Self Mutilation requires different interpretations depending upon culture and value system. Suggestions are offered as to symptoms and ways of coping upon discovery.
Self-Mutilation is the voluntary act of inflicting injury upon the self. Usually, teenagers who self-mutilate cut, bruise and provoke scabbing of the skin on their arms or legs. However, as the illness progresses, the injuries can spread to other more private areas of the body.
Tattooing and body piercing have become more respected methods for expressing one's inner thoughts and feelings. Their popularity among varying socio-economic and cultural boundaries has rendered diagnosing a possible borderline illness more difficult for professionals and family members. For instance, discerning the difference between what is a rebellious form of expression as opposed to a serious indication of an illness is more problematic and less concrete in definition.
This article hopes to demonstrate symptoms that would target a cry for help as well as signs that would demonstrate simple creative expression. Also, the author hopes to illustrate ways to handle a discovery so that further communication between adolescent and parent occurs. Moreover, guidelines for seeking further help are listed.
Adolescents who are self-mutilating as a means for calling attention to a psychological issue tend to injure themselves in areas not easily seen by others. In fact, they may go to great lengths to hide what it is they are doing and almost invariably injure themselves in private.
Adolescents who are injuring themselves in private tend to do so for two reasons. Some adolescents report feeling such pain and grief that the self-mutilation is a method for feeling something other than the despair that they cannot seem to shake. In essence, they are searching for a force greater than the internal one that is plaguing them. Their feelings indicate a chronic, moderate depression. Aleviating the internal depression can go a long way to encourage the cessation of self-injury.
The other group of self-injurers have a much different issue. These adolescents report feeling 'empty' most of the time. They demonstrate a lack of identity. Some are not even certain of their gender orientation. Frequently, they try different looks but once a group of adolescents embraces them into their clique, they alter the 'look' for fear of being 'labled.' Their self-injury is a venue for which they search for proof of being alive. The adage, "I had to pinch myself to make certain I wasn't dreaming' suits this group. Their issues speak of a possible borderline illness which is a personality disorder in which the adolescent is unsure of bounderies that separate themselves from others.
Both reasons for self-injury encourage compulsive use of the self-mutilation. Adolescents who self-mutilate report feeling bereft if unable to self-injure. Over time, they recognize that others are suspicious of their 'accidents.' At this point, many wear long sleeves and long pants to hide their injuries. Moreover, they report needing to find new areas of unscarred territory in which to self-mutilate. Ironically, they also report self-loathing for what it is they have done to their bodies. Their self-loathing encourages further isolation which encourages further self-injury. Caught up in a vicious cycle many report eventual feelings of suicidal longing.
Often parents who discover the scars or scabs of a self-injurer tend to forbid the child from doing it again or threaten grounding. Neither of these methods work, and instead, facilitate greater secrecy and deception upon the part of the adolescent. If a discovery is made, the parent, teacher or counselor should ask the child to identify the reasons for the injuries. The depth and placement of the injuries can also indicate the seriousness of acting quickly. For instance, some adolescents injure in a surface-like way; others demonstrate a strong urgency to broach suicide. If a parent, teacher or counselor sees injuries close to the inside of the wrist or the sides of the neck, this is cause for quick action to the nearest emergency room.
It is most important for a parent, teacher or counselor who discovers a self-injurer to convey a sense of calm upon the discovery. This may sound ironic; however, it is important if further communication can ensue. Adolescents who self-mutilate already possess a wealth of intense feelings. If they see in your eyes the panic reflected back to them, they will most likely shut down and not elucidate. Instead, convey concern and a need for outside help.
Explain that their behavior has a name which indicates that there are others who share in the strangeness of the behavior. Tell them that you would like to help them find a referral to a counselor or psychologist who could evaluate them for depression or help them identify how to overcome their fears.
Referral to a counselor or psychologist is necessary in these cases, as the adolescents have been enured to the dangers of what self-injury does. They need strategies for weaning themselves from the behaviors, increased social support to discourage isolation and possible pharmaceutical intervention to alleviate the throes of depression. The road to recovery is difficult but rewarding for these adolescents. Many do not appreciate the depth of perspective that they have and need guidance for expressing their feelings in a constructive way. Moreover, many of the adolescents have difficulty confronting wounds and issues.
Therefore, a referral should be made to someone who holds a license in counseling or psychology and who has an expertise in self-mutilating behavior. Assess carefully the background of the professional and encourage the adolescent to identify whether or not he/she feels he/she could reveal inner most thoughts and feelings. However, it should also be indicated to the adolescent that whomever is chosen as a therapist will be selected for the long haul. Often, adolescents with these issues desire to break off the therapy at a point when much is uncovering. Let it be known that they have a choice in who the therapist is, but that they must commit to accessing help.
Finally, remember that not all injuries that are self-inflicted are indicative of an illness. Those that are easily shared with peers and parents, those that are sanctioned by a peer group or society and those that do not occur in a compulsive way are ones that parents and others can warn of hygienic and infection concerns. However, injuries that are isolatory, compulsive, and a means for expressing pain or emptiness warrant careful referral to an outside source. Remember that the behaviors of self-mutilation are not who the adolescent is but a mere avenue for expression. Reaching out in a non-shaming way is the path that stretches out to recovery.
