Articles: Self-Injury
By Leslie Goldman
THE FIRST time she hurt herself intentionally, she was 4 years old, said Erica, a counseling-psychology graduate student in a Chicago suburb who told her story on the condition of anonymity: In her short life, she had already been sexually abused by both parents. She was later molested in foster care. Unable to communicate her anguish, Erica taught herself to use physical pain to relieve her mental hurt.
"I would scratch myself until I bled, and then I would interfere with the healing," she recalled.
In her teens, her self-injury escalated until she was cutting and burning herself on her legs, hands and arms. "I was numb," she said. "Every time I self-injured, it was always a relief. For me, it was looking at the blood and thinking, 'I'm getting rid of what I feel.'"
Doctors prescribed antibiotics for her infections, but not counseling for her psyche. The aunt with whom she lived throughout junior high and high school, ignored her cries for help, accusing her of being manipulative and simply seeking attention, Erica said. In college, if people questioned her wounds, "I would just make up some excuse."
Practiced by a shocking 3 million people in this country alone, according to experts in the field, self-injury is defined as the physical alteration of a person's own body tissue, via cutting, scratching, burning or purposefully breaking bones. The self-injury can be quite covert. Knives or razor blades present an obvious threat, but a home office or kitchen boasts a virtual arsenal of equally self-injurious tools: paper clips, needles, pushpins and scissors to cut the body; oven cleaner, bleach and matches to burn it. Affected individuals typically irritate their wounds to prevent healing, donning long-sleeved shirts and pants to hide the marks.
Why? The answer, as it turns out, is comparable to the driving force behind other addictions. Much like an alcoholic seeks solace in the bottle or an anorexic is comforted by a rumbling stomach, self-injurers feel so depressed, so numb, that hurting themselves is - paradoxically - the only way they feel alive.
"The internal conflict is so overwhelming, they can't articulate it emotionally," said Karen Conterio, who in 1985 cofounded the nation's first in-patient center for self-injurers. At Self-Abuse Finally Ends (SAFE) Alternatives in Chicago, she said she and cofounder Wendy Lader receive 5,000 calls per month.
The self-injurer's actions serve to re-create a communication scenario typically reserved for childhood, Conterio said: "Like when a little kid skins his knee, his mom kisses it. Or when a baby's fussy, the parent must interpret."
The strongest risk factor for self-injury is a poor - or nonexistent - family communication network, a modern scourge made worse by the profusion of computers and televisions, she said. An estimated 50 percent of all self-injurers have a history of being physically - and often emotionally or sexually - abused.
"In one way, they want to punish the body," Conterio explained. "The body was 'bad'; it betrayed them. When they start to heal, the pain is immense."
Self-injurer demographics are similar to those of eating disorders: overwhelmingly female and white, intelligent and perfectionistic, much like Princess Diana, who, in a 1995 BBC interview, disclosed that she had dabbled in self-injury. One of her biographies says she once threw herself into a glass cabinet at Kensington Palace and cut herself with razor blades and a lemon slicer as ways of dealing with an unhappy marriage.
The problem has been spotlighted on television on "Beverly Hills, 90210" and "7th Heaven." And rapper Eminem sings in one song; "Sometimes I even cut myself to see how much it bleeds/It's like adrenaline, the pain is such a sudden rush for me."
For even the healthiest of teens, adolescence is a time of physical and emotional susceptibility. Lader, who is SAFE's clinical director, explained that young adults are separating from parents, their bodies are changing, their sexuality is emerging, and self-esteem issues are beginning to surface.
"It becomes, 'There's something wrong with me,' not 'There's something wrong with this situation,'" Erica said.
Those changes clear the way for what Lader called the "body-as-bulletin-board" phenomenon, which may be expressed by healthy teens in a tattoo or piercing, as well as by self-injurers. "It's a way to ... say who they are, where they belong ... to set them apart," she said.
