Articles: Self-Injury Cases Widespread
By Leslie Petrovski
April 27 - Three years ago when Brianna Hughes was 15, she began carving her skin with the scissors her mother used to cut hair.
At first it was just enough to draw a little blood, a few cuts here and there on her forearms. Then she began engraving her shoulders and stomach. Oddly, she says it didn't hurt.
Once she and a girlfriend even cut themselves while speaking on the phone, describing each detail of their actions.
The more she cut, the more she needed to cut.
What's even more peculiar is that she learned to do it from friends. Brianna, who asked that her real name not be used, is among the huge number of teens and young adults who self-injure. Although statistics are unavailable, mental health workers put the number of adolescents who en gage in some form of self-mutila tion between 1 percent and 40 percent.
Jennifer Hagman, medical director of in-patient psychiatry at Children's Hospital and co-director of the hospital's eating disorders program, estimates that as many as 40 percent of kids have experimented with self-injury. "I see quite a bit of it," she says. "We screen every child who (shows) an emotional disturbance for this."
Other experts say as many as 2 million people engage in self-injurious behaviors, which can range from cutting and burning to head banging, hair pulling or even severe nail biting.
A bizarre manifestation of a troubled psyche, self-injury may be more difficult for the public to wrap their minds around than eating disorders (which can be viewed as a form of self-injury) or even obsessive-compulsive disorder.
Although some mental health pro fessionals see the incidence of self-injury increasing among young people, others say the public is just becoming more aware. Recent confessionals like Princess Diana's admission that she cut her arms and legs as a way to cope with her emotional pain, and Johnny Depp's revelation that the scars on his arms are self-inflicted, have brought this behavior to light.
In 1998 a handful of books, including Marilee Strong's "A Bright Red Scream: Self-Mutilation and the Language of Pain," and Karen Conterio and Wendy Lader's "Bodily Harm" appeared on the scene, further illuminating the problem. The TV show "Seventh Heaven" even featured an episode highlighting a character with the problem. Not a new problem
"This has been going on for years and years," explains Tracy Alderman, author of "The Scarred Soul: Understanding and Ending Self-In flicted Violence."
"Self-injury is where eating disorders were 20 years ago. It's going through the same process (of public perception)."
Sometimes called "cutters" - if that's how they choose to hurt themselves - self-injurers don't see their behavior as suicidal, but rather as a coping mechanism or cry for help. People who self-injure don't want to die; rather, they want to release the overwhelming emotions welling up inside or feel something other than numbness.
Some experts argue that self-injury can be viewed as an extreme form of other popular body-altering behaviors like tattooing or piercing, and as such has gained a degree of peer acceptance.
While tattoos and extraneous piercings don't classify as self-injury, "there is a segment of (the teen population) that's accepting of this or that views this as a badge of courage," explains Julia Parisian, a psychologist with Colorado Counseling Professionals. Patterns noted, "With certain non-mainstream groups - the...heavy metal types - this is seen as an acceptable thing and a way to get positive attention from peers." A vast majority of people who self-injure come from homes where there has been physical, sexual or emotional abuse, substance abuse, or from homes where emotions were suppressed. The self-injury, then, can be a re-enactment of past abuse over which the individual has some control - they can start and stop it as they wish - or it can be a way to manipulate their environment - it can be a ticket to the hospital and out of school. It can also be a way to release the nuclear feelings boiling inside an angry kid.
"If you haven't learned to express feelings," explains Irwin Levy, a psychiatric consultant for the Excelsior Youth Center, "if what you feel is ultra-intense, you have to do something to avoid exploding. That something might be alcohol, drugs or self-injury."
Julie Hammer, 20, began cutting her feet with razor blades at the age of 14 when she learned that her body couldn't handle the demands of a ballet career. Hammer, who grew up in New Mexico and now lives in Aus tin, Texas, said she used cutting as a way to release stress and anger.
"I was angry at my body," she says. "In frustration I cut my feet."
One of the prevailing theories as to why self-injury makes someone "feel" better is that the physical injury causes the brain to release endorphins that can lead to feelings of euphoria and a respite from the psychological pain they were feeling.
The tangible hurt of a wound can also be easier to handle than the complex stew of emotions churning inside a troubled kid.
Many people have no idea where they learned to self-injure. Often an accident like breaking a glass or a happenstance cut precipitates the behavior.
"When they feel some tangible pain and see the blood," explains Carol Beauchamp-Hunter, director of treatment at Excelsior, "they can nurse it back to health. It's easier than the emotional pain."
People who self-injure often don't remember their acts of self-abuse. It's as if they enter a trancelike state, what psychologists call a dissociative state, where they experience an almost out-of-body apartness from their surroundings. During a dissociative episode, people tend to feel less pain, and many self-injurers say the cuts don't hurt until after they've snapped out of it and the wounds begin to heal.
While the intent of most self-injurers isn't death, the behaviors can be dangerous and typically escalate. Eventually, the relief that cutters experience lessens, and to achieve the same level of emotion al release, they up the ante.
