Getting a Handle on Self-Harm

Emotional distress is both cognitive and unconscious. Quieting the mind by focused meditation, be it breathing or yoga or cutting, eliminates both levels of emotional response for the duration of the meditation. Training the mind can reduce cognitive behavior, thoughts, that induce emotional distress, rather quickly and without cost. Sustained 'talk therapy' does eventually impact the unconscious distress, given time, an effective therapist, interim medication, and lots of money.

A San Francisco photographer Charles Gatewood made a video about 20-30 years ago called "Falcon" which was about a woman who was in a consensual submissive relationship, and one of the things her mistress would do was surface skin cutting. This was part of the Modern Primitives movement.

It feels good - with the initial controlled pain comes a flood of chemicals similar to scratching an itch. Simply put it’s controlled feelings when feelings have been messed up or overwhelming

There was a friend I began to date in graduate school who I discovered cut himself regularly. He was in the same graduate program as me, and quite frankly I didn’t know what to do and it scared me. I was afraid he was going to kill himself. I tried to get him to see professionals and he swore me to secrecy. In the end I felt overwhelmed. I’m curious to anyone reading this, what is the proper way to help someone? Especially when it can be difficult and take a lot of time to find the right professional help? I feel racked with guilt sometimes that I couldn’t help him.

I wish there was less anecdotal narrative and epidemiological narrative before getting direct about what apparently causes self-harm and what can be done. After a couple of paragraphs, there should have been inserted text boxes which bulletpoint list primary apparent causes, primary effective interventions, and contact links. Persons who want a casual read don't lose a thing. But those who are in close contact with the issue deserve vital information easy to find.

I am, and have always been a 'cutter.' But, I really don't understand why people think it's such a horrible thing. I'm probably not the typical 'cutter', because I consider it to be a form of 'ritual scarification.' Also, I found out that certain Native American tribes would practice this exact same ritual. I have enjoyed 'cutting' during certain moments, as a sort of physical release from 'emotional distress' usually as a result of insomnia, stemming from emotional anxiety. There is also a component to feeling pain, that makes you feel alive, and I find that the endorphin release often helps alleviate my anxiety. In general, our lives in the West are very sterile, and we have little interaction with 'the real world', both physically and emotionally. We are encouraged to 'zone out' in front of a TV, or in front of a media device. But, ask yourself, what kind of life is it to live this way? We 'zombify' the individual, in order to turn them into 'mindless consumers.' Directly inflicting a physical wound can help reorient yourself within a world that causes you to feel numb. Maybe some people really are doing it for attention. Maybe some people are doing it because of other reasons. I think it's important to ask people questions about why they feel compelled to 'self-harm.' Also, we are a civilization on a planet with an environment that we are purposefully destroying. Isn't that a form of 'collective suicide', or 'self-harm?'

Rest assured that self-harm has been around for as long as their have been humans, and has also been observed in non-human primates. While self-harm should not be encouraged or dismissed as unimportant, it is not the emergency or epidemic that many people seem to think it is. It is a natural human behavior like crying, screaming, getting a piercing, or tattoo. True, not everybody self-harms. But not everybody gets a tattoo either. These are nonetheless natural human behaviors. What self-harm may do for the person doing it is debatable. What it means for the person observing it is not: It should be considered a sign of distress and a cry for help. The person who self-harms needs as much understanding and compassion as we can give them. We may not be able to stop the harm, but we can at least help the person who is doing this to feel little better understood.

As a person with experience in self-harm and experience with trying to get others into a mindset where they are able to not use it to cope, I think that this article should be handed over to every garbage school therapist with too much work to handle, every parent with a cruddy 9-5 job and no experience in these areas, and every friend who has no idea what to do in these situations. SELF HARM IS NOT ALWAYS ABOUT SUICIDE. Shout it to the rooftops. Think about it while writing legislation. Consider it before sending someone to a live-in residence that might make their state of mind worse.

“In the 1990s, the idea of self-injury and its underlying psychic misery began to enter popular culture.” You can see & study what’s right there in front of you. You can see the self harm. You can NOT see the why unless you connect the dotted line of DNA/RNA to culture. We need research.

Interesting. Your empathy, NYT, for women. Self-cutting. Self-induced vomiting. It's terrible. Why, then, have you no empathy when it comes to gender dysphoric youth? When it comes to breast binding - a real rib breaker and oxygen robber - and double mastectomies for gender dysphoric girls. Growth blockers and cross hormones that eat away at bones and joints, and sterilize any girl who is subject to them before or during puberty, you offer no editorial that questions this. It's blatant self-harm for the very same reason that girls self-cut and self-induce vomit. Yet over and over your editorials refuse to question this abuse of the gender dysphoric girl.

