Thursday, April 14, 2011

Self Injury: Cutting, Burning, etc.

Myth: Self-harm is a suicidal act.
  • Fact: Although people do die from self-harm, these instances are accidental; in general, self-harmers do not want to die. In fact, self-injury may be a way of coping, of regaining control of pain—in order to go on living.
Myth: People who self-injure are crazy.
  • Fact: Those who self-harm are usually dealing with trauma, not mental health problems. There are exceptions, but by and large, you are probably trying to cope with problems in the only way you know how.
Myth: Injuring yourself is a cry for attention.
  • Fact: Friends, family, and even healthcare professionals may think that if you hurt yourself, you are seeking attention, but the painful truth is that people who self-harm generally try to hide what they are doing—rather than draw attention to it—because they feel ashamed and afraid.


"Favazza and Rosenthal (1993) identify pathological self-mutilation as the deliberate alteration or destruction of body tissue without conscious suicidal intent. A common example of self-mutilating behavior is cutting the skin with a knife or razor until pain is felt or blood has been drawn. Burning the skin with an iron, or more commonly with the ignited end of a cigarette, is also a form of self-mutilation. "

"Why Do People Cut Themselves?
It can be hard to understand why people cut themselves on purpose. Cutting is a way some people try to cope with the pain of strong emotions, intense pressure, or upsetting relationship problems. They may be dealing with feelings that seem too difficult to bear, or bad situations they think can't change.

Some people cut because they feel desperate for relief from bad feelings. People who cut may not know better ways to get relief from emotional pain or pressure. Some people cut to express strong feelings of rage, sorrow, rejection, desperation, longing, or emptiness.

There are other ways to cope with difficulties, even big problems and terrible emotional pain. The help of a mental health professional might be needed for major life troubles or overwhelming emotions. For other tough situations or strong emotions, it can help put things in perspective to talk problems over with parents, other adults, or friends. Getting plenty of exercise can also help put problems in perspective and help balance emotions.

But people who cut may not have developed ways to cope. Or their coping skills may be overpowered by emotions that are too intense. When emotions don't get expressed in a healthy way, tension can build up — sometimes to a point where it seems almost unbearable. Cutting may be an attempt to relieve that extreme tension. For some, it seems like a way of feeling in control.

The urge to cut might be triggered by strong feelings the person can't express — such as anger, hurt, shame, frustration, or alienation. People who cut sometimes say they feel they don't fit in or that no one understands them. A person might cut because of losing someone close or to escape a sense of emptiness. Cutting might seem like the only way to find relief or express personal pain over relationships or rejection.

People who cut or self-injure sometimes have other mental health problems that contribute to their emotional tension. Cutting is sometimes (but not always) associated with depression, bipolar disorder, eating disorders, obsessive thinking, or compulsive behaviors. It can also be a sign of mental health problems that cause people to have trouble controlling their impulses or to take unnecessary risks. Some people who cut themselves have problems with drug or alcohol abuse.

Some people who cut have had a traumatic experience, such as living through abuse, violence, or a disaster. Self-injury may feel like a way of "waking up" from a sense of numbness after a traumatic experience. Or it may be a way of reinflicting the pain they went through, expressing anger over it, or trying to get control of it."

"Cutting can be habit forming. It can become a compulsive behavior — meaning that the more a person does it, the more he or she feels the need to do it. The brain starts to connect the false sense of relief from bad feelings to the act of cutting, and it craves this relief the next time tension builds. When cutting becomes a compulsive behavior, it can seem impossible to stop. So cutting can seem almost like an addiction, where the urge to cut can seem too hard to resist. A behavior that starts as an attempt to feel more in control can end up controlling you."


"Nondissociative self-mutilators usually experience a childhood in which they are required to provide nurturing and support for parents or caretakers. If a child experiences this reversal of dependence during formative years, that child perceives that she can only feel anger toward self, but never toward others. This child experiences rage, but cannot express that rage toward anyone but him or herself. Consequently, self-mutilation will later be used as a means to express anger.

Dissociative self-mutilation occurs when a child feels a lack of warmth or caring, or cruelty by parents or caretakers. A child in this situation feels disconnected in his/her relationships with parents and significant others. Disconnection leads to a sense of "mental disintegration." In this case, self-mutilative behavior serves to center the person (Levenkron, 1998, p. 48). "


For Adults

"Identify the 'trigger' that gives you the urge to self harm. The moment you have the urge to harm yourself, stop and think of what has just occurred. Remember it and try to avoid these situations. For example, if you've just had an argument with somebody close to you, and are having the urge to self harm, stop and ask yourself what's making you feel this way; "I feel like harming myself because I've just had an argument with somebody I love, and it's making me feel really bad." Determine what in particular makes this situation trigger off negative emotions: a certain feeling, or maybe an action? Work on reducing this issue until you have it under control or completely diminished.