In Julie Hammer's case, her cutting increased in frequency until she was doing it every day. Others might injure themselves to such a degree they end up in the hospital with broken bones or a case of bleeding they can't stop.
Many end up with physical scars that last a lifetime.
"It really prevents a person from having a normal life," explains Paulette Pasquale, clinical nurse specialist with the SAFE Alterna tives program out of Chicago, the country's only residential treat ment program specifically for self-injury. "There's no way they can be injuring and not have it affect their life pretty drastically. There's a lot of loss around relationships. People don't trust them, or they're hiding out (because they're embarrassed). People think it's really creepy." Self-injurers usually start in ado lescence, continue through their 20s and drop the behavior as they mature, although some continue hurting themselves for decades.
Depending on the severity of the case, if a self-injurer gets help and works at it, the odds are pretty good they'll stop. Treatment focuses on helping the person identify and express feelings as well as develop healthier coping strategies like exercise or relaxation techniques. In some cases, antidepres sants are prescribed.
In Brianna's case, she didn't stop until her medication was regulated and her family threatened to turn her over to the state. She is deeply embarrassed now by the pain she caused her family. Last year, she graduated from high school and got a job, and someday she hopes to study counseling. Today, most of her scars have healed, although some spidery white marks remain.
"You're not really a bad person because you're doing it," she says. "The only thing is, you hurt the people around you, not just your self."
WARNING SIGNS
There are a number of warning signs to help identify someone who is self-abusing.
The most obvious is if you see frequent, inexplicable wounds - most commonly cuts and burns. Because many people feel ashamed of this behavior, they might wear long sleeves and pants even in warm weather to cover up their injuries.
Other markers include low self-esteem, problems handling emotions, poor functioning at work or school, and relationship problems.
If you suspect that a family member is self-injuring, express concern and get them professional help. Your pediatrician might be able to recommend a therapist with experience in this area.
Other resources include:
1-800-DON'T-CUT: This is not a hot line but an information line about the SAFE Alternatives program, the country's only in-patient treatment program for people who repeatedly self injure.
"Bodily Harm: The Breakthrough Treatment Program for Self-Injurers' by Karen Conterio and Wendy Lader: Written by the directors of SAFE, "Bodily Harm' offers an examination of self-injury in addition to a treatment regimen.
"The Scarred Soul: Understanding and Ending Self-Inflicted Violence' by Tracy Alderman: This is a self-help guide designed to educate self-abusers about the phenomenon and teach them strategies to stop.
"A Bright Red Scream: Self-Mutilation and the Language of Pain' by Marilee Strong: A Pulitzer-prize winning journalist, Marilee Strong interviews psychiatrists, self-injurers and researchers to present a broad overview of the current thinking regarding this problem.
At first it was just enough to draw a little blood, a few cuts here and there on her forearms. Then she began engraving her shoulders and stomach. Oddly, she says it didn't hurt.
Once she and a girlfriend even cut themselves while speaking on the phone, describing each detail of their actions.
The more she cut, the more she needed to cut.
What's even more peculiar is that she learned to do it from friends. Brianna, who asked that her real name not be used, is among the huge number of teens and young adults who self-injure. Although statistics are unavailable, mental health workers put the number of adolescents who en gage in some form of self-mutila tion between 1 percent and 40 percent.
Jennifer Hagman, medical director of in-patient psychiatry at Children's Hospital and co-director of the hospital's eating disorders program, estimates that as many as 40 percent of kids have experimented with self-injury. "I see quite a bit of it," she says. "We screen every child who (shows) an emotional disturbance for this."
Other experts say as many as 2 million people engage in self-injurious behaviors, which can range from cutting and burning to head banging, hair pulling or even severe nail biting.
A bizarre manifestation of a troubled psyche, self-injury may be more difficult for the public to wrap their minds around than eating disorders (which can be viewed as a form of self-injury) or even obsessive-compulsive disorder.
Although some mental health pro fessionals see the incidence of self-injury increasing among young people, others say the public is just becoming more aware. Recent confessionals like Princess Diana's admission that she cut her arms and legs as a way to cope with her emotional pain, and Johnny Depp's revelation that the scars on his arms are self-inflicted, have brought this behavior to light.
In 1998 a handful of books, including Marilee Strong's "A Bright Red Scream: Self-Mutilation and the Language of Pain," and Karen Conterio and Wendy Lader's "Bodily Harm" appeared on the scene, further illuminating the problem. The TV show "Seventh Heaven" even featured an episode highlighting a character with the problem. Not a new problem
"This has been going on for years and years," explains Tracy Alderman, author of "The Scarred Soul: Understanding and Ending Self-In flicted Violence."
"Self-injury is where eating disorders were 20 years ago. It's going through the same process (of public perception)."
Sometimes called "cutters" - if that's how they choose to hurt themselves - self-injurers don't see their behavior as suicidal, but rather as a coping mechanism or cry for help. People who self-injure don't want to die; rather, they want to release the overwhelming emotions welling up inside or feel something other than numbness.
Some experts argue that self-injury can be viewed as an extreme form of other popular body-altering behaviors like tattooing or piercing, and as such has gained a degree of peer acceptance.
