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Dealing with Self-Injury: Understanding Risk And Helping Prevention

Cutting is a common and often misunderstood behavior that is not always associated with a psychiatric disorder or with an intention to die. Some individuals use this behavior to cope with strong negative emotions.

While several types of psychotherapy may be helpful, there is very limited data regarding potential medication treatments. Management of cutting and other forms of self-injury remains challenging and complicated.

The act of cutting is a behavior within the category of self-injury. According to a recent survey administered by the CDC, one in 4 girls and one in 10 boys report that they deliberately harmed themselves. Included is cutting, burning, skin carving, severe abrasion or scratching, and punching or hitting. Adolescent girls are more likely to cut themselves whereas adolescent boys more frequently reporting hitting themselves.

Not all individuals who cut themselves have a diagnosable mental illness. Still, some psychiatric disorders are associated with higher rates of self-injury. For example, almost 75 percent of individuals with Borderline Personality Disorder (BPD) tend to engage in self-injury. Patients with BPD report that self-injury provides relief from unpleasant emotions and reduces symptoms of dissociation, or detachment from reality.

Other disorders associated with self-harming behaviors include Dissociative Disorders, Post-Traumatic Stress Disorder, Major Depressive Disorder, Anorexia Nervosa and Bulimia Nervosa.

Individuals report a sense of relief or even euphoria while engaging in a seemingly painful and harmful act. One theory surmises that cutting releases the body’s natural opiates (or endorphins) that causes a feeling of pleasure or relief. This theory may also explain the addictive nature of cutting for certain individuals. A person’s brain somehow begins to seek or crave the opiates released by cutting.

Another theory states that cutting combats a feeling of numbness or being dead inside.

Additionally, self-injury may serve as a way of coping with extremely negative emotions; rather than having to deal with anger or sadness or low self-worth, the individual instead turns the focus of attention onto the cutting behavior.

There are several signs that warrant a prompt referral to behavioral health services. These signs include but are not limited to the following:

  • Intense thoughts about suicide while self-injuring
  • High frequency and intensity of self-injury (multiple times per week, more than five wounds per episode)
  • Duration greater than six months and more than 50 separate episodes of self-harm
  • Use of three or more methods of self-harm
  • Injury to the genitals, breasts, or face
  • Early childhood onset
  • Hospitalization or stitches required
  • Neglect of wounds or reopening of wounds

If you suspect that someone’s cutting behavior is escalating or may be related to suicidal thinking or plans, get help. Consider a local suicide prevention hotline, a mental health crisis hotline, a mental health professional, or a visit to the emergency room. If an individual is cutting but is not suicidal, parents should seek advice from a mental health professional in order to determine the proper course of action.

Several types of psychotherapy may be helpful in decreasing cutting behavior, including transference-focused psychotherapy, mentalization-based therapy, dialectical behavior therapy, and manual-assisted cognitive-behavioral therapy. All types of effective therapy for self-injury involve intensive and consistent contact with a treatment provider over an extended period of time (12 to 18 months or longer.)

Another component of successful treatment is the individual’s willingness to change. Can they learn, develop, and apply new skills?

There are no FDA-approved medications for the specific treatment of self-injury. However, there is preliminary evidence that certain medications (Naltrexone, Clozapine, and Topiramate) may decrease the urge to cut.

If you know someone who is engaged in cutting behavior, the first step is to understand the underlying emotion that is dulled by the behavior. Most people have a negative and judgmental reaction to self-injury. Despite your personal feelings, try to be understanding and encourage that individual to seek professional help.

Are you in crisis? Please call 1-800-273-TALK

Are you feeling desperate, alone or hopeless? Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), a free, 24-hour hotline available to anyone in suicidal crisis or emotional distress. Your call will be routed to the nearest crisis center to you.

Dr. Christina Delos Reyes is the Chief Clinical Officer of the ADAMHS Board of Cuyahoga County in Cleveland, Ohio.

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