Thursday, June 25, 2009

Sue Scheff: Self Harm - Self Injury

“If I get upset or mad usually upset and I'll want to cut, but then I'll try to think about other things. It's like it’s really hard because it's like in your stomach. Like you feel like you have to do it. It like goes throughout your whole body like the urge.”

– Stephanie, 16 years old

16-year-old Stephanie says she’s angry and frustrated for lots of reasons.

“Getting really nagged by my parents… And I don’t have many friends and I’m lonely a lot,” she says.

So, in 9th grade she began cutting herself. Small surface cuts at first using pins, but, “Each time you have to go deeper, to get like more satisfaction I guess,” she says, “Like the last time I’ve been doing it I’ve been using razors and stuff and have like really deep ones.”

Sharpened pencils, paper clips, knives, even razors… but… why? Why would a child do this?

“By cutting themselves it takes their mind off what they’re struggling with,” says counselor Lara Wilson.

“The physical pain makes you not think about the emotional pain,” says Stephanie, “Like when you look at the cut you just focus on the cutting and it makes other problems seem better.”

Experts say if a child wears several bracelets, thick sweatbands, or long sleeves… those are warning signs.

And parents who discover them need to understand… it’s a cry for help. “They want to be the type of parent that the child can say ‘mom, dad, I have this struggle, I have this pain. I have this problem. I need to talk to you,” says Wilson.

Wilson adds the child may also need professional help for the underlying cause of the cutting, “Whether it be depression, obsessive compulsive disorder.”

Stephanie is now seeing a counselor. She stopped cutting herself 2 months ago. She says she wishes she had never started.

“It’s like ruined my body,” she says, “I can’t wear like bathing suits, I can’t wear shorts. Cause I have really big scars on my thighs. It just really messed up my body. And I wish I hadn’t done that.”

Tips for Parents

Self-mutilation is the act of deliberately harming oneself physically, and different groups and cultures in society view it differently. The act of self-mutilation seems to be gaining popularity, especially among adolescents. According to experts at the American Academy of Child & Adolescent Psychiatry (AACAP), some common forms of self-mutilation or injury include:

■Picking and pulling skin and hair
■Head banging
■Excessive body piercing
Parents are encouraged to talk with children about respecting and valuing their bodies. Parents should also serve as role models for their teenagers by not engaging in acts of self-harm. Experts at the AACAP suggest the following helpful ways for adolescents to avoid hurting themselves:

■Accept reality and find ways to make the present moment more tolerable
■Identify feelings and talk them out rather than acting on them
■Distract themselves from feelings of self-harm (for example, counting to ten, waiting 15 minutes, saying “NO!” or “STOP!” practicing breathing exercises, journaling, drawing, thinking about positive images, using ice and rubber bands, etc.)
■Stop, think and evaluate the pros and cons of self-injury
■Soothe themselves in a positive, non-injurious way
■Practice positive stress management
■Develop better social skills
If your child is involved in self-mutilation, he/she may suffer from Borderline Personality Disorder (BPD), a psychiatric illness characterized by a pattern of instability in relationships, self-image, mood and impulsivity in a variety of situations. People who suffer from BPD very often have an intense fear of family members, friends and romantic interests. They may have an unstable self-image as well. They frequently engage in impulsive behaviors such as reckless driving, unsafe sex, physically harming themselves or substance abuse. Instability in mood and chronic feelings of emptiness are also common among BPD sufferers. They may be prone to rage attacks as well.

BPD can lead to significant impairment. The disorder accounts for approximately 20 percent of inpatient psychiatric hospitalizations and about 10 percent of patients with BPD commit suicide. According to the Mt. Sinai School of Medicine Department of Psychiatry, some clues to the presence of Borderline Personality Disorder include:

■Unstable, intense “love-hate” relationships
■Feeling abandoned
■Rapid or frequent mood swings
■Rage attacks in response to interpersonal slights or frustrations
■Difficulty controlling anger
■Risk-taking and impulsiveness (i.e. gambling, shopping sprees, reckless driving, binge eating, substance abuse)
■Feeling depressed, sad or empty
■Zoning out under stress
■Intentional self-mutilating behavior (i.e., cutting or burning self)
■Recurring suicide attempts
■Addictive behaviors
Historically, it has been very difficult to successfully treat BPD. However, recent developments in the study of the neurobiology of this disorder have given clinicians new tools to help patients.

■American Academy of Child & Adolescent Psychiatry
■Department of Psychiatry – Mt. Sinai School of Medicine
■Everything You Need to Know About Self-Mutilation: A Helping Book for Teens Who Hurt Themselves by Gina Ng