
By Steven Covey

Reviving Ophelia
By Mary Pipher, PhD.

The Shelter of Each Other: Rebuilding Our Families
By Mary Pipher, PhD.

The Scarred Soul: Understanding and Ending Self-Inflicted Violence
By Tracy Alderman, PhD.

A Bright Red Scream: Self-Mutilation and the Language of Pain
By Marilee Strong

The Hurried Child
By Dr. David Elkind

The Dance of Connection: How to Talk to Someone When You're Mad, Hurt, Scared, Frustrated, Insulted, Betrayed, or Desperate
By Harriet Lerner