  • If you need to hurt yourself, do it in a controlled and less harmful way. A good idea is to wear a rubber band around your wrist. Every time you want to cut, snap the rubber band against your wrist instead. You can also draw on your wrist with red pen, or rub an ice cube on your wrist. Although all of these cause some immediate pain, it is much milder and much less dangerous.

  • Express your emotions. For example, when you feel like harming, try doing one or more of the following:

    • Drawing or scribbling on paper
    • Painting, on white paper
    • Get a punch bag of some sort to relieve your anger on.
    • Listening to music that relates to your emotions and has a positive effect on them.
    • Squeeze ice cubes until they melt.
    • Writing down your emotions in a diary/journal
    • Writing songs/poetry
    • Call a friend

  • After a day or so, analyze what you have done. Try to determine how you felt, and what you can do to reduce or stop these emotions, or work around them.

  • Distract yourself. Some people feel that rather than analyzing their emotions, they feel better when they get rid of them or forget them completely. When you feel the urge to self harm, try distracting yourself by trying out the following:

    • Drink a glass of water
    • Watch TV
    • Do some form of exercise-run, walk, ride your bike, or just dance like crazy
    • Take your dog for a walk, or spend some time with a pet"

    Panic List of alternative behaviors

    Pros & Cons exercise

    For Teens

    Getting Help

    There are better ways to deal with troubles than cutting — healthier, long-lasting ways that don't leave a person with emotional and physical scars. The first step is to get help with the troubles that led to the cutting in the first place. Here are some ideas for doing that:
    1. Tell someone. People who have stopped cutting often say the first step is the hardest — admitting to or talking about cutting. But they also say that after they open up about it, they often feel a great sense of relief. Choose someone you trust to talk to at first (a parent, school counselor, teacher, coach, doctor, or nurse). If it's too difficult to bring up the topic in person, write a note.
    2. Identify the trouble that's triggering the cutting. Cutting is a way of reacting to emotional tension or pain. Try to figure out what feelings or situations are causing you to cut. Is it anger? Pressure to be perfect? Relationship trouble? A painful loss or trauma? Mean criticism or mistreatment? Identify the trouble you're having, then tell someone about it. Many people have trouble figuring this part out on their own. This is where a mental health professional can be helpful.
    3. Ask for help. Tell someone that you want help dealing with your troubles and the cutting. If the person you ask doesn't help you get the assistance you need, ask someone else. Sometimes adults try to downplay the problems teens have or think they're just a phase. If you get the feeling this is happening to you, find another adult (such as a school counselor or nurse) who can make your case for you.
    4. Work on it. Most people with deep emotional pain or distress need to work with a counselor or mental health professional to sort through strong feelings, heal past hurts, and to learn better ways to cope with life's stresses. One way to find a therapist or counselor is to ask at your doctor's office, at school, or at a mental health clinic in your community.

    Although cutting can be a difficult pattern to break, it is possible. Getting professional help to overcome the problem doesn't mean that a person is weak or crazy. Therapists and counselors are trained to help people discover inner strengths that help them heal. These inner strengths can then be used to cope with life's other problems in a healthy way." 


    "Things That Might Distract You
    Like all urges, the urge to cut will pass if you wait it out. Distracting yourself with something else helps timego by and gets your mind off the urge to cut. The more you wait out the urge without giving in, the more your urges will decrease over time.
    Here are some things you can try while waiting for a cutting urge to pass:
    • call a friend and talk about something completely different
    • take a shower (make sure you don't have razors in the shower)
    • go for a walk or run, take a bike ride, dance like crazy, or get some other form of exercise
    • play with a pet
    • watch TV (change the channel if the show gets upsetting or features cutting)
    • drink a glass of water

    Things That Might Soothe and Calm You

    Sometimes people cut because they're agitated or angry — even though they may not recognize that feeling. If that's true for you, it can help to do something calming when you feel the need to cut.

    Even if you're not sure why you're cutting, it's worth giving these ideas a try:
    • play with a pet
    • take a shower (make sure you don't have razors in the shower)
    • take a bath (make sure you don't have razors near the tub)
    • listen to soothing music that will shift your mood
    • try a breathing exercise
    • try some relaxing yoga exercises"

    For Parents

    "Parents can help teens who cut — and the earlier, the better. Cutting can be habit-forming, and sadly, many people underestimate the risks of getting seriously sick or hurt that go along with it.

    What Parents Can Do

    If your teen is cutting, there ways to help. By coping with your own feelings, learning about cutting, finding professional help, and just being there to love and believe in your teen, you'll provide the calm, steady support that he or she needs.

    Accept your own emotions. If you know or suspect that your teen is cutting, it's natural to feel a whole range of emotions. You might feel shocked, angry, sad, disappointed, confused, or scared. You might feel hurt that your teen didn't come to you for help or feel guilty that you didn't know about it. All these emotions are completely understandable. But it's not your fault, and it's not your teen's fault.
    Take time to identify your own feelings and find a way to express them. This might mean having a good cry, talking with a friend, or going for a walk to let off steam or quietly reflect. If you feel overwhelmed, talking with a therapist can help you sort things through and gain some perspective so that you can provide the support your teen needs."

    "Talk to your child. It can be hard to talk about such a painful topic. You may not know what you're going to say. That's OK. What you say won't be nearly as important as how you say it. To open the conversation, you might simply say that you know about the cutting, and then convey your concern, love, and your willingness to help your child stop.

    It will probably be hard for your teen to talk about it, too. He or she might feel embarrassed or ashamed, or worried about how you'll react or about what the consequences might be. You can help ease these worries by asking questions and listening to what your teen has to say without reacting with punishment, scolding, or lectures.

    Let your teen know that cutting is often related to painful experiences or intense pressures, and ask what difficult issues your teen may be facing. Your teen might not know why he or she cuts or be ready to tell you. Even if that's the case, explain that you want to understand and find ways to help."

    "Be patient, and be hopeful. Finding out that your teen is cutting may be the beginning of a long process. It can take time to stop cutting — and sometimes a teen doesn't want to stop or isn't ready to make the changes it involves.

    To stop cutting takes motivation and determination. It also takes self-awareness and practicing new skills to manage pressures and emotional distress. These things can take time and often require professional help.
    As a parent, you may need to be patient. With the proper guidance, love, and support, know that your teen can stop cutting and learn healthy ways to cope."


    "It's important to note that self-injury is rarely life threatening. However, because of the revulsion many people feel about it, some health care providers have an appropriate response. That said, it doesn't matter how severe or minor the physical injuries are. It's what's going on inside that matters.

    What is the Payoff of Cutting?

    Self-injury releases tension - both physiological and psychological - very quickly. A person who cuts can turn a state of overwhelm into a state of relative calm almost immediately. Cutting reduces panic to simply feeling bad.

    It is a destructive coping skill like many others in our society - drinking, anorexia, or working too much. It does not mean the person is crazy, or that they are attempting suicide. In fact, the self-injury may relieve tension to the point that the person no longer considers suicide."

    "Like with other addictions, a kid cannot be forced not to cut himself. He needs to be ready to accept help and do the work it takes to change the behavior. Do not issue ultimatums or punish the self-destructive behavior. Threatening to hospitalize or institutionalize a self-injurer can make feelings of lack of control and overwhelm even worse.

    Once the child is ready to stop, there are many therapeutic techniques employed by mental health professionals to help him. It's best to consult a professional with specific experience working with kids who self-mutilate. There may be underlying serious mental conditions that need to be diagnosed."


    Medication: Naltrexone

    "Leboyer et al, 1988, observed decreasing self injurious behaviour (SIB) in 2 autistic girls age 10 and 12 years during Naltrexone therapy using 1-2mg/kg daily. Kars 1990, also noticed decreasing frequency of SIB, during a double blind placebo controlled cross over study with 50mg Naltrexone daily for 3 weeks. Campbell 1990, reported a reduction in hyperactivity and fidgetiness with Naltrexone and said that the most consistent symptom changes observed in each of a group of 18 autistic children, 14 male s and 4 females, were decreases of withdrawal, increase of verbal production and communicative speech, but in 1993, with 41 autistic children, only a small beneficial effect on decreasing SIB was observed. It was also shown by Bystritsky and Strauser, 1996,in a 46year old male, who had a history of obsessive compulsive disorder that 50mg per day of Naltrexone was effective in the termination of cutting behavior but the cutting behavior recurred when Naltrexone was discontinued."

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