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A Cry For Help

Incidents of self-harm continue to grow among young women. Though not necessarily a prelude to suicide, it is indicative of depression or anxiety.

Sudden epidemic or gradual increase over the years? Either way, self-mutilation is a huge and growing problem that "has now reached critical mass and grabs our attention," says Russ Federman, Ph.D., director of counseling and psychological services at the University of Virginia.

Nearly 70 percent of counseling center directors report increases in cases of self-injury such as deliberate cutting or cigarette burning of body tissue. "It's now on all our radar screens," Federman notes. "It gets talked about with deans."

Self-harm is not a diagnostic category, so its exact incidence is unknown. But women are twice as likely to do it as men. And it typically accompanies a range of conditions—borderline personality disorder, eating disorders, anxiety and depression. It most commonly occurs, however, in antisocial personality disorder, accounting for a high rate of self-harm in prisons.

It's highly disturbing for a student to walk into her dorm and find her roommate cutting her thighs or arms with shards of glass. Further, self-injury always mobilizes a crisis response; suicidal intent must be ruled out.

Self-harm is a serious symptom, says Federman. "But it isn't about taking one's life. It freaks others out. But rarely does cutting constitute imminent danger to the self. There's not usually suicidal ideation."

Self-mutilation is "the opposite of suicide," insists Armando Favazza, M.D., professor and vice chairman of psychiatry at the University of Missouri, author of Bodies Under Siege: Self-Mutilation in Psychiatry and Culture and a leading authority on the subject. "Those who do it want to live. They do it to feel better. It's an impulsive act done to regulate mood."

It is an extremely effective treatment for anxiety, he points out. People who do it report it's "like popping a balloon." There's an immediate release of tension.

It serves "an important defense—distraction," adds Federman. "In the midst of emotional turmoil, physical pain helps people disconnect from intense emotional turmoil." But the effect lasts only hours.

Further, "it is the only action that can effectively stop dissociative episodes," says Favazza. "That makes it especially common among girls who were sexually abused."

Too, self-mutilation has to do with self-punishment. Not to be overlooked is the sense of power it confers. "It allows students to take control of painful processes they feel are out of control, especially chaotic relationships," says Federman.

Sometimes it's a cry for help. Cutting is usually a private process and the scars are hidden. But some people will cut an arm and don a short-sleeve shirt.

Although most cutting is a private act, Favazza reports that he knows of cutting parties—groups of girls who get together to cut in each other's presence. And some students like to hang out with the cutters. That has given rise to "pseudo-cutters," those who cut not to gain release but to belong to a social group.

It's imperative to stop self-mutilation as soon as it's discovered, as cutting can take on a life of its own with addiction-like qualities. Treatment usually involves psychotherapy plus SSRI antidepressants, which decrease the impulsivity behind most acts of self-harm.