"I encounter two characteristics in all self-mutilators: (1) A feeling of mental disintegration, of inability to think; and, (2) rage that can't be expressed, or even consciously perceived, toward a powerful figure (or figures) in their lives, usually a parent."

Cutting: Understanding and Overcoming Self-Mutilation,
Steven Levenkron, (c)1998, W. W. Norton and Company

Self-injurers commonly report they feel empty inside, over or under stimulated, unable to express their feelings, lonely, not understood by others and fearful of intimate relationships and adult responsibilities. Self-injury is their way to cope with or relieve painful or hard-to-express emotions. Although it is generally not a suicide attempt, the relief that results is only temporary, and without proper treatment a self-destructive cycle often develops. Early diagnosis and treatment are of the utmost importance.

Self-injury is sometimes referred to as the "wounding embrace," because people use it to harm and comfort themselves at the same time. The razor blade takes the place of a hug, a compliment, a mother's kiss.


The behaviors include: cutting, scratching, picking scabs or interfering with wound healing, burning, punching oneself or objects, infecting oneself, inserting objects in body openings, bruising or breaking bones, hair-pulling and other various acts of bodily harm. Such acts, which pose serious risks, may be symptoms of a mental health problem that can be treated.

Though not exclusively, a self-injurer is usually from a middle to upper class background, of average to high intelligence, and has low self-esteem.


There is an important distinction between those who are self-injurers and those who are suicidal. "People who are suicidal obviously want to end their lives," says Dr. Armando Favazza. "Self-mutilators do not want to die. They simply want to feel better and their act is one of self-help -- although it's a morbid form of self-help." In the end, of course, it is "a faulty coping mechanism that does not resolve a problem and can leave a person horribly scarred and disfigured."


Dr. Favazza goes on to say that there are many factors - both psychological and cultural - that may lead people to harm themselves in this way. Some can't make the transition to adulthood responsibility. About 40 percent will have a history of eating disorders, and about half have a childhood history of abuse. But he stresses there is no single pattern or profile to the behavior. "Every person has a different life experience and some will end up being sick and some won't," he says. "They're just caught up in a behavior they cannot control."

Diagnosis and Treatment:

If someone displays the signs and symptoms of self-injury, a mental health professional with self-injury expertise should be consulted. An evaluation or assessment is the first step, followed by a recommended course of treatment to prevent the self-destructive cycle from continuing. Self-injury treatment options include outpatient therapy, partial (6-12 hours a day) and in-patient hospitalization. When the behaviors interfere with daily living, such as employment and relationships, and are health or life-threatening, a specialized self-injury hospital program with an experienced staff is recommended.

The effective treatment of self-injury is most often a combination of medication, cognitive/behavioral therapy, and interpersonal therapy, supplemented by other treatment services as needed. Medication is often useful in the management of depression, anxiety, obsessive-compulsive behaviors, and the racing thoughts that may accompany self-injury. Cognitive-behavioral therapy helps individuals understand and manage their destructive thoughts and behaviors. Contracts, journals and behavior logs are useful tools for regaining self-control.

Interpersonal therapy assists individuals in gaining insight and skills for the development and maintenance of relationships. Services for eating disorders, alcohol/substance abuse, trauma abuse, and family therapy should be readily available and integrated into treatment, depending on individual needs.

About the documentary.

What is self-injury?

Resources

• Unexplained frequent injuries, including cuts and burns
  
  
• Wearing long pants and sleeves in warm weather
  
  
• Low self-esteem
  
  
• Difficulty handling feelings
  
  
• Poor functioning at work, school or home
  
  
• Relationship problems

• The onset is usually at puberty and has a duration of 5 to 10 years - often much longer without appropriate treatment
  
  
• nearly fifty percent of those engaged in such behaviors report physical and/or sexual abuse during childhood
  
  
• ninety percent report being discouraged from expressing emotions, particularly anger and sadness
  
  
• one-half to two-thirds have an eating disorder
  
  
• a significant number are also struggling with alcohol or other substance abuse problems
  
  
• a self injurer is usually a white female from a middle to upper class background, of average to high intelligence, and has low self-esteem.

Successful courses of treatment are marked by:

1. Patients who are actively involved in and committed to their treatment.
   
   
2. Aftercare plans with support for the patient's new self-management skills and behaviors.
   
   
3. Collaboration with referring and other involved professionals.