Michael Ceo

By Michael Ceo

03/02/2004

There has been an increase in the number of teens who self-mutilate, and hardly anyone is talking about it. Some young people usually beginning at age 15 seek to relieve tension by putting a blade to their arms or legs and making repeated slices in their skin.

These lacerations are deep with significant bleeding and are often deliberately hidden by clothing.

In one reputable study to determine the frequency of this alarming practice, a staggering 13.9 percent of adolescents have reported cutting themselves, many during the previous week. My son, a high school sophomore, told me four of his friends are “cutters.” I was stunned.

Since self-mutilation is an SOS for serious emotional disorder, anyone in contact with young people needs to be on the lookout for this behavior and to act as a first responder, educating, making appropriate interventions and referrals.

The dangers and risks are significant when people self-mutilate. In addition to infection, there is the danger of miscalculation where a vein could be cut and loss of blood could cause the person to pass out and bleed to death even though tension relief rather than suicide was the intention. Cutting can often become an habitual attempt to relieve emotional tension. However, tolerance builds with each cutting episode, so deeper or more violent cutting is required to produce the same degree of relief.

“Causing pain and bleeding brings an actual emotional release of huge psychic tension,” said Leesburg psychologist Toby Behrmann. “If it sounds weird or bizarre, it’s because you don’t understand the incredible emotional twisting the individual struggles with,” said Behrmann. He explained that making anything big happen quickly, like pain and bleeding, feels like you have power and actually reduces the inner tension temporarily.

An article in the “Clinical Psychiatry News” pointed out that self-cutting is not necessarily a suicide attempt. Statistically, only a tiny percent of self-cutters will kill themselves. Rather, it seems that self-mutilating is a desperate attempt to regain control over private suffering. The cuts represent visible evidence or proof of a private shame and anguish.

A phone call to Anne Lewis, supervisor of guidance and health at Loudoun County Schools, revealed that school officials are taking action to get more information on the topic. Ms. Lewis has arranged for a training program March 17 for school guidance counselors, which will be conducted by a leading expert on self-mutilating behavior among young people. Ms. Lewis said her hope is for guidance staff to become alert to the problem and offer educational material to the parents and teachers of adolescents who are found to be self-cutters.

What characteristics make adolescents at risk for self-injurious behavior? Self-cutters experience themselves as being lost and abandoned. They sometimes describe themselves as being “lost in a big hole.” Cutters feel hopelessly stuck. They have an isolating inability to express or communicate emotions. Shame and a hunger for revenge against those whom they perceive as having neglected or abused them are central to their experience. Shame is poison to self-esteem. It is like a virulent festering mold that thrives on darkness and isolation. Cutters hold a dark hidden place within themselves that they retreat to when under stress. In this private reality cutting turns emotional pain into physical pain. The inflicted wounds are easier to care for and heal than emotional injury.

Psychotherapy for teens who self-mutilate can use individual, group and family therapy formats. In my view, a sequence of these treatment formats would best address the underlying emotional pain. Learning to trust a therapist is the first phase of treatment. Second, expanding the therapy relationship to include other young people in the form of group counseling is a very powerful tool for healing.

Group therapy is a useful and, I believe, under-utilized and hard-to-find therapy format for adolescents. Groups teach skills in communication, conflict resolution, problem solving, leadership and assertiveness, social skills that self-cutters are desperately in need of learning. Family therapy can also be a crucial phase of treatment for self-cutters in order that healing can be brought to the fundamental family relationships and problems that underlie their daily lives.

You, the parents, teachers, neighbors, physicians and friends of cutters, are the first responders. You will be faced with the challenge of linking emotionally troubled teens with resources for help. It is you who have the sacred responsibility of guiding them toward the light.

	The silent scream: Teens who cut themselves By Michael Ceo 03/02/2004 There has been an increase in the number of teens who self-mutilate, and hardly anyone is talking about it. Some young people usually beginning at age 15 seek to relieve tension by putting a blade to their arms or legs and making repeated slices in their skin. These lacerations are deep with significant bleeding and are often deliberately hidden by clothing. In one reputable study to determine the frequency of this alarming practice, a staggering 13.9 percent of adolescents have reported cutting themselves, many during the previous week. My son, a high school sophomore, told me four of his friends are “cutters.” I was stunned. Since self-mutilation is an SOS for serious emotional disorder, anyone in contact with young people needs to be on the lookout for this behavior and to act as a first responder, educating, making appropriate interventions and referrals. The dangers and risks are significant when people self-mutilate. In addition to infection, there is the danger of miscalculation where a vein could be cut and loss of blood could cause the person to pass out and bleed to death even though tension relief rather than suicide was the intention. Cutting can often become an habitual attempt to relieve emotional tension. However, tolerance builds with each cutting episode, so deeper or more violent cutting is required to produce the same degree of relief. “Causing pain and bleeding brings an actual emotional release of huge psychic tension,” said Leesburg psychologist Toby Behrmann. “If it sounds weird or bizarre, it’s because you don’t understand the incredible emotional twisting the individual struggles with,” said Behrmann. He explained that making anything big happen quickly, like pain and bleeding, feels like you have power and actually reduces the inner tension temporarily. An article in the “Clinical Psychiatry News” pointed out that self-cutting is not necessarily a suicide attempt. Statistically, only a tiny percent of self-cutters will kill themselves. Rather, it seems that self-mutilating is a desperate attempt to regain control over private suffering. The cuts represent visible evidence or proof of a private shame and anguish. A phone call to Anne Lewis, supervisor of guidance and health at Loudoun County Schools, revealed that school officials are taking action to get more information on the topic. Ms. Lewis has arranged for a training program March 17 for school guidance counselors, which will be conducted by a leading expert on self-mutilating behavior among young people. Ms. Lewis said her hope is for guidance staff to become alert to the problem and offer educational material to the parents and teachers of adolescents who are found to be self-cutters. What characteristics make adolescents at risk for self-injurious behavior? Self-cutters experience themselves as being lost and abandoned. They sometimes describe themselves as being “lost in a big hole.” Cutters feel hopelessly stuck. They have an isolating inability to express or communicate emotions. Shame and a hunger for revenge against those whom they perceive as having neglected or abused them are central to their experience. Shame is poison to self-esteem. It is like a virulent festering mold that thrives on darkness and isolation. Cutters hold a dark hidden place within themselves that they retreat to when under stress. In this private reality cutting turns emotional pain into physical pain. The inflicted wounds are easier to care for and heal than emotional injury. Psychotherapy for teens who self-mutilate can use individual, group and family therapy formats. In my view, a sequence of these treatment formats would best address the underlying emotional pain. Learning to trust a therapist is the first phase of treatment. Second, expanding the therapy relationship to include other young people in the form of group counseling is a very powerful tool for healing. Group therapy is a useful and, I believe, under-utilized and hard-to-find therapy format for adolescents. Groups teach skills in communication, conflict resolution, problem solving, leadership and assertiveness, social skills that self-cutters are desperately in need of learning. Family therapy can also be a crucial phase of treatment for self-cutters in order that healing can be brought to the fundamental family relationships and problems that underlie their daily lives. You, the parents, teachers, neighbors, physicians and friends of cutters, are the first responders. You will be faced with the challenge of linking emotionally troubled teens with resources for help. It is you who have the sacred responsibility of guiding them toward the light.