Self-injury behaviors in adolescents have been reported with increasing frequency during recent years. These behaviors include cutting, burning, and other methods of deliberately inflicting tissue damage upon oneself. Parents and others are often bewildered by such behaviors, since most of us have never experienced a temptation to deliberately hurt ourselves. To us, these behaviors can appear frightening and perverse, and the idea that they often represent efforts to cope with intense emotional distress seems foreign indeed.
Self-injury behaviors need to be taken seriously. Sometimes they express or accompany suicidal thoughts or actions and in some (though by no means all) cases, they may be part of an actual suicide crisis. Although these behaviors are often not associated with suicidal intent, this determination must be made via a psychiatric evaluation performed by a child/adolescent psychiatrist, psychologist, or other mental health professional competent to evaluate and diagnose such behaviors and their underlying problems. Even when self-mutilation behaviors are not associated with suicidal intent, they usually indicate intense emotional distress and limited personal resources for coping with that distress. These are problems that require professional help.
A clinician conducting an evaluation of an adolescent who has been engaging in self-injury behaviors will attempt to learn not only about the specific behaviors being exhibited, but also about the problems, conflicts, and vulnerabilities that the adolescent may be coping with by engaging in these behaviors. In this respect, such an evaluation does not differ from the sensitive assessment of all patients who present for help with psychiatric or psychological problems. After learning about the patient’s history, strengths, weaknesses, and difficulties, the evaluator will be in a position to recommend and discuss treatment options.
Over the past two decades, several excellent treatment approaches for the problems associated with self-injury behaviors have been developed and tested in clinical research settings. Some of these approaches, which were initially developed for adult patients, have been adapted for the treatment of adolescents. If you or someone close to you is struggling with self-harm urges or behaviors, talk to your family doctor or pediatrician for referral to an appropriate mental health specialist. The take-home message is that self-injury behaviors and their associated problems can be worked with, and individuals who are struggling with them can be helped.
Dr. Stone, a clinical psychologist, is an Assistant Professor of Psychology in Clinical Psychiatry at Weill Medical College of Cornell University, and Director of the Dialectical Behavior Therapy Program for Self-Injuring Adolescents at the Westchester Division of New York-Presbyterian Hospital in White Plains, New York. He resides in Pawling with his wife, Susan, and their family.