Newswise — On the hottest days in August, Leslie* dresses herself in pants and long sleeve shirts while other teenage girls wear fashionable low-riding pants and midriff tops. Leslie keeps her body, marked and scarred from almost a decade of self-harming behaviors, concealed from curious eyes.
As a young child, Leslie experienced the stress of divorce in her family. As a way to cope, she began to chew her knuckles until they bled. Her obsession led to cutting her body with paper clips, safety pins, knives and razor blades. To deal with the uncontrollable circumstances in life, Leslie found herself backing away from emotional pain by hiding it in her self-mutilating habits.
In the United States, adolescent self injury, frequently known as cutting, has become alarmingly common. Physicians estimate that almost 3 million people, most of them adolescents, exhibit this dangerous behavior.
"Self-harm doesn't seem to be a part of the typical adolescent experience," says David Rosen, M.D., director of Teenage and Young Adult Medicine and clinical associate professor of the Department of Pediatrics and Communicable Diseases at the University of Michigan Health System. "It really seems to be more connected to intense, out of control, bad feelings that some teens have, and which are different from what young people would normally experience."
What is cutting?Cutting is a form of self-injury and is an act of deliberately destroying body tissue. Self-injury includes a broad range of behaviors such as cutting, burning, sticking oneself with sharp things, hitting and bruising oneself. These acts are intentional, impulsive and repetitive.
More adolescent females than males tend to cut. These young adults come from a wide range of familial and economic backgrounds. There are, however, constants for those who self-harm. People who self-harm are generally experiencing depression, anxiety and low self-esteem, along with feelings of guilt, emptiness and numbness.
There are many reasons why people will cut themselves, says Rosen. Some do so to express how terrible they feel. This tangible, real form of feeling pain helps the cutter make his or her emotional pain more real. Some cut because they feel empty or numb and the physical pain helps them feel more alive. Others cut because they don't have any other way of expressing what they feel. Leslie wouldn't allow herself to deal with her emotions and turned instead to cutting.
"I wanted to get rid of the pain that was inside me, so I would cut myself to release that pain," says Leslie. "The physical pain from the razors was far easier to deal with than the emotional pain that I felt."
How can parents help?Parents are often the first to recognize their child has a problem with emotions or behavior, says Rosen. Changes in school performance, depression, anger and aggression are all warning signs that something may be wrong in an adolescent's life. Also, parents need to be on the alert for signals such as scratches, wearing long sleeves in the summer or not wanting to put on a bathing suit. Parent's need to step forward and attempt to gently discuss the issues, he notes. Then, seek help from your family physician.
Patients will be evaluated in a regular check-up appointment. Doctors will evaluate the patient's history and administer a physical exam to determine the extent of the cutting and the presence of other health issues. Subsequent evaluation by a mental health professional is almost always required and may assist in identifying and treating the underlying cause of self-injury.
Upon diagnosis, a treatment plan is proposed. U-M experts take part in a multidisciplinary approach to treatment. This approach encourages patients to attend therapy sessions with trained professionals. In these sessions, patients learn how to accept reality and how to make the present moment more tolerable. In addition, patients identify their emotions and talk them over instead of acting on them. Over time, patients learn how to handle emotional situations and how to control their own impulses. In addition to the therapy sessions, medications can be issued. Anti-depressants are the most frequently used with cutting patients.
"People who cut themselves do get better," says Rosen. "If we provide people with great support and treatment and sometimes medicine, we see people improve. Families should be optimistic that with proper treatment, their son or daughter can stop this behavior completely."
Leslie has spent the greater portion of her life hiding from her emotions and cutting herself to make the emotional pain disappear. With the help of U-M doctors, she is well on her way to recovery. "I really don't want to hurt myself anymore," she says. "I just want control of my life. I want to do this not by physical pain, but by emotional strength."
Facts about Cutting:-The rate of self-injury is increasing in the adolescent population.-The majority of the 3 million people who self-harm are adolescents.-Self-injury behaviors include carving, scratching, branding, picking at hair and skin, burning, cutting, biting, head banging, sticking oneself with sharp objects, hitting and bruising oneself, tattooing, and excessive body piercing.-The self-injury acts are intentional, impulsive, and repetitive.-Self-injury is viewed differently by groups and cultures within a society.
*Not her real name
For more information, visit the following Web sites:
U-M Health Topics A - Z: Self Injuryhttp://www.med.umich.edu/1libr/pa/umselfin.htm
U-M Depression Centerhttp://www.med.umich.edu/depression/
American Academy of Child and Adolescent Psychiatry: Self Injury in Adolescentshttp://www.aacap.org/publications/factsfam/73.htm
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