Sally is sixteen years old and somewhat defiant but then again she’s 16 years old. Her mother made her come to see me for an addiction assessment because during a parental search of her room, they found some “synthetic” marijuana. Of course, she is angry about being “violated” by the search. Purportedly, her erratic behavior prompted the search. During the course of her visit I ask about self mutilation. She breaks eye contact, looks at the floor and then says: “Yes. But I’m not crazy.”
I don’t think she’s crazy either. I do think she is using cutting as a maladaptive coping mechanism. She tends to cut her upper legs and upper arms when she needs to “just feel” or to “deal with” negative emotional states. Those negative states can be depression, overwhelming emotions, no emotions (numbing), anxiety, abandonment fears, self loathing, and others. She might have Post Traumatic Stress Disorder; she might have a co-occurring eating disorder; she might be on her way to a diagnosis of Borderline Personality Disorder; she might have a history of being abused; she might have a Substance Use Disorder or is at high risk for developing one; and/or she might have learned it from others. She tells me that cutting gives her relief and sometimes she does it just to know she is alive. In this particular case, she tells me that it also makes her feel euphoric at times. She has tried to hide this behavior and she has little trust of doctors at this point. “I ended up in the emergency room once because I cut my wrist. They thought I was suicidal and I got sent to nut house for three days. I was not trying to kill myself. I actually cut myself to not be suicidal. Nobody seems to understand me.”
Non-suicidal Self Harm can become an automatic response. It is not limited to cutting. Burning, hitting walls, and/or piercing are other methods. Self harm can become a “diabolically” learned response. As such, it can become a compulsive or addictive behavior. Self Harm has no specific causes or “roots”. It usually occurs in young females and they often feel alone or isolated and are fearful of letting other know about their behaviors. There is no “magic” cure. Therapy consists of Cognitive Behavioral Therapy to encourage new coping skills, to develop problem solving skills and competing behaviors, and to establish a support system. There is some indication that low serotonin may play a part in some cases of Self Harm. As such, SSRI antidepressants can be prescribed if medically indicated. Special caution must be taken in prescribing these mediations to young patients for several reasons but space does not permit me to cover that here. Obviously, any co-occurring disorders, such as Drug Dependency, must be addressed. Indeed, the paradigm for treating addiction can be integrated into treatment of Self Harm. It is not infrequent that I encounter Self Harm behaviors in young addicted female patients. My dual message to those suffering from Self Harm is that you are not alone and treatment works.