But with so many teenagers experimenting with body modification, how can a parent differentiate between a child's harmless foray into self-expression and a more serious psychological disorder?
"I think it does the problem a disservice, saying self-injury is just a cultural variant and just further down the continuum from body modification," said Barbara Stanley, a neuroscience researcher at the New York State Psychiatric Institute at Columbia University. "There's nothing pretty about self-injury. People can't fathom it - even people who treat it."
Key factors distinguishing self-injury from body modification include motivation and drive, Lader said. A healthy teenager may seek out an assortment of piercings without being at risk for self-injury. The problem has appeared when the desire evolves into a need. "They see blood as life-affirming," Lader said.
As Erica explained, "I made a conscious choice. It wasn't painful in the moment. I was so caught up in getting [my emotional pain] released, that I just shut that part out."
In an effort to tease out the factors feeding into self-injury, Stanley has been conducting research comparing its possible clinical and biological roots. Stanley said research has indicated a possible link between self-injury and the release of pain-regulating opiates. This may explain why sufferers are able to cut or burn themselves.
"In the moment," Erica said, "it's trancelike."
Ultimately, Lader and Conterio said, patients have to want to get better. They estimate SAFE's two-year success rate at about 75 percent.
"We have patients who have been told, 'You will be nothing, you can accomplish nothing,'" Conterio said, "and they're getting married, holding down a job."
Leslie Goldman wrote this story for the Chicago Tribune.
GETTING OVER SELF-INJURY
IN THIS EXCERPT from "Reviving Ophelia: Saving the Selves of Adolescent Girls" (Ballantine), author Mary Pipher writes about treating self-mutilation:
"Therapy can teach girls to identify early that they are in pain. They need to label their internal state as painful and then think about how to proceed. They must learn new ways to deal with intense misery and also new ways to process pain. Their stock way has been to hurt themselves. They must learn to recognize pain and help themselves.
"Fortunately, this tendency to inflict harm on the body when in psyche pain is quite curable. Young women can be taught to process pain by thinking and talking, instead of punishing themselves. Most young women respond quickly to guidance about how to stop this behavior and develop more adaptive ones. They stop the self-mutilating and begin to talk about the stresses they are under."
"I would scratch myself until I bled, and then I would interfere with the healing," she recalled.
In her teens, her self-injury escalated until she was cutting and burning herself on her legs, hands and arms. "I was numb," she said. "Every time I self-injured, it was always a relief. For me, it was looking at the blood and thinking, 'I'm getting rid of what I feel.'"
Doctors prescribed antibiotics for her infections, but not counseling for her psyche. The aunt with whom she lived throughout junior high and high school, ignored her cries for help, accusing her of being manipulative and simply seeking attention, Erica said. In college, if people questioned her wounds, "I would just make up some excuse."
Practiced by a shocking 3 million people in this country alone, according to experts in the field, self-injury is defined as the physical alteration of a person's own body tissue, via cutting, scratching, burning or purposefully breaking bones. The self-injury can be quite covert. Knives or razor blades present an obvious threat, but a home office or kitchen boasts a virtual arsenal of equally self-injurious tools: paper clips, needles, pushpins and scissors to cut the body; oven cleaner, bleach and matches to burn it. Affected individuals typically irritate their wounds to prevent healing, donning long-sleeved shirts and pants to hide the marks.
Why? The answer, as it turns out, is comparable to the driving force behind other addictions. Much like an alcoholic seeks solace in the bottle or an anorexic is comforted by a rumbling stomach, self-injurers feel so depressed, so numb, that hurting themselves is - paradoxically - the only way they feel alive.
"The internal conflict is so overwhelming, they can't articulate it emotionally," said Karen Conterio, who in 1985 cofounded the nation's first in-patient center for self-injurers. At Self-Abuse Finally Ends (SAFE) Alternatives in Chicago, she said she and cofounder Wendy Lader receive 5,000 calls per month.
