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Dangerous release: Professionals describe self-harm behavior

Photo courtesy Goshay Productions, LLC.

Mental health professionals say patients they see engaging in cutting and other self-harm are resorting to the behavior to relieve the intense emotions they are unable to manage in a healthy way.

Ajeng Puspitasari, a clinical psychologist at Mayo Clinic in Rochester, Minn., said such behaviors are more prevalent "in younger populations—adolescents and young adults, but adults do engage in self-injurious behavior."

"It's a way to cope with intense emotions," she said. "Unfortunately, some feel better immediately after they cut, but there are consequences—the wounds, the responses from others—that are more severe and problematic."

That sense of relief, or emotional release, can also increase the likelihood that the behavior will become a habit, Puspitasari said.

The act of using a sharp instrument to self-inflict pain is difficult for most people to understand.

"Some (patients) say that it's easier to feel physical pain rather than emotional pain—because emotional pain is internal, it's harder to express," Puspitasari said.

Unless the patient learns healthier coping strategies to deal with strong emotions, self-harm can lead to more serious, even life-threatening behaviors, experts say.

Young people who cut "are grasping at a means to cope with difficult aspects of life," said Allana Danduran, integrated therapist at Sanford Children's in Fargo. "We want to replace that with different types of skills."

"I've come to view (someone who cuts) as a person with maladaptive or dysfunctional coping skills. So when there's a crisis or emotional distress, they don't have the skills to tolerate that," Danduran said.

Cutting is "pretty common," she said. "I don't know if it's becoming more common, but it may be more out in the open because the stigma surrounding mental health is decreasing all the time. There's much less shame in getting help."

Websites and social media such as Snapchat, Instagram and YouTube channels may be contributing to the phenomenon, she said.

"I wonder if, on these sites, cutting is being presented as an option for young people—like, 'Oh, you could try this.' "

Signs and symptoms

Cutting is not a clinically diagnosed "disorder," said Puspitasari.

"It is one of the symptoms that may be exhibited by people who suffer from disorders such as borderline personality disorder or by people who have trauma issues, eating disorders or substance use disorder," Puspitasari said.

People who are experiencing depression, post traumatic stress disorder or anxiety disorder can also exhibit these types of behaviors, she said.

For those who engage in cutting, "it is an unhealthy way of coping with strong emotions that are overpowering for them," said Dr. Ellen Feldman, child psychiatrist at Altru Health System in Grand Forks.

"The behavior typically starts in childhood," she said, and often stems from a past traumatic experience that produces a strong emotional response.

Mental health professionals "look for trauma," Feldman said. "What made it difficult to process emotion? Where is the trauma that made it so hard for this particular person to experience those emotions, talk about those emotions and weather them?

"We also look at personality and probably genetics."

Signs of self-harm include scarring, particularly on the wrists and arms as well as frequent fresh cuts, scratches, burns, bruises and other minor injuries, experts say.

Other signs include wearing long-sleeved garments and pants even when not weather-appropriate, impulsiveness or unpredictability, trouble maintaining interpersonal relationships, low self-esteem, and trouble at work or school.

Triggers

The triggers that prompt the urge to cut "are different for every person," said Puspitasari.

"The trigger may be in their environment—like a high-stress job or an interpersonal conflict, such as fight with their spouse," she said.

In a crisis situation, to alleviate the urge to cut, Puspitasari teaches patients to "just stop, put down the object—the scissors or knife—and not make things worse," she said.

She also suggests engaging in an activity which provides a similar sensation, such as a cold shower, placing an ice pack on the wrist, or going outside for fresh air," she said.

"An intense physical activity, a walk, a run, or going up and down stairs" can also help in a crisis moment.

"Then, when they're out of the crisis, we teach them what other strategies they could do as well" to avoid cutting, she said.

High stress environment

If cutting is on the rise—or just more out in the open in the culture today—several factors may be contributing.

"The environment we are currently living in is a high-stress environment," Puspitasari said. "For example, with social media, there's 24/7 exposure to information."

The potential for cyber-bullying is non-stop, she said, whereas in the past "kids could go home" and not confront bullying, at least until their return to school the next day.

"Today, there's a lower intensity of social connections," she said. "We have a highly individualized society, so asking for support is more challenging."

"In our culture, for those who experience strong emotions and do ask for help, others' responses may not be validating," Puspitasari said. "They may be seen as weak or not productive or not able to solve their problems."

Some who engage in self-harm "probably started out by asking for help with their words," but didn't receive it, she said.

"For some, cutting becomes a way to communicate how much suffering they are in, and how much they need people to provide support."

The good news is that the tendency to cut is "something that's highly treatable," Feldman said, "and the earlier it's stopped—before it becomes an ingrained habit—the better."

Psychotherapy, or talk therapy, whether individually or in groups, has proven effective, she said.

"Medications sometimes can help a person tolerate the emotions, so they feel less overpowering," she said, "so you can find out what's going on—why am I now experiencing emotions about something that happened to me three years or five years or 10 years ago?"

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