Saturday, July 24, 2010

Self Harm, Fad or Epidemic?

Believe it or not self harm has been around for centuries. Some cultures and religions include types of harming the body. These types of self harm are not what I am writting about in this post. Teens across the country are resorting to various forms of self harm in record numbers, so much so that it is considered to be epidemic. Self harm or nonsuicidal self injury is rapidly becoming the chosen method of dealing with the stresses of modern day life in schools across the nation. Cutting is not the only method used. Some kids use excoriaton, hair pulling, head banging, or burning their bodies with lighters, cigarettes or chemicals. The reasons vary, as do the backgounds of the kids who use this form of coping. Some are survivors of various kinds of trauma. Others are from very wealthy, upscale families who have no obvious reasons to inflict harm on themselves. Teens use self harm to deal with things like anxiety, depression, isolation, pain,lack of control, and a host of other "reasons".
All of them have one thing in common. They do not know how to deal with very strong or overwhelming emotions. Some feel that emotionally charged situations or events will actually kill them. All say they have never seen extreme emotions modeled successfully by any adult in their life. All of them say the compulsion to harm themselves is unrelenting and impossible to resist. They all say they experience immediate relief when they engage in self harm, no matter what the feeling is they are trying to control or avoid. They are willing to share their find with friends who may be experiencing diffulties in their lives. In a recent group of approximately 25 members of school districts, 100% reported seeing evidence of self harm in their students. Teachers and school staff report seeing self harm in children as young as 6, while most kids do not start using self harm until they are entering puberty. Girls are more likely to use self harm than boys, but boys are staring to use self harm to cope with feelings associated with sexual identity confusion. In a recent discussion with a local therapist who treats self harm, she reported the male clients she sees are more likley to act out their distress violently against others, especially the therapist. This is contrary to what has been noted in treating girls. There are relatively few studies that delve into the phenomenon of self innjury for a coping skill. There are however some recent reports emerging that lead to a possible genetic predisposition to self harming. What is known currently is kids who self harm have a mental health issue unerlying the need to cope with self harming behaviors. They may be experiencing depression or anxiety. Another common thread in all who self harm is it is not undertaken as an act of suicide.It is an act of desperation and one of trying to remain alive just one more day. Kids generally will try to conceal their injuries by harming in places easily covered by clothing such as the upper arms, inner thighs, trunk, hips and breasts. Eventually, the effects of the self harming doesn't work as well as it did and the person needs to up the ante and cut deeper or in a more tender area. The urge and need to self harm compounds itself until the ritual of self harming begins to become the focus of the day for the child or adult. They plan for opportunites to harm, and look forward to the release experienced when they do. They may have very complex rituals involving specifc instruments, pehaps in a specific location or a particlar time. The rituals may involve use of antiseptics and gauze after the harm to clean the wounds and dress them. It is not uncommon for those who self harm repetativley for long periods of time to become very knowledgable about the anatomy of the body so they know just where and how deep they can cut without doing permanent or terminal damage.
So as adults, where does all this leave us? What do we do if we discover our child or our friend is engageing in self harming? The main thing is be calm and non judgemental. Remember they have been using this to cope with some pretty scarry stuff and it is working for them for now. Be sure any injuries are not in need of medical attention. If they are and you are not capable of treating the wound yourself, go with the person to have the wounds treated. Be prepared to meet prejudice and stigma in the emergency room. Some medical professional have been known to place staples to close a wound without anethesia. Remember, these kids can feel pain just like anyone else can and deserve to be treated with dignity respect and compassion. Next, let the person now you are intersted in what is causing them to use this behavior and what they find it does for them. You really ned to listen and not judge. Validate it is working and they did try to solve the problem on their own and were successful, for now. Let them know they can stop and you will support them as much as you can. Let them know it is a process and you don't expect them to stop quickly. This will be like saying goodbye to a long trusted friend, much like saying goodbye to a drug of abuse is for an addict. Let them know you need to be able to trust they will tell you when they are feeling like cutting. Let them know you will help them talk through it, teach them to journal and discover the feelings and thoughts that lead up to the act. They will sometimes slip up, but the key is to keep moving forward. Once the feelings and thoughts are identified, then you can help them practice thougtt stopping. This will cause them to stretch the time out between the idea, the impulse and the act. With continued work, the minutes will become hours, will become days, and months until the person has successfully developed a healthy way to cope with most stressful emotionally charged situations. As new research emerges, we may learn more about what brain chemicals are triggered in specific individuals who self harm. The American Psychological Association is considering including NSSI in the upcoming edition of the Diagnostic Statistical Manual as a free standing diagnosis. This may be the first inroads to having self harm be covered by insurance companies for treatment. Until then, we can only strive to try what currently works, love, compassion and patience. There are several places that offer support for self harm. My recommendation is the SAFE Alternatives program out of Chicago. They can be found at

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