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Cutting: Teens Who Hurt Themselves
The medical community calls it "non-suicidal self-injury" (NSSI); the kids call it "cutting." By either label, it is the act of deliberately causing injury to one's body and while it is not performed with conscious suicide intent, it can have a more serious outcome than anticipated.
A recent article shed some light on this surprisingly common behavior and underscored the need for parents, physicians, and those who work with teens and young adults to know how to respond when they see it.(1)
Who Does It?
Self-harm behaviors usually begin in adolescence and these teens. It is more common in girls than boys. The prevalence of NSSI is 12-37.2 % in US high school students and 12-20% of late adolescent/young adults. NSSI is seen from ages 10-25, although more typically starts between 11-15 year olds.(2) Cutting may be a single episode or a chronic pattern, but self-harmers think of themselves as "one who self-injures." About a quarter of the adolescents and young adults who report NSSI have only done it once. Among those who repeat the injury, 40% stop within a year and almost 80% start within five years of starting.(3) Self-harmers may have psychiatric diagnoses including depression or anxiety, but may also occur independently of other mental health conditions.
Self-injury tends to spread within teenage populations. The Internet and media can act to facilitate this. As with other risky adolescent behaviors, media attention can show NSSI in a falsely normalized and romanticized light, which tends to reinforce such actions.
What Do They Do?
The authors of the recent study in the Public Library of Science Medicine describe "common" NSSI(4) as self-injury that is performed compulsively, episodically, and repetitively. Injuries include scratching, cutting, punching, banging oneself with an object capable of causing injury, biting, ripping, burning or tearing skin, and falling, jumping and bone breaking. Girls are more likely to cut themselves, while boys are more likely to hit bite or punch themselves. Girls are more likely to self-harm as a solitary activity, while boys may perform acts alone, or in groups.
Boys may engage in self-harm in the context of a peer challenge, a test of will, strength, endurance, or "masculinity."(5)
Why Do They Do It?
There are many possible reasons why teens may engage in cutting or NSSI and explanations have ranged from psychological to social to biological. NSSI may be an attempt to decrease psychological pain and distress by using self-injury to distract oneself. Self-harmers are more likely to have thought about or performed suicidal acts.(5) Unlike a suicide attempt, self-injury is most commonly used to temporarily diminish distress, rather than escape stress by ending one's life.
Some researchers believe that acts of NSSI should be seen as signals that an individual is feeling considerable stress and that these feelings may in fact lead to consideration of suicide if they don't obtain some relief.(1) When self- injurious acts are performed frequently and the methods of self-injury are of the type to cause severe tissue damage, the risk of severe mental health problems and future behaviors related to suicide are increased.(1)
A study that explored the motivations of self-harmers found they showed more emotional distress, more antisocial behavior, difficulty with anger, and poorer self-esteem than non-self harming peers.(5) Study participants endorsed a desire to externalize their inner pain; they wanted to send a message about inner pain, or to move the pain from their heart. After the episode they felt relief.
Some self-harmers, usually girls, expressed a need to hurt themselves because of shame, or disgust. When this was the motivation, their negative emotions were worsened by the self-harming episode. Boys were also motivated by boredom perceiving the self-harm activity as fun, or desiring to win membership in a peer group.(5)
Studies have shown that while a significant proportion of adolescents harm themselves intentionally, an even larger proportion think about hurting themselves and have self-destructive thoughts. The authors concluded, based on their view of self-harm as a maladaptive effort to relieve stress, that adolescents need both recognition of their emotional distress and attention to safer, and more effective coping skills.(5)
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