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There’s help for those who hurt themselves

Nonsuicidal self-injury is misunderstood, becoming more common among the young

Teesha McClam

ENLARGE PHOTO

Teesha McClam

ENLARGE PHOTO

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By Cornelius Frolik, Staff Writer 4:37 PM Friday, April 15, 2011

Nearly all of the knife wounds have healed and her bruises are gone, but Monica Arcaro is still recovering from her struggle with intentional self-injury, a compulsive behavior that experts say between 14 percent and 24 percent of youths try at some point in their lives.

Arcaro, 21, a University of Dayton student, said she began cutting herself with a steak knife 10 years ago, when she was in the sixth grade, after classmates incessantly taunted her for being overweight and sent her messages online urging her to harm herself.

Like millions of young people across the country, mostly girls, Arcaro said she deliberately injured herself to relieve powerful emotions and anxiety. Slitting open her skin, she said, brought pain but also a sense of control and emotional release.

After years of private struggles and hidden scars, Arcaro said she is finally learning how to overcome those harmful impulses and relies now on exercise, friendship and more healthy support systems to alleviate emotional distress.

But she said it is sad that many other young people continue to suffer in private and turn to razor blades, pencil erasers and lighters to quell strong and painful feelings. Psychologists said nonsuicidal self-injury is a commonly misunderstood behavior that appears to be gaining popularity.

“I am growing up, and so I am really understanding there are other ways to take my frustrations out, not on myself but in a positive way,” Arcaro said.

Wounds for the wounded

Cutting, burning and other forms of self-injury is mainly the result of people struggling to cope with overwhelming inner turmoil, said Julie Stucke, a child psychologist with the Children’s Medical Center of Dayton.

“It’s a poor coping strategy for dealing with very difficult emotions,” Stucke said. “Most of the kids and teens will tell me they kind of experience an emotional release when they cut.”

Many children and teenagers who injure themselves suffer from depression, anxiety, borderline personality disorder or are having a difficult time dealing with loss and loneliness. Self-injury can result from the same kinds of impulses that lead people to abuse drugs and alcohol.

Stucke said some research suggests cutting and burning can be addictive because it relieves emotional pressure and triggers endorphins in the brain that produce similar effects to drugs. One common misperception is that people who intentionally injure themselves are suicidal.

Experts said self-injury has apparently grown in popularity in recent years and has even encroached into popular culture.

Actresses such as Angelina Jolie and Megan Fox have publicly admitted to cutting. Some emo bands reference the activity in their songs.

A study published February in the journal Pediatrics found that 100 YouTube videos showing teens deliberately cutting and wounding themselves had been viewed more than 2 million times. It suggests many youths are fascinated and curious about the activity.

A combination of factors, including the cultural contagion effect, have contributed to the appeal of self-mutilation among youths, said Janis Whitlock, the director of the Cornell Research Program on Self-Injurious Behavior in Adolescence and Young Adults in Ithaca, N.Y.

The increasing acceptance of body modification, where the body is seen as a canvas for emotional self-expression, makes self-injury much more socially acceptable, she said. Also, self-injury offers an instant cure to painful feelings, which always appeals to unhappy youths with proclivities for instant gratification.

Whitlock said young people these days grow up in very complex, stressful and fast-paced environments, and self-injury provides a method to “down-regulate” the physiological, emotional and cognitive arousal.

Young people who feel bad often scramble to find something quick to fix their feelings rather than work through them and let them pass, Whitlock said.

The numbers vary by population, but generally between 50 percent and 70 percent of self-injurers are female, she said.

Local research with big implications

The psychiatry department at the Boonshoft School of Medicine at Wright State University just finished a multi-year study of the brain activity of women diagnosed with borderline personality disorder and who cut themselves.

Functional Magnetic Resonance Imaging scans showed that women who cut themselves had more activity in the amygdala than the control group of depressed patients, said Jerald Kay, professor and chairman of the school’s psychiatry department. The amygdala is part of the limbic system that helps regulate and color emotions.

The scans found also less activity in the prefrontal cortex of cutters, which is the part of the brain in charge of “executive functions” and higher decision-making, Kay said.

“Basically, the engine runs hot and the brakes don’t work,” he said. The connections between the amygdala and prefrontal cortex are not as strong or effective.

Kay said they will soon submit the study to a scientific journal and expect its publication within the next year. He said it is important because it shows that the brains of people who deliberately injure themselves tend to operate differently.

“It reaffirms that we are dealing with emotional dysregulation and impulsivity,” Kay said. “I think if we can understand how the mind and brain work together, it will provide us with some better ways of treating this behavior and maybe some ways of preventing it.”

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