While tattoos and extraneous piercings don't classify as self-injury, "there is a segment of (the teen population) that's accepting of this or that views this as a badge of courage," explains Julia Parisian, a psychologist with Colorado Counseling Professionals. Patterns noted, "With certain non-mainstream groups - the...heavy metal types - this is seen as an acceptable thing and a way to get positive attention from peers." A vast majority of people who self-injure come from homes where there has been physical, sexual or emotional abuse, substance abuse, or from homes where emotions were suppressed. The self-injury, then, can be a re-enactment of past abuse over which the individual has some control - they can start and stop it as they wish - or it can be a way to manipulate their environment - it can be a ticket to the hospital and out of school. It can also be a way to release the nuclear feelings boiling inside an angry kid.
"If you haven't learned to express feelings," explains Irwin Levy, a psychiatric consultant for the Excelsior Youth Center, "if what you feel is ultra-intense, you have to do something to avoid exploding. That something might be alcohol, drugs or self-injury."
Julie Hammer, 20, began cutting her feet with razor blades at the age of 14 when she learned that her body couldn't handle the demands of a ballet career. Hammer, who grew up in New Mexico and now lives in Aus tin, Texas, said she used cutting as a way to release stress and anger.
"I was angry at my body," she says. "In frustration I cut my feet."
One of the prevailing theories as to why self-injury makes someone "feel" better is that the physical injury causes the brain to release endorphins that can lead to feelings of euphoria and a respite from the psychological pain they were feeling.
The tangible hurt of a wound can also be easier to handle than the complex stew of emotions churning inside a troubled kid.
Many people have no idea where they learned to self-injure. Often an accident like breaking a glass or a happenstance cut precipitates the behavior.
"When they feel some tangible pain and see the blood," explains Carol Beauchamp-Hunter, director of treatment at Excelsior, "they can nurse it back to health. It's easier than the emotional pain."
People who self-injure often don't remember their acts of self-abuse. It's as if they enter a trancelike state, what psychologists call a dissociative state, where they experience an almost out-of-body apartness from their surroundings. During a dissociative episode, people tend to feel less pain, and many self-injurers say the cuts don't hurt until after they've snapped out of it and the wounds begin to heal.
While the intent of most self-injurers isn't death, the behaviors can be dangerous and typically escalate. Eventually, the relief that cutters experience lessens, and to achieve the same level of emotion al release, they up the ante.
In Julie Hammer's case, her cutting increased in frequency until she was doing it every day. Others might injure themselves to such a degree they end up in the hospital with broken bones or a case of bleeding they can't stop.
Many end up with physical scars that last a lifetime.
"It really prevents a person from having a normal life," explains Paulette Pasquale, clinical nurse specialist with the SAFE Alterna tives program out of Chicago, the country's only residential treat ment program specifically for self-injury. "There's no way they can be injuring and not have it affect their life pretty drastically. There's a lot of loss around relationships. People don't trust them, or they're hiding out (because they're embarrassed). People think it's really creepy." Self-injurers usually start in ado lescence, continue through their 20s and drop the behavior as they mature, although some continue hurting themselves for decades.
Depending on the severity of the case, if a self-injurer gets help and works at it, the odds are pretty good they'll stop. Treatment focuses on helping the person identify and express feelings as well as develop healthier coping strategies like exercise or relaxation techniques. In some cases, antidepres sants are prescribed.
In Brianna's case, she didn't stop until her medication was regulated and her family threatened to turn her over to the state. She is deeply embarrassed now by the pain she caused her family. Last year, she graduated from high school and got a job, and someday she hopes to study counseling. Today, most of her scars have healed, although some spidery white marks remain.
"You're not really a bad person because you're doing it," she says. "The only thing is, you hurt the people around you, not just your self."
WARNING SIGNS
There are a number of warning signs to help identify someone who is self-abusing.
The most obvious is if you see frequent, inexplicable wounds - most commonly cuts and burns. Because many people feel ashamed of this behavior, they might wear long sleeves and pants even in warm weather to cover up their injuries.
Other markers include low self-esteem, problems handling emotions, poor functioning at work or school, and relationship problems.
If you suspect that a family member is self-injuring, express concern and get them professional help. Your pediatrician might be able to recommend a therapist with experience in this area.
Other resources include:
1-800-DON'T-CUT: This is not a hot line but an information line about the SAFE Alternatives program, the country's only in-patient treatment program for people who repeatedly self injure.
"Bodily Harm: The Breakthrough Treatment Program for Self-Injurers' by Karen Conterio and Wendy Lader: Written by the directors of SAFE, "Bodily Harm' offers an examination of self-injury in addition to a treatment regimen.
"The Scarred Soul: Understanding and Ending Self-Inflicted Violence' by Tracy Alderman: This is a self-help guide designed to educate self-abusers about the phenomenon and teach them strategies to stop.
"A Bright Red Scream: Self-Mutilation and the Language of Pain' by Marilee Strong: A Pulitzer-prize winning journalist, Marilee Strong interviews psychiatrists, self-injurers and researchers to present a broad overview of the current thinking regarding this problem.