Self-Injury: Cutting, Purging, and Other Addictive Behaviors

October 17, 2012 | By

Adolescents who are struggling to find ways to cope with a variety of intense emotions may resort to self-mutilation, also termed self-inflicted violence (SIV). SIV is defined as intentionally harming one’s body, without suicidal intent. These unwise coping attempts include cutting (the most common form of self-injury), burning, hitting oneself, picking at skin, reopening wounds, hair-pulling, self-starvation, and purging (intentionally ridding oneself of food by inducing vomiting or using laxatives). SIV is often seen in conjunction with or arising out of an eating disorder. When self-starvation or purging is the form of self-injury, the person is attacking the body internally to gain the same relief that a cutter or burner does in attacking the body externally. SIV typically begins in adolescence (the mean age of onset is 16) and most commonly affects girls. Since cutting or burning is often done on the arms and legs, a teen’s refusal to wear shorts or short-sleeved shirts in warm weather can be a warning sign. Frequent accidents and numerous cuts or burns on the arms or legs that can not be logically explained also can be indicative of SIV.

Often the first incident happens by “accident,” or the teens have heard about or seen others participate in self-injury. The act is described as relieving intense feelings such as sadness, anger, loneliness, and guilt, and resulting in more peaceful and less painful feelings. The physiological response to cutting, burning, or other self-injuries is an increase in the level of endorphins in the bloodstream, which indeed can give a numbing or even pleasurable response. Another appealing aspect of these behaviors is the fact that they make the “pain” external and under the teen’s control, whereas before the act, the teen likely felt an uncontrollable internal swirl of painful emotions. Because self-injury so effectively can grant relief and control of these emotions, SIV can become quite addictive. In other words, the adolescents might often feel compelled to repeat the behavior, and with increasing frequency and/or severity. Once an addictive cycle begins, the behavior is likely to continue until the adolescents and their families deal with the underlying issues and learn healthier ways to cope. The addictive aspect of self-injurious behaviors often takes teens by surprise, as they begin to lose control over a behavior which was chosen, in part, because it gave them more control. At this point, the teen may admit their behavior to parents, or make their behavior more obvious or visible, consciously or unconsciously hoping to be “caught.”

It is quite normal, initially, for parents to react negatively to SIV. However, to react angrily, deny the teens’ distress, and/or demand that the behavior simply “stop” is harmful, and often makes the problem worse. Understanding that SIV is an attempt to release and control painful and intense emotions, and unquestionably an addictive behavior, can enable families to respond in a better manner, and begin the recovery process. The adolescents who hurt themselves typically view the behavior as positive since it gives them relief, control, and in their mind, even helps them to survive. Parents can help by being willing to listen, encouraging expression of emotions, and spending time together as a family doing enjoyable things. Some suggestions of healthy ways for adolescents to cope with intense painful feelings are:

  • Talking with a friend or trusted adult (e.g., parent of a friend, youth minister, school counselor)
  • Initiating psychotherapy
  • Exercising and/or participating in a sport
  • Deep breathing/relaxation techniques
  • Writing in a journal
  • Verbalizing emotions or otherwise making them known, instead of suppressing them
  • Comforting or helping others
  • Prayer, meditation, attending a church or house of worship
  • Practicing yoga
  • Allowing oneself to cry, express anger in a safe way, or otherwise “vent” emotions

If adolescents are found to be “flirting” with addictive self-injuries as a coping mechanism, help is available. Therapists can help parents address the episodes differently, increase understanding, and facilitate more constructive expression of emotions. The teens can learn wise and healthy alternatives for dealing with their emotional distress.

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