The self-injurer's actions serve to re-create a communication scenario typically reserved for childhood, Conterio said: "Like when a little kid skins his knee, his mom kisses it. Or when a baby's fussy, the parent must interpret."
The strongest risk factor for self-injury is a poor - or nonexistent - family communication network, a modern scourge made worse by the profusion of computers and televisions, she said. An estimated 50 percent of all self-injurers have a history of being physically - and often emotionally or sexually - abused.
"In one way, they want to punish the body," Conterio explained. "The body was 'bad'; it betrayed them. When they start to heal, the pain is immense."
Self-injurer demographics are similar to those of eating disorders: overwhelmingly female and white, intelligent and perfectionistic, much like Princess Diana, who, in a 1995 BBC interview, disclosed that she had dabbled in self-injury. One of her biographies says she once threw herself into a glass cabinet at Kensington Palace and cut herself with razor blades and a lemon slicer as ways of dealing with an unhappy marriage.
The problem has been spotlighted on television on "Beverly Hills, 90210" and "7th Heaven." And rapper Eminem sings in one song; "Sometimes I even cut myself to see how much it bleeds/It's like adrenaline, the pain is such a sudden rush for me."
For even the healthiest of teens, adolescence is a time of physical and emotional susceptibility. Lader, who is SAFE's clinical director, explained that young adults are separating from parents, their bodies are changing, their sexuality is emerging, and self-esteem issues are beginning to surface.
"It becomes, 'There's something wrong with me,' not 'There's something wrong with this situation,'" Erica said.
Those changes clear the way for what Lader called the "body-as-bulletin-board" phenomenon, which may be expressed by healthy teens in a tattoo or piercing, as well as by self-injurers. "It's a way to ... say who they are, where they belong ... to set them apart," she said.
But with so many teenagers experimenting with body modification, how can a parent differentiate between a child's harmless foray into self-expression and a more serious psychological disorder?
"I think it does the problem a disservice, saying self-injury is just a cultural variant and just further down the continuum from body modification," said Barbara Stanley, a neuroscience researcher at the New York State Psychiatric Institute at Columbia University. "There's nothing pretty about self-injury. People can't fathom it - even people who treat it."
Key factors distinguishing self-injury from body modification include motivation and drive, Lader said. A healthy teenager may seek out an assortment of piercings without being at risk for self-injury. The problem has appeared when the desire evolves into a need. "They see blood as life-affirming," Lader said.
As Erica explained, "I made a conscious choice. It wasn't painful in the moment. I was so caught up in getting [my emotional pain] released, that I just shut that part out."
In an effort to tease out the factors feeding into self-injury, Stanley has been conducting research comparing its possible clinical and biological roots. Stanley said research has indicated a possible link between self-injury and the release of pain-regulating opiates. This may explain why sufferers are able to cut or burn themselves.
"In the moment," Erica said, "it's trancelike."
Ultimately, Lader and Conterio said, patients have to want to get better. They estimate SAFE's two-year success rate at about 75 percent.
"We have patients who have been told, 'You will be nothing, you can accomplish nothing,'" Conterio said, "and they're getting married, holding down a job."
Leslie Goldman wrote this story for the Chicago Tribune.
GETTING OVER SELF-INJURY
IN THIS EXCERPT from "Reviving Ophelia: Saving the Selves of Adolescent Girls" (Ballantine), author Mary Pipher writes about treating self-mutilation:
"Therapy can teach girls to identify early that they are in pain. They need to label their internal state as painful and then think about how to proceed. They must learn new ways to deal with intense misery and also new ways to process pain. Their stock way has been to hurt themselves. They must learn to recognize pain and help themselves.
"Fortunately, this tendency to inflict harm on the body when in psyche pain is quite curable. Young women can be taught to process pain by thinking and talking, instead of punishing themselves. Most young women respond quickly to guidance about how to stop this behavior and develop more adaptive ones. They stop the self-mutilating and begin to talk about the stresses they are under."