Why People Self-Harm and How to Treat It

Posted on June 23rd, 2016

Young Man Suffering From DepressionShe collected the blood for years, cutting herself a couple times a day, watching as the dark red fluid dripped from her wrist into the vial. Although she knew it was an unhealthy habit, it felt good. It made her feel alive.

Now, she no longer cuts herself, but instead stares at the vials that hold the product of her past rituals. It is part of her treatment for self-injury, a surprisingly common and misunderstood mental affliction. Looking at her collection of blood gives her a sense of relief. It’s her protection. Just the sight of it is enough to keep her from cutting herself again, her therapist says. The visual alone soothes her.

The young woman in treatment for self-injury is among 23 million people in the U.S. who are in recovery from addiction. And while Americans are coming to understand that addiction to alcohol and other drugs is a chronic but treatable brain disease, the compulsion to cut, burn or otherwise self-injure remains incomprehensible to most. Why would someone deliberately harm themselves? An entry from the LiveJournal blog provides some insight:

My head racing, can’t stop
My heart so broken and hurt
It stings, the first cut
It hurts so good
I watch as the blade rips my pale skin

The “cutter” can finally feel something. “It hurts so good.”

“The infliction of pain, and the drawing of blood, is an effort at feeling, being alive … it is not an attempt to die but to live,” writes Dr. James Egan, former chairman of the Department of Psychiatry at the Children’s Hospital National Medical Center in Washington, D.C., in a study on self-harming behavior in people with borderline personality disorder. And oftentimes, there is no discomfort involved. Research shows that one-half to two-thirds of people who self-harm experience little or no pain from the wounds they inflict.

Need for Compassion

Self-mutilation is an addiction that is hugely misunderstood, even among medical professionals. In fact, the behavior is so misinterpreted that a woman in Australia recently had her wounds stapled without anesthesia in the ER because, she was told, “you did it to yourself.” And in the U.K., 21-year-old Becci Wain, in recovery for self-mutilation, was turned away by a cashier when she tried to buy a bottle of champagne after the scars on her arms became visible.

“That was in front of the whole queue,” Wain told the BBC. “I just wanted the ground to swallow me up. It was horrible.”

As incomprehensible as the behavior may seem, self-mutilation is surprisingly prevalent, especially among young women. Recent data show that 12% to 23% of teens have cut, carved, burned or otherwise injured themselves.

Why Do People Self-Harm?

At the root of self-harm is deep emotional pain. Some people do it to cope with pressures from family or school. For others it may be a way of dealing with sexual abuse. When life feels unbearable, self-injury gives the sufferer a sense of control — a means of relieving the tension.Olga Yahontova, MD, who has treated people who self-injure for more than 20 years, says one of the biggest misconceptions is that patients like hers wish to end their lives.
“There’s a lot of misunderstanding about this behavior,” Yahontova said. “People think it’s about suicide, but it’s really a cry for help. People want to get better, they want to stop. They just can’t.”

Yahontova, a therapist at Malibu Vista, a mental health treatment center for women in Malibu, California, says cutting works on the same mechanism in the brain as alcohol or drugs.

“Cutting is a temporary relief from emotional pain,” said Dr. Yahontova, who is also a forensic psychiatrist. In her work with prison inmates, Dr. Yahontova has seen self-harm in the extreme — people swallowing spoons, cutting their genitals, even cutting off parts of their bodies. “Because any injury to our bodies gives us endorphins, people who cut get an immediate release of endorphins,” she said. “People who have depression, they resort to doing this to themselves.”

Risk Factors for Self-Harm

Contrary to popular belief, the vast majority of people who self abuse, which is also known as nonsuicidal self-injury (NSSI), are not trying to manipulate anyone but don’t know a better way to ask for help. Self-harm in itself is not a mental illness, although it is associated with several illnesses, such as borderline personality disorder, depression, anxiety, eating disorders and post-traumatic distress disorder. A childhood history of family violence, family alcoholism, and sexual or physical abuse is also linked to self-injury. Adolescent and college-age females are more likely to self-harm than males although the male population of self-injurers is growing.

What Are the Treatments for Self-Harm?

Eradicating self-harming behavior takes time and hard work. Dr. Yahontova says it is one of the most difficult psychological behaviors to treat, partly due to the self-loathing felt by the sufferer.

“This is one of the most stigmatized conditions,” Dr. Yahontova said. It comes with a lot of shame and many, many, many people would like to stop it.”

Psychotherapy such as cognitive behavioral therapy (CBT) has been shown to help those who self-injure learn to change negative thought patterns and develop skills for coping with situations that trigger self-harm. Another effective treatment is dialectical behavioral therapy (DBT), which builds on CBT by incorporating training in a variety of areas such as mindfulness, relationship skills, emotional regulation and tolerance to distress.

Medication Treatment for Self-Mutilation

There are no medications that are currently approved by the Food and Drug Administration to treat self-injuring behavior, but the medication naltrexone, which is typically used to block the effects of heroin and other opioid drugs, has shown promise in helping people limit or stop the behavior. Dr. Yahontova, who was one of the first to treat self-injury with naltrexone, said a prison inmate who displayed some of the most dangerous self-harming behavior was her inspiration.

“One of the cases that helped me understand and find a way to treat the condition was a guy who would literally cut off pieces of his body,” she said. “I’ve spent a lot of time with him because he’s done it for years and everybody pretty much gave up on him. He clearly was getting high from this experience. I started treatment with naltrexone, and it was very successful. It blocks opioid receptors that are used for pleasure, and they stop feeling that euphoria. It just kind of disappears. It’s very safe to take. It doesn’t have complications.”

Battling the stigma associated with the behavior is another challenge Dr. Yahontova faces on a daily basis. She says parents will come to her under the mistaken belief that their children are doing this for attention and could stop if they wanted to.

“In this culture, there’s not much discussion of self-harm at all,” she said. “But there is a lot of judgment about it. It is our job to let people know they’re not being judged and that we’re here to help them. There is light at the end of the tunnel.”

By Laura Nott

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