Promoting Hope, Preventing Suicide

Research and advice on preventing teen and adult suicide

Self-Injury: Addiction? Parasuicide? Cry for Help? Or None of the Above?

These tools cannot fail us in the ways that people can.

Non-suicidal self-injury strikes me as one of those mysteries of human behavior. The purpose of self-injury is not to cause permanent damage to the body; self-injury is not always intentional self-mutilation. Yet, the outcome of self-injury is often a permanent mark.

Lest we think that it is not happening where we live, at least one state, Massachusetts, added a self-injury question to the administration of the Youth Risk Behavior Survey. The survey examines a number of health behaviors, including substance use, dietary habits, behaviors leading to injury, and sexual behaviors. In 2007, 17% of high school students surveyed admitted to self-injurious behavior. Just for context, this percentage, at least for Massachusetts, is higher than any of the measures of suicidal thoughts and behaviors.

According to a young woman who I heard speak recently on the subject, self-injury can be a sort of addiction - an addiction to the release of emotions. Unlike talking to another person about anger or fear, the tools used in self-injury give a reliable response. These tools cannot fail us in the ways that people can.

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The failure of others to respond in the ways self-injurers need extends to parents, teachers, and those in the helping professions.

One young woman attempted suicide after her parents and teachers found out about her cutting. She was hospitalized, and her cutting was taken away as a coping mechanism. I can't help but think about how that experience might have contributed to her suicide attempt.

In order to learn to give up self-injury behavior, young people need to substitute other behaviors that can be equally soothing and provide a similar emotional release. No-harm contracts or forbidding the self-injury behavior, according to these young people, does not work. For one, if the instruments are taken away in a specific setting like a hospital, the young people will resort to self-injury behavior once out of that setting and with access to the tools. Additionally, these sorts of bans do not actually teach the young person appropriate coping mechanisms for difficult emotions.

The suggestion to therapists is to shift the focus from the behavior itself to what's behind the behavior - what's going on in the client's life that is making her feel like she wants and needs to do this behavior? Perhaps because the behavior is so disturbing to adults, and so seemingly destructive, the focus of some therapies is on stopping the behavior, without necessarily addressing the underlying causes.

As I listened to the stories of two young women who had self-injured as teens, I was most interested in what they said about the response of their school counselor. This counselor listened fully and with genuine interest to these girls and made them feel that their needs were truly prioritized. They were able to be honest with her, and get the help they needed, because of her approach to and acceptance of them.

When confronted about their self-injury behavior, young people may say things along the lines of, "I stay home and I cut. All my other friends go out and get drunk or high and drive around. What's worse, really?"

Really. I've worked in both substance abuse and injury prevention, and I do have to wonder.

Copyright 2009 Elana Premack Sandler, All Rights Reserved

Elana Premack Sandler, L.C.S.W., M.P.H., is a public health social worker specializing in violence and injury prevention and adolescent health promotion.

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