Heather had seen me for hypnosis sessions to deal with a fear of driving after being a passenger in a minor traffic accident, so later she scheduled a consultation with me after she walked in on her 16-year-old daughter Emily intentionally cutting herself in the bathroom.
The experience was understandably traumatic, especially after Emily reluctantly showed her multiple wounds on her arms and legs in various stages of healing. Heather was bursting with questions. Is this behavior at all common among teenagers? Why would someone do this to themselves? Had she done something wrong as a mother to bring this about? Did this mean that Emily was mentally ill? Did this mean that Emily might commit suicide? And, finally, are there any effective treatments for this behavior? There are answers to all these questions, and I would like to share them here.
Getting a handle on the prevalence of non-suicidal self-injuring is challenging. First, the behavior is almost always done alone, in secret. Also, the behavior does not have its own specific diagnosis the way, for instance, depression, anxiety or substance abuse disorders do. So collecting and counting the numbers is not straightforward. In the last few years, however, careful analyses of studies from around the world have begun to yield consistent findings. The prevalence of self-injuring among adults is about 5% (one in 20) and about 17% (one in six) among adolescents. Since earlier statistics are not reliable, it is difficult to see trends. Nonetheless, professionals in the field are convinced that these behaviors are on the rise, especially among teenagers.
One popular explanation for self-injuring sees it as attention-getting behavior. Another idea suggests the importance of social contagion in that young people may be influenced by movies or other media that seem to romanticize such behaviors. And being acquainted with others who have self-injured does seem to increase risk. So there may be some truth to these views in some cases, but the heart of the matter lies in the observation that people who self-injure are using it as a maladaptive coping strategy to reduce emotional and psychological pain or numbness. People report that an episode of self-injury enables them to overcome overwhelming feelings of despair and get on with daily life. The behavior can begin to look like an addiction in that the injury causes the brain to produce some opioid-like substances, which reinforce feelings of relief.
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While it is not helpful or accurate to blame parents when young people self-injure, there are some family dynamics and childhood histories that are often seen. A parental pattern of high control and low intimacy is prevalent. And, as with so many dysfunctional behaviors, childhood abuse, especially sexual abuse, is a strong risk factor.
Patients with certain psychiatric diagnoses, such as schizophrenia, bipolar disorder, autism and borderline personality disorder, are at increased risk for self-injuring behaviors. The majority of people who self-injure, however, do not have any of these or other psychiatric disorders. It seemed clear to me that while Emily’s behavior was troubling and serious, she was not otherwise mentally ill.
Common sense might suggest a clear relationship between self-injuring and suicide. Attacking one’s own body might seem to be a first step toward the ultimate and fatal attack of suicide. But the reality is almost the opposite of that. Most people who self-injure have no suicidal intent and, in fact, consider their self-injuring to be a way of coping with, and in the short term, improving the quality of daily life. This is baffling when looked at from the outside, but from the inside, often seems to work. But, of course, it is a risky strategy.
With one in six adolescents now engaging in this disturbing behavior, it is no surprise that mental health professionals are beginning to pay attention, conduct research and devise innovative clinical practices to address what may be a spreading crisis.
We in the central New York area are fortunate that one of the most innovative programs in North America is the Self-injury and Recovery Resources Program in the College of Human Ecology at Cornell University. Founded in 2003, the program offers professional consultations and provides a wealth of information on its website. With their help, Heather found the support and services she needed for her daughter. A few months ago, the program’s director, Janice Whitlock, co-authored the book "Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones." It is a readily available and highly recommended resource.
Dr. Victor Garlock holds a Ph.D. in psychology and is the author of "Your Genius Within: Sleep, Dream Interpretation & Hypnosis." He was a professor of psychology at Cayuga Community College for over 30 years. He currently is offering individual hypnosis sessions as well as personal counseling at The Center, a holistic health center and spa located in Auburn. For more information, call (315) 704-0319 or visit thecenter4wellness.com.