Cutting to cope

In my last article, I wrote about non-suicidal self-injury disorder (NSSI). According to American researchers, 17% to 18% of young people report that they have tried this behavior, with 7% to 8% becoming chronic repeaters. What motivates a person to harm him/herself? Non-suicidal self-injury is usually the result of a person's inability to cope with psychological pain in healthy ways. Often, the person has difficulty regulating, expressing and/or understanding emotions. The mix of emotions that could trigger self-injury is complex. For instance, there may be feelings of worthlessness, loneliness, panic, anger, guilt, rejection, self-hatred or confused sexual identity. Many of these individuals report that they do not feel at all; that is, they feel numb. Self-harm is a way of externalizing repressed feelings, since the person does not have the skills to express those feelings. “I did it when I felt so removed from this world that I did not even feel real anymore. I think I cut myself because I wanted to feel pain – because feeling anything, even pain, would mean that I was alive, real, and living in this world, and not fading into the background,” said a 16-year-old girl. While I focused last time on cutting (cuts or severe scratches with a sharp object), NSSI includes several other types of self-harm behavior. They include scratching, burning the skin (using matches, cigarettes or hot sharp objects), carving words or symbols on the skin, hitting or punching oneself, piercing the skin with sharp objects, pulling out hair (trichotillomania) and/or persistently picking at or interfering with wound healing. Nevertheless, cutting is the most common expression of self-injury. Most frequently, the arms, legs and torso are the body areas of self-injury. Prevention and help What should parents, teachers and other caring people look for? Primarily, be aware that the self-harm behavior is more common than many would believe. The goal is to help the teen stop the behavior before it becomes a pattern. Watch for the following signs that can be potential red flags that a young person is harming him/ herself. • Unexplained wounds or scars • Fresh cuts, bruises, burns, or other signs of bodily damage • Bandages worn frequently • Inappropriate clothing for the season (e.g., always wearing long pants or sleeves in the summer) • Constant use of wristbands or other jewelry that cover the wrists or lower arms • Unexplained cutting implements (e.g. razor blades or other equipment in your child's room) • Heightened signs of depression, anxiety and/or social withdrawal • Difficulties in interpersonal relationships • Persistent questions about personal identity, such as “Who am I?” “What am I doing here?” • Behavioral and emotional instability, impulsivity and unpredictability • Statements of helplessness, hopelessness or worthlessness • Eating disorder behavior such as bulimia has been shown to be associated with cutting behavior • Self-harm websites that promote young persons' hurting themselves may be found on the laptop or other electronic devices used by the teen What should you do if you suspect the self-harm behavior? If you are a parent, teacher, relative, friend, rabbi, and/or counselor and become aware of a teen displaying the above signs, make sure there is a frank and open discussion between the child and a trusted adult. In general, I think it is the parents' job to speak with the child directly, and others – such as school officials, teachers, counselors and rabbis – should notify and alert the parents about their concern. When adults do not pay attention to these signs or minimize their seriousness, they are in fact enabling the behavior to continue. If parents do not know how to approach their child, they should seek professional help from a mental health specialist for guidance. School personnel may want to call an emergency meeting with the parents, teacher, school guidance counselor or psychologist to discuss the problem. Ultimately, the young person will need a professional evaluation by a trained mental health specialist to determine the extent and pattern of the self-harm behavior. Such an evaluation will assess the psychosocial issues that led to the behavior. Treatment In my experience, a combination of cognitive-behavioral therapy and motivational and problem-solving counseling for the teenager coupled with parental counseling and/or family therapy can get to the issues that underlie the self-harm and help the teenager find healthier ways to solve his/her emotional problems. Depending on the diagnosis, psychiatric medication may be a useful adjunct to this treatment. The good news is that as scary as it is for parents to find out that their child is intentionally harming him/ herself, psychological treatment, once undertaken for NSSI, can be very effective. ■ The writer is a marital, child and adult cognitive-behavioral psychotherapist with offices in Jerusalem and Ra'anana. www.facebook.com/drmikegropper ; drmikegropper@gmail.com

Cutting to cope

‘The good news is that as scary as it is for parents to find out that their child is intentionally harming him/herself, psychological treatment can be very effective’

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Cutting to cope

‘The good news is that as scary as it is for parents to find out that their child is intentionally harming him/herself, psychological treatment can be very effective’

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