Whether cutting, burning, head banging, scratching, and even scab picking, growing numbers of adolescents are hurting themselves. In fact, the latest statistics show that as many as 3 million people -- mainly adolescents -- practice self-harm.
And "the rates certainly seem to be increasing," says David S. Rosen, MD, MPH, chief of the section of teenage and young adult health in the department of pediatrics at the University of Michigan Health Systems in Ann Arbor.
"We live in a more stressful world; people's behaviors are more infectious because of the Internet and instantaneous communication, and we recognize [self-harm] much more than we have in the past."
While doctors are getting better at recognizing it, treatment is still evolving, experts tell WebMD.
Why Do Young People Harm Themselves?
Actress Angelina Jolie has talked openly about how she once cut herself to express pain. The movie Thirteen, which was written by a 13-year-old girl, highlighted cutting. In it a 13-year-old girl is transformed from a well-behaved honor student into a rebellious member of her school's popular crowd.
According to many experts, self-harm is not necessarily attention-seeking behavior. Most agree that self-harm is a way of coping with feelings that the individual has difficulty controlling or expressing.
"If you think about youth suicide, which 15 years ago was heavily portrayed in the media, it did seem as though media representations increased rates of that behavior, so if that is a model, then a lot of media attention to [self-harm] could, in fact, increase the likelihood that someone might try this if she is feeling bad," he says.
What Is Self-Harm?
Cutting is overwhelmingly the most common type of self-harm, but some people bang their head, some people stick themselves with pins and needles, and some people scratch or rub until they abrade their skin, he says.
"Picking scabs can also be a [type of] self-harm," says Karen Conterio, author of Bodily Harm and founder of SAFE (Self Abuse Finally Ends) Alternatives at Linden Oak Hospital in Naperville, Ill.
"Everyone has picked off a scab, and that doesn't mean they should be running to the nearest psychologist," she says. But "if you pick a scab because you are anxious and can't get the words out or think 'I am fat' or 'I am ugly' and then pick a scab, or if you created a wound on your face and then picked the scab, it could be self-harm," she says.
Cutting Is Not a Suicide Attempt
"Many people are viewed as suicidal, but [self-harm] is much more of a self-preservation act," she says.
Steven Levenkron wrote the book(s) on cutting -- literally. Levenkron took a fictional look at the behavior in The Luckiest Girl in the World and examined it further in Cutting: Understanding and Overcoming Self-Mutilation. The USA network made a movie on his fiction called Secret Cutting.
"The first cut is a result of a large insult or catastrophe, and the second cut takes less provocation. The third cut takes even less, and the next thing you know you are cutting because you anticipate having a bad day, and after that they cut because they are at a low point in [their] mood cycle, and then finally they cut because its been too long since the last cut," Levenkron tells WebMD.
Who Cuts?
Self-harm can occur with other disorders such as depression, obsessive-compulsive disorder, addictions, and eating disorders. It usually starts around puberty and can get worse if not treated.
And "anybody could be doing it," Rosen says. "It's more girls than boys, and more people start when they are 13 or 14, and self-harm is associated with depression, low self-esteem, anxiety, and a history of trauma or abuse," Rosen says.
Women who are abused physically or verbally by their partner are 75 times more likely to harm themselves, according to a study in the Emergency Medical Journal. And men who harm themselves were more than twice as likely to report partner abuse than their non-self-harming counterparts, report researchers from Addenbrooke's Hospital in Cambridge, England.
However, they are not sure if it's the chicken or the egg. Either domestic abuse could lead to self-harm, or self-harm could be associated with personality traits that make a person more likely to choose to be or stay in an abusive relationship.
"There seems to be a high percentage of people who report physical, sexual, or emotional abuse, but that doesn't have to always be the red flag," SAFE's Conterio says. "Divorce can be a trigger, or sometimes there is an ill child in the family where the healthy child is neglected and may feel guilty, as in 'why I am I healthy? Why is my sibling sick?' So they self-harm," she says.
You can tell by "unexplained injuries or injuries such as 'my cat scratched me' or hiding of arms or legs in warmer weather. I think if a parent does suspect their child is self-harming, they should ask, 'Are you hurting yourself?" she says. If they say yes, then get some evaluation to see how serious it is, she recommends.
"Noticing a cutter in summer is easy as pie if they are wearing short sleeves -- its 'gotcha,'" says Levenkron.
Parents and peers need to recognize the signs of distress linked to cutting such as being increasingly anxious, depressed, unable to handle feelings or emotions, and panicky.
"We try to help people understand why they do this and develop strategies to manage the anxiety, [and] there is some sense that medication can be helpful," Rosen says.
Cutting is often associated with other psychiatric illness, so addressing other disorders can help stop the self-harm, he says.
SAFE offers a 30-day inpatient program for adolescents, and for adults there is an inpatient/outpatient program.
With a combination of medications and therapy, Levenkron says that 90% of self-mutilators in his practice give up the self-harming behaviors within one year of treatment. This is followed by much longer period of time in therapy to heal the underlying causes of these behaviors.
For more information, call SAFE at (800) DONT CUT or visit www.selfinjury.com.