Let's be clear - self-harm, like other psychological conditions including eating disorders and compulsive exercise, are not confined to young women and teens. There are people of all ages and genders who use coping methods like self-harm that are destructive and maladaptive. It's also a myth that self-harm leads to suicide. While many adults who self-harm began in their teen years, there are some who begin as adults. Self-harming releases endorphins, allows psychological pain to be "turned into" physical pain, and cuts through the numbness of trauma, depression, anxiety. There is also an element of control, of perfectionism. When I harm, I know where and how to do so - how far I can go without causing serious injury. Usually. It's also comforting to balance my perfectionism - to self-punish, to express my self-hatred. There is treatment, and hope, for those who self-harm if they find a team that understands this illness. For many including me, it is inseparably tied to eating and exercise disorders, body dysmorphia, feelings of inadequacy, and depression. As for those who argue it is related to the increased pressures on youth today, sorry but no. I see the pressures my kids and others are under and it is nothing in comparison to the pressures my husband and I had when we were teens 30-40 years ago. There was far more drinking, drug use, sex, and risky behavior in the 70's and 80's than now. This generation is sheltered in comparison.

Early childhood trauma can lead to self-mutilation later on. I was terribly abused from the age of two and a half to three and a half. I recovered the memory in therapy and was able to confront someone who was in the house when it happened. She confirmed it. Much later as a teen I became self-destructive and the very people who permitted the abuse, never intervening on my behalf, blamed and persecuted me for my destructive activity. I didn't recover memory of the abuse until late middle age, though. Looking back on it all as an almost 80 year old woman, I see it clearly and I see the horrendous injustice that was inflicted on me. I can only hope and pray that others will not experience such injustice. I made sure my own children never experienced anything like it.

I often think that self-harm is like a new type of self-medicating ie:drinking, drugs, etc. It numbs the pain. One person does it and it takes off and pretty soon others are doing it. I think that if you are in an environment where no one is listening to you, or validating your feelings, then you need an outlet. And people do many things to release pain. I don't think the release of pain is new, but the cutting is. I beg to differ that it is not a pre-cursor to suicide. I believe it definately is. Who would cut themselves and show blood if they weren't depressed or suicidal?

I know that not every adolescent who cuts is necessarily the victim of child abuse, but this was certainly the case for me when I started cutting myself at age 12 (and subsequently stopped when I distanced from the abuser) and also for two of my three older sisters (one of whom was given every imaginable psychiatric diagnosis over the decades that ensued). We were part of a family (nuclear and extended) and a society that implicitly and explicitly made it clear that the truth of what we carried (that our charming professor father who could be quite kind and affable was also a very abusive man and an addictive pedophile) was unacceptable. Our pain and rage was transmitted to cuts on our arms. For two of us, it ended fairly quickly but for the eldest daughter (one of those "nightmare" "BPD" patients that many psychiatric doctors and nurses dread), it went on for decades until she died of an opiate overdose in 2017. I do not think she was chemically imbalanced. I do not think that her brain chemistry needed more studying. She was amazing— an artist, a dancer, an actress, a lifelong learner and music appreciator, an enjoyer of life, an animal activist, and a protector. Cutting was a symptom, in my opinion, not of an innate illness or problem with her but of a grossly ill family and society that tacitly allowed such terrible abuse to happen, never investigated or prosecuted, and allowed (forced?) her to carry the blame internally and externally for her whole life. Enough.

I’m finding that authors in the New York Times are using single articles rather than a body of evidence to state their argument recently. Self-injury is prevalent in any ways as others have noted e.g. drug use, injurious sports, etc. Some more socially acceptable than others and therefore, less shocking. I think that psychological pain can be excruciating and inescapable for many persons with behaviors that put them outside of society’s norm and frequently experience disappointment in self. Those with early-life trauma, early life neglect, PTSD, developmental disabilities that result in intense and painful emotions such as shame and self-loathing. Perhaps the answer to less self-injury is less exclusion of difference?

I am a retired counselor. A few decades ago I used to wonder who got tattooed and why. The world has changed a lot since then and now tattooing is commonplace. I'm curious to know of the relationship between tattooing and self harm, especially of those whose tattoos are excessive.

I wonder if including scarification or extreme tattooing in cutting studies could present new insight.

It is concerning that so limited a picture of treatment is presented in this article. DBT or CBT are not always the way forward, and as others have said, it is problematic to label teens with syndromes such as Borderline Personality Disorders or Bipolar 2. Talk therapy of many different kinds can be helpful. It is the presence of an interested and curious other, who is willing to bear the pain which someone who needs to express themselves through self harm that is ultimately most powerful. Oft cited suggestions of some so called evidence based treatment rarely explore the breadth of research. CBT is a good example of a treatment that has been over valued without real longterm evidence that it works.

Glad you mentioned the college students are by definition a privileged group. Very important to point that out.

I would argue that this is not necessarily a teenage girl affliction. We should look closely at young males who excessively work out - under the guise of body building - where they afflict a great amount of pain on their bodies through weight lifting. I’ve seen relatively healthy young boys put themselves through excessive pain in order to look “ripped” or other socially acceptable pursuit of the perfect body. They may damage their bodies in a different way - many leading to steroid abuse - but the drive to “feel” in a numbing world shouldn’t be discounted.

Good luck finding a DBT/CBT program that is both available and affordable. My son is BPD, and we have struggled for years to find a program willing to work with him. And we are down the block from the supposed gold standard, Zucker Hillside. Very frustrated after many years of in-and-out of the same hospitals for inpatient psychiatric stays, but trying to get into DBT has consumed all of our energies with no result. We are a middle class, two parent family and we can't navigate the system. I can't imagine what it's like for those less advantaged. Shame on the health care system, and the individual providers in particular, for not making this treatment more accessible. It's hard enough dealing with a child with mental illness. When trying to get a basic, well publicized treatment becomes a full time job, there's something wrong.

That’s a visually arresting illustration, but why show a woman leaping into pain (or perhaps I should say a girl, even though the body is that of a full grown woman)? The does article say that self harm is especially prevalent among adolescent girls, but it also happens among boys and tran teens. You should be careful about gender typing.

Not sure if my comment will be considered helpful, but as someone who grew up in western Europe, I wanted to remind everyone of the true insanity of what it represents to grow up and live in America today, not just because of Trump or the state of the planet (in itself a very valid source of despair for any 15-year old who is paying attention) but because American society is so incredibly harsh and has become increasingly so over the past 30 years. Being an American teenager today means not getting shot at school, trying to work yourself into some form of perfection that will ensure that you go to a good college (let's not even think about the Ivies), then later land a job that will provide you with some sort of benefits and a way to pay back your student loans, etc. Paid maternity leave, low prices for medical drugs and practices completely optional. Life does NOT need to be like that. My kids have a golden ticket though, a European passport. I am pretty sure that they will make good use of it when the time comes, provided that they make it through high school and college alive, literally and figuratively.

Non-suicidal self-injury is well recognized in current psychiatry. There is a new treatment which is promising and can facilitate talk and behavioral therapies like CBT, DBT, and others. Naltrexone is an opioid-blocker which has been found to be of some help in early studies and further research continues.

People engage in self harm because it *is*a powerfully effective way of managing emotional distress. It is probably more widespread now because everyone has heard of it and it has become more normalized so more people try it. And they find that it works so they continue. The challenge then becomes either to learn to tolerate distress without acting, or to find less risky/destructive ways of managing it. Not easy.

I first encountered this practice in my freshman college dorm in 1971. A young woman from a very successful family was doing it. I was astonished. I thought I was an angsty teen, but the idea of doing something like this to yourself was terrifying. Could it have something to do with people's inborn body integrity templates, something about mixing up the inside and outside?

My daughter is a high functioning autistic kid who picks scabs, often turning the tiniest scratch into a gaping wound over time. It is hard for me not to freak out when they sometimes become infected, in ways that could cause sepsis if she's not careful. But having gone through such heavy criticism for nail biting (which she also does) I understand that having someone point out that the behavior is deleterious doesn't mean that you can control it. I wonder - is this sort of compulsive behavior, which I have always considered to be more like tics than a self harm strategy, also something that could be treated? Everything I've read about picking scabs or pulling out hair indicates that it is virtually untreatable without medication, and even that doesn't really always work. Is it possible that she will just eventually grow out of this phase?

I have a daughter who has gone thru cutting. She learned about it from another friend at camp. That friend, sadly, checked out presumably by accident. This cutting stuff is everywhere now and it's absolutely another form of drug use. One great choice my daughter made was bunking with her younger sister. That constant companionship has gone a long way to reducing this behavior.

It’s not at all surprising that many people with BPD self harm. I think most do, in fact. Maybe not by cutting, but through extremely reckless and self-destructive behavior. But most people who self harm - 1 in 5 college kids in that survey had done so at least once - do not have BPD!

I don't see any recognition here of the physiological response of bodies to injury: After pain registers injury, repair is initiated and endorphins go along with that. Why cutting has become a preferred method of releasing endorphins may be a sociological question, but I doubt it can be answered if what it is actually doing to relieve mental anguish is not recognized.

I was a psychiatric RN for 35 years. These self harming patients were all diagnosed as borderline personality disordered. They are by and large the most difficult of those personality disordered to deal with. I worked in a State psychiatric hospital. When the community doctors and facilities could no longer deal with them; they were court committed to the State Hospital. Staff would groan when seeing the diagnosis of the admission. Our psychiatrists and psychologists and nurses were not trained to treat those with BPD. They inevitably self harmed and were placed on 1:1 supervision. DBT was introduced, but with the ever present short staffing, it was difficult to fully use this method. These patients lingered for years in the hospital. If discharged to family or group home setting; they would eventually be returned to the hospital due to self harm. The patients who self harm should not be committed to psychiatric hospitals for more than 3 weeks to assist with an exacerbation of symptoms. I have seen so many admitted as young adults, and linger on continuous 1:1 through middle age. More community based treatment with individual DBT would definitely be the answer, but there is little funding for MH treatment. This has been my experience in dealing with self harming individuals.

It important for parents not to overreact and to manage their own anxiety about their kids. When your kid is engaging in self harm, they feel an enormous amount of shame. We know that behavior and feeling are connected but we don't know always know the feeling. Kids need a safe space where they can vent about their lives without worrying about other people’s feelings. It’s helpful when they can develop a relationship with a therapist who can help them get underneath the behavior and help them connect it to a feeling. There is a connection and we want to put them together (action = feeling). Be curious about what your kid’s behavior is telling you. Don’t take it personally. Be pro-active about getting them the help they need. And yourself too. Parents who are self-aware and have done a lot of self reflection will be better role models and a source of support for their kids. Have hope.

It is beyond tragic that in order to handle feelings of intense pain or intense numbness, the best strategy the girls and women in this story (although I am sure there are boys and men that resort to this as well) can find is self-harm. When they turn to it for even small injustices, or out of abject boredom, we have a serious crisis on our hands. Neuroscience knows very well how endogenous opiates and dissociation work. Many psychologists don't. Too many young people are amazingly unprepared to handle even brief or mild dysphoria. We have truly created a generation of kids who received medals just for showing up and whose small failures were fixed before they could experience them. And then there are all the untreated abuse survivors that find drugs don't fix pain. BTW, Teaching DBT techniques will work best when clients aren't so dissociated that they cannot use language to heal, and when the sources of pain aren't ongoing.

First of all, most mental health professionals have known for years that self injury behavior is markedly different from suicidal behavior if for no other reason than that if someone really intended to kill themselves they wouldn't need tens if not hundreds of attempts to succeed. Second, the diagnosis that still fits with most cases of self injurious behavior is borderline personality disorder. In fact, it is so common, someone with this type of behavior is generally considered to have this disorder unless there is evidence to the contrary. thus finding that a therapy for BDP is effective for self injurious behavior is no surprise. And although Mr. Carey almost always studiously avoids any suggestion that psychotropic medications can be beneficial for mental disorders, in fact there are studies demonstrating that some of the antidepressants and antipsychotics can be beneficial for treatment of BPD. They aren't cures but neither is the therapy he describes.

I first start cutting in the mid 1960's when I was 15. First thinking of suicide then later because I could feel the pain which was easier than the isolating emotional pain. I thought I was the only one in the world that was doing this. After years of burying the pain and self medicating with alcohol, I finally received psychiatric therapy. My diagnoses was bipolar, borderline with depression. Now 70 years old, I can say that I am finally on the high road of recovery. Luckily children and adults nowadays have therapy available to them and hopefully can avoid a lifetime of pain. I will live with the scars on my arms which is an unpleasant reminder of the past.

This phenomenon is yet another indication of the pressure that young people have felt as a result of largely adult competitiveness -- the urge to succeed, achieve prestige, and "be the best you can be." It all involves grades, over-involvement in activities, college admissions, sports -- and a general sense that a child/youth can and even should do everything and be everything before reaching adulthood. Parents and teachers don't explicit state this -- but it's just in the atmosphere. And kids feel the pressure intensely -- and as developing social beings, they can't help imitating each other, and can't find other ways to relieve the pressure. Drinking, drugs, sex, cutting -- all coping mechanisms for handling a high-pressure culture. Parents aren't to "blame" -- but we're all responsible. I do hope counselors and therapists are careful about associating "borderline personality" with those who cut and self-harm. We do a lot of labeling in our society, often to the detriment of an individual who needs a unique, personal approach.