Self-Injury: More Common Than You Think

Since my first “Mental Health Matters” column appeared in the Patch in January, several people have reached out to me concerning self-injury. It is a difficult topic for people… especially worried parents… to discuss.  

At first these inquires surprised me. Based upon my experience and the available research, though, it should not have been surprising. This unhealthy phenomenon is far more common than generally recognized. 

Self-injury, also known as self-mutilation or cutting, is the act of deliberately harming your own body in ways, such as cutting or burning one’s self. It's not meant as a suicide attempt. Rather, self-injury is an unhealthy way to cope with emotional pain, intense anger and/or frustration.

While self-injury may bring a momentary sense of calm and a release of tension, it's usually followed by guilt and shame and the return of painful emotions. An obvious consequence of self-injury is the possibility of inflicting serious or even fatal injuries.

Because self-injury is often done on impulse, it may be considered an impulse-control behavior problem. Self-injury may accompany a variety of mental illnesses, such as depression, eating disorders and borderline personality disorder.

It’s estimated that about two  million people in the U.S. injure themselves in some way. The majority are teenagers or young adults, with young women outnumbering young men by a margin of 4 to 1. They are of all races and backgrounds, with the highest prevalence being among Caucasians.

Unfortunately there is no one or “best way” to treat self injury. Treatment must be planned based upon the specific issues and any existing mental health conditions, such as depression. Treatment takes time, hard work and a desire on the part of the individual to recover. Because of the seriousness of self-mutilation and the related mental health conditions (e.g. eating disorders, sexual abuse victim), treatment with a licensed mental health professional is highly recommended.

There are three major types of treatment for self injury and the associated mental health issues… psychotherapy, medication and, in rare circumstances, psychiatric hospitalization. Treatment may consist of one modality or a combination of all three.

Psychotherapy can help one identify and manage underlying issues that lead to self-injury. Therapy can assist in learning skills to better tolerate stress, regulate emotions,  improve self image, enhance relationships and problem solve. A goal of psychotherapy is to help the individual find healthier ways to cope with their emotional pain. Strategies may be taught to help the teen release pain without harming themselves. Many individuals begin the recovery process by simply being willing to talk about it. Psychotherapy can be provided by a psychiatrist, a psychologist, a licensed clinical social worker or a licensed professional counselor.

There are no medications that are specifically used for self-injury. A doctor may recommend treatment with antidepressants or other psychiatric medications that can help improve depression, anxiety or other mental illnesses associated with self-mutilation. Treating the underlying conditions may result in the person being less likely to hurt themselves. While medications are not for everybody, they have been shown to be effective in some circumstances.

For those who injure themselves seriously or repeatedly, a doctor may recommend admission to a psychiatric unit. This course of action is sometimes necessary to provide a safe environment and more intensive treatment until the crisis is averted. Upon discharge the individual can then continue to participate in less intensive treatment, such as a day treatment program or psychotherapy.

Parents need to be aware of the potential signs of self-mutilation, such as a teen wearing a long-sleeved shirt or long pants on a hot day. Teens may wear wristbands or thick bracelets to conceal cuts on their wrists. If you discover that your teen is engaging in destructive behavior such as self-injury, it is important to reach out to a trusted professional for guidance such as your school counselor or pediatrician. As previously mentioned, what might appear to be benign or superficial cutting may escalate to serious injury.

The bad news is that this issue impacts far more people than we like to think. The good news is that treatment is available and recovery is possible. People can and do recover from self-injury and underlying mental health issues, going on to lead productive lives. The important step is to seek help…"cutting” is not a phase. It is a serious matter demanding immediate intervention.

For help, please reach out to your doctor, school counselor or the Mental Health Association of Essex County. We can be reached at 973-509-9777 or www.MHAEssex.org.