A Swiss army knife was her tool of choice, but when that was not available — when, for instance, she was hospitalized for depression — Julie would use what she could find; paper clips, staples, screws, or plastic knives.
Julie, a 35-year-old nursing student in Massachusetts, has grappled with the urge to cut herself for half her life. Therapy held the urge at bay for seven years, only to have it slither back in 2006, during a wrenching breakup with her boyfriend.
“The cutting makes me calmer, or it enables me to feel emotion and that makes me calmer,” said Julie, who asked that her last name not be used to protect her identity.
She cut places on her body that didn’t show — on her thighs and stomach — but has not cut herself for eight months, after trying a different type of therapy. “It’s an addiction,” she said. “Those urges dissipate over time, but they don’t go away.”
Some secretly slice their thighs with scissors. Others repeatedly scratch their wrists until they draw blood. And there are those who chronically punch themselves. For many who wince at a paper cut, the thought of picking up a knife, and intentionally slicing a thigh or arm, seems unimaginable.
But mental health specialists say they are increasingly encountering young patients, including children, who cut, punch, burn, and find other ways to hurt themselves in a desperate attempt to cope with stress, anxiety, and depression.
It’s difficult to pinpoint just how widespread the behavior of self-injury is. It’s not tracked by health officials, and rates of self-harm revealed through research vary widely. Estimates of prevalence in the general US population range from about 2 to 6 percent, while findings among high school students have pegged it much higher, between 13 and 25 percent. A recent study found that roughly 15 percent of college students surveyed admitted engaging in the behavior at some point in their lives.
“There are more than 10 child therapists in our center and we’ve all seen at least one or two in the past year,” said Brooke Rosing, a licensed clinical social worker at Brookline Community Mental Health Center, which treats students referred from the town’s school district.
Rosing and other mental health specialists said it is hard to know whether the number of self-injurers is actually climbing, or whether the apparent increase is fueled by greater awareness of the problem among clinicians and teachers, coupled with growing social media focus on celebrity self-injury stories.
Much is still not known about the disorder, which has been traced to ancient times, however most specialists accept the definition used by the International Society for the Study of Self-Injury. The society describes it as a deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned. Tattoos and body piercings, for instance, are not considered self-injury.
There has been much debate among mental health specialists over whether self-harm is an illness unto itself, or whether the behavior is a symptom of other health problems, such as depression, anxiety, or borderline personality disorder. Researchers who specialize in this field say fear of litigation from studying such dangerous behavior if a subject harms him or herself, and a lack of consensus about whether self-injury is a distinct illness or merely a behavior on a suicide continuum, have stymied progress on understanding the phenomenon.
Scientists say that most who self-harm are not trying to kill themselves, but instead are typically searching for a way to relieve anxiety, similar to the way some abuse alcohol or prescription sedatives to cope with anxiety, depression, or other mental health problems. Yet new research of college students finds that often the behavior is a sort of gateway to suicide, lowering the threshold to taking the next step.
Cornell University researcher Janis Whitlock and colleagues tracked 1,466 students at five US colleges in the Northeast and Midwest and found that those who had self-injured were roughly three times more likely to attempt or consider suicide. Students with a history of more than five self-injuries were four times more likely, according to the study published in the Society for Adolescent Health and Medicine.
Self-injury “allows them to practice hurting their body,” said Whitlock, a scientist at Cornell’s Bronfenbrenner Center for Translational Research.
Whitlock’s earlier research of college students found that, on average, those who self-harmed started around age 15, a mercurial time when hormones are raging and brains are still developing. Continued...