People injure themselves to ease painful emotions, but the behavior can be treated

A 14-year-old girl rolls up her sleeve, takes a razor blade in her right hand and carefully cuts into her forearm. Watching the blood begin to flow, she feels an intense sense of relief.

Self-injury is not something people talk about very often. But studies estimate that 2 to 3 million people injure themselves, mainly by cutting with razors, utility knives, scissors, needles, broken glass or whatever they find to make repetitive slices on their wrists, arms, legs or other body parts.

Experts say the majority of people who self-injure themselves are women between the ages of 13 and 30, but there are cutters of every age, gender and economic group.

People who do so are not usually suicidal. They do, however, intentionally inflict injuries upon themselves, sometimes in response to trauma, sexual abuse or chaotic family conditions. Their injuries may vary from minor cuts that heal quickly to serious wounds that leave permanent scars.

“Non-suicidal self-injury in the form of cutting has no single cause,” said Dr. Alec L. Miller, chief of child and adolescent psychology at the Montefiore Medical Center/Albert Einstein College of Medicine in New York. “While most lay people think it is due primarily to attention-seeking, many individuals who cut do so privately.”

Negative emotions

Some common reasons for cutting include self-punishment or as a way to express negative emotions such as anger, anxiety or depression.

“Very often it’s related to anger, and it’s almost like people don’t know what to do with those feelings, and there’s a release to be gained by hurting themselves,” said Dr. Rudy Nydegger, chief of psychology at Ellis Hospital.

“Other times people will feel so intensely anxious that it’s almost like they have to do something to get their mind off of how badly they feel, and cutting is more of an escape or distraction from the anxiety.”

Many patients report they feel a significant release after cutting, and sometimes a very peaceful, calm feeling, said Dr. Allen Stefane, medical director of child and adolescent psychiatry at Ellis Hospital.

“It’s difficult to understand why a patient cuts, but many of them report they are desperate for relief of very painful emotions,” said Stefane.

Dr. Judith Barr, a Brookfield, Conn., psychotherapist and author of “Power Abused, Power Healed,” said cutting moves people away from emotional pain associated with their feelings.

“The emotional pain is actually more unbearable than the physical pain,” said Barr.

To really heal, Barr said the person must get to the root of their problem.

“The therapist needs to help them build the capacity to feel their feelings, and how long that takes is different for each individual,” she explained.

“Once the person goes through that process, they don’t have to hold those feelings at bay anymore. Then all that life energy that’s been used for trying to get away from those feelings can be used for fulfilling their potential.”

Self-injury usually indicates that somewhere during development, the person didn’t learn good ways of coping with overwhelming feelings or stress. They are not sick or insane. They just never learned positive ways to deal with feelings and emotions for various reasons.

People who injure themselves usually hide the cuts and marks, and sometimes no one else knows.

Cutting is sometimes associated with depression, bipolar disorder, eating disorders, obsessive thinking, post traumatic stress disorder and borderline personality disorder — a mental health disorder that causes aggressive behavior and difficulty controlling emotions.

“One of the reasons people cut is to have control over the emotions they feel,” said Susan J. Elliott, former emergency psychiatric services clinician and certified grief counselor in New York.

Cutting can become a compulsive behavior, meaning the more a person does it, the more he or she feels the need to do it.

“I think they become so focused on the physical pain, they are able to divert themselves away from the emotional pain,” said Elliott. “And when it works, it becomes somewhat compulsive for them.”

Many people say they do not feel pain when they hurt themselves. Researchers have discovered that for some people, the stress of traumatic memories or emotional pain causes the brain to release calming chemicals called endorphins that act as a kind of pain reliever. So once people start cutting, it can be hard to stop, even if they know that it’s not healthy to do.

Coping skills

Still, positive coping skills can be learned at any point in life. People who self-injure can learn to use new and healthier coping mechanisms.

“I think the most important thing is for patients to admit they are cutting to someone, and to try to get an adult or parent to get them some professional help,” said Stefane.

Treatment depends upon what is producing the cutting behavior.

“If it’s anger, we would help the person learn how to deal with anger or identify the source of anger,” said Nydegger. “If it’s anxiety, you have to treat the anxiety disorder. If it’s depression or self-harm, then those are the things we want to get after.”

Stefane suggested individual therapy focusing on improving coping skills to deal with their overwhelming feelings.

“Some of the things we recommend are using a rubber band under their arm and snapping it if they are feeling overwhelmed,” he said. “We also recommend breathing exercises, keeping a journal, rubbing ice on their hands.

“All these things can help get them past the urge to hurt themselves until they can talk to someone. We encourage them to soothe themselves in a positive, non-injurious way.”

Parental action

Parents who suspect their children are cutting should not overreact.

“But I wouldn’t excuse it either,” said Nydegger. “I would say, ‘Look I’ve noticed this. Is there anything you need to talk to us about?’ If the kid says ‘yes,’ follow up. If the kid says ‘no,’ say, ‘I’m going to make an appointment for you to talk to somebody, and I want you to go once. If you don’t like it you don’t have to go back.’ Usually, after the person who cuts finds a sympathetic therapist who wants to help, they want to go back.”

Stefane said most cutters can be helped.

“A lot of times, patients will say it’s hopeless at first,” he said. “But after a while, they’ll turn around and realize that there definitely is hope.”

May 21, 2008
4:50 a.m.

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coachmike ( no real name given ) says...

If you talk about hope..the only hope that can take care of this is beleiving in Christ,that he is the only one who can cure those who need hope. Mankind tries to find an answer to everything,but only throws out bandaids for deep cuts, they say they know what the problem is but does not know how to cure it, anyone who tries to destroy there body is destroying that which God gives them, they give up hope that anyone or most importantly God is the help they need. Rely on God to help with the sin that is in you and he will releive the problems, go to him and he will save you, confess and turn from the sin and he will bring you to himself. Cutting is often referred to a demonic possesion and Christ is the one who can cast the demon from you.