IN HARM’S WAY

Driver’s licenses, body piercings, birth control chats, college funding. With all the challenges and stamina required to raise a teenager, parents may think they’ve become bulletproof.

But to discover, amid an ocean of other challenges, that a child is self-harming can knock even the most stalwart parents off their feet.

John Murphy is a peer counselor and patient advocate at Eastern State Hospital, where he facilitates communication between inpatients and their care providers.

Despite people having a natural revulsion when hearing about self-injury, Murphy says, “I try to get others to see that this behavior isn’t repulsive. It’s simply a coping mechanism.”

Self-harm, or self-injury, can include cutting, scratching, burning or hurting the body in some other way. This behavior is not so much a mental illness by itself, but often is associated with other conditions such as depression, obsessive-compulsive disorder, and bipolar or borderline personality disorder.

Hard data on nonsuicidal self-injury is sparse. Estimates are difficult because some statistics include a broad definition of self-harm, such as eating disorders.

The national public education program Mental Health First Aid points out that self-harm goes beyond cutting or burning. Excessive/obsessive exercise, increased alcohol consumption, overdosing with nonfatal intentions and staying in abusive relationships can all represent forms of self-harm.

Studies suggest that 9 to 39 percent of adolescents in the general population self-harm. Research indicates that adolescent girls may account for nearly 70 percent of people with self-harming behaviors.

So, why do people do it?

“Because it works,” psychologist and self-injury expert Dr. Michael Hollander says in his book “Helping Teens Who Cut: Understanding and Ending Self-Injury” (The Guillford Press, 2008). 

Like an emotional rebooting, self-injury is self-soothing. Cutting or burning, two of the most common methods, are used when someone feels emotionally overwhelmed or out of control. But sometimes the only impetus is a sense of feeling empty.

“When our emotions are unavailable to us,” writes Hollander, “we feel numb and alone. Our lives feel sterile and bland, as if everyone else’s life were in Technicolor and ours was in black and white.”

Self-harm becomes a kind of controlled pain. When the body is injured, it releases natural opioids to help soothe and heal itself. 

But just as with man-made drugs, the effects can diminish over time and create the need for greater self-injury to achieve the same level of relief. This creates an unhealthy cycle of self-injury and temporary relief, followed by feelings of guilt and self-loathing.

In a recent issue of People magazine, teen singer/actress Demi Lovato was asked why she lied about photos showing cuts on her arm – something she previously denied as self-injury.

“I wasn’t ready, because self-harm is such a taboo to talk about,” she said. “It was a way of relieving pressure when I was stressed and had anxiety.”

Lovato said she eventually harmed herself in places not easily seen.

As Spokane Mental Health’s supervisor of intensive outpatient services, Neldon Mitchell oversees programs that help provide both group and individual counseling for clients with self-harming behaviors.

At the heart of self-injury, says Mitchell, is emotional dysregulation. Someone with emotional dysregulation may be unusually sensitive, have quick, intense emotional reactions and take longer to recover from emotional upheavals.

Adolescents may frequently lash out, act impulsively or soothe themselves with injury.

“Kids who self-injure have the emotional engine of a Ferrari,” writes Hollander, “with the transmission of a Toyota Corolla.”

He urges family members to see that these kids have a different way of interpreting things. 

“You need to understand how hard it is for your child to negotiate any situation that evokes anger, sadness, or disappointment,” Hollander writes.

With emotional dysregulation, things can feel extremely disproportionate.

“What seems like a small brushfire to you,” writes Hollander, “feels like a five-alarm fire to your child.” 

Dialectical Behavior Therapy, developed in the late 1980s and 1990s by University of Washington researcher Marsha Linehan, directly targets the specific emotional and behavioral problems of those who self-injure.

Mitchell says Spokane Mental Health uses DBT in its programs. The format includes such therapeutic elements as present-moment awareness, distress tolerance, identifying and labeling emotions, asking for what one needs and how to say “no.”

Hollander praises this technique in “Helping Teens Who Cut,” saying he noticed that while treating his clients only with long-term “talk therapy,” they continued to self-injure.

“DBT helps to get the injurious behavior under control now, as opposed to later, after years of talk therapy,” he writes.

Eastern State Hospital’s Murphy, who also teaches “Mental Health First Aid” – a pilot program to help laypeople handle mental health crises – sees patients with more severe cases of self-injury who need intense care.

While he believes DBT has benefits, he says it’s not always practical.

“This model doesn’t work well for people that are in inpatient settings because it takes too much time,” Murphy says.

He thinks DBT is an effective tool, however, once patients are released and working with a mental health care provider.

Along with counseling, some people who self-injure will benefit from the use of anti-depressants and other medications.

There are some standard do’s and don’ts in self-harm recovery. 

Typical parental techniques like reassurance often fail when working with self-harm. When someone who self-injures is distressed, old standbys like “Don’t let it bother you” or “I’ve been there” are not helpful.  Neither is attempting to put things in perspective.

“Being insincere, patronizing or placating is counterproductive,” Murphy says. 

But active listening and validating the individual’s experience are effective methods for diffusing a situation that might otherwise lead to self-injury.

Getting help as early as possible is important. The longer someone engages in self-injury, the greater the risk of a suicide attempt later in life.

People who self-harm are encouraged to seek help, identify triggers and stick with their treatment program.

Working with a loved one who copes with self-injury can be challenging.

“One step forward, two steps back,” is a realistic approach, says Murphy.  “Even reducing self-harm, as opposed to eliminating it completely, is still progress.”

Hollander’s book reminds parents that burnout is common.  It’s easy, he says, to lose sight of your own health and personal relationships when working with a child who self-injures.

Murphy says he always tells parents, “It’s important you get your own counseling, too.”