Nov. 21, 2002 -- For desperate teenagers overwhelmed with emotions that they cannot express, deliberate self-injury is becoming an increasingly popular and dangerous form of self-expression.
A British study of nearly 6,000 students shows that over their lifetime, 13% of 15- and 16-year-olds have carried out an act of deliberate self-harm. Within the past year, an act of deliberate self-harm occurred in about 400 of the students. Only 50 students went to the hospital, which suggests that the problem may be even more widespread. American experts say those numbers aren't surprising, but until now there has been relatively little research on the issue.
The study, which appears in the Nov. 23 issue of the British Medical Journal, was based on a survey conducted in England from fall 2000 to spring 2001.
Wendy Lader, PhD, co-author of the book Bodily Harm, says an estimated 1% of the U.S. population as a whole resorts to physical self-injury to cope with extreme emotional distress, but that rate is much higher among adolescents and females.
Lader says the phenomenon of self-harm has been around forever, but not at the level it is now. She says that not only are people talking about it more but it's also becoming more common as teens search for a new way to rebel and express themselves.
"It's harder for kids to get noticed as individuals, and they don't have the words for it," says Lader, who is also clinical director of the SAFE (Self-Abuse Finally Ends) Alternatives program at Linden Oaks at Edward Hospital in Naperville, Ill. "So they show it -- even if it's just to themselves because it makes it real for them. It's almost like their body becomes a bulletin board on which to notch their pain."
For some, hurting themselves is a form of suicidal behavior. In fact, nearly half of the students surveyed who engaged in the behavior said they had wanted to die. But for others, Lader says self-injury is a survival method.
"It's a coping strategy to deal with intolerable pain, but it works for them so it's a way of surviving," says Lader. But she says there is always the risk that once the method stops working for them, they could commit suicide -- either accidentally or purposefully.
Researchers say girls seem to be especially prone to self-injurious behavior, and the study found acts of self-harm were four times more common among girls than boys.
Lader says that when girls have a strong emotional response, they tend to act inward rather than outward because it's not "feminine" to be that angry.
"Girls will act on themselves and tend to say that they would rather hurt themselves than anyone else -- not realizing that no one needs to get hurt," says Lader. Coupled with the fact that girls tend to be very body conscious and more dissatisfied with their bodies, she says it's not a stretch for some girls to take their anger out on their body.
David Fassler, MD, a child and adolescent psychiatrist in private practice in Burlington, Vt., says the study's findings are important because they show that there is a significant number of adolescents both in this country and elsewhere in world who have either suicidal or other self-destructive thoughts, plans, and impulses who actually engage in these acts.
"These are kids that are calling out for help, and we need to do a better job at recognizing the warning signs and getting these kids the help that they need," says Fassler, who is also a spokesman for the American Academy of Child and Adolescent Psychiatry.
Warning signs of self-injurious behavior may include the following:
- A history of emotional problems, abuse, or exposure to violence (even if the child was not physically abused)
- Drug or alcohol abuse
- Impulsive behavior
- Low self-esteem
Fassler says emotional events such as a breakup with a girlfriend or boyfriend or being kicked out of class or a sports team may also act as a trigger for this type of activity. He says many of the adolescents that resort to harming themselves suffer from undiagnosed depression or other mental disorders that require evaluation and treatment by a trained professional.
As the study authors conclude, "In many cases, self harming behaviour represents a transient period of distress; in others it is an important indicator of mental health problems and risk of suicide.
"Our findings support the need for development and evaluation of school based programmes for the promotion of mental health," write study author Keith Hawton, professor of psychiatry at the Centre for Suicide Research at Warneford Hospital in Oxford, England, and colleagues.