While training to become a psychologist, I decided to specialize in treatments for self-injury and suicidality. Although I liked working with adolescents, there wasn't a lot of research on treatments for adolescents with these problems. Again, self-injury in adolescence seemed to be a relatively small and contained mental health issue. I nonetheless became intensively trained in working with this population, but always presumed these clients would make up only a small portion of my practice.
Then something happened. I'm not sure exactly why or when, but over time I began getting more and more calls from parents with adolescents who were intentionally harming themselves. Rather than dodging my questions or denying it, the teens I was seeing were often quite cavalier about their self-harm. More and more of the teens I was treating had friends who also cut. Some wore their scars proudly, almost like badges of achievement.
Things have indeed changed since I was in high school. A World Health Organization (WHO) survey in England reported a three-fold increase over the last decade in the number of adolescents (ages 11, 13, and 15) who have self-harmed. One in five 15 year olds reported having self-harmed in the last year alone. In the United States, recent community studies found that one-third to one-half of adolescents have engaged in some form of self-harm (Yates, Tracy, and Luther, 2008).
At this point, we are probably all asking the same question: what's going on?!
Self-harm has always been more common in individuals struggling with developmental disorders, eating disorders, and/or borderline personality disorder. However, recent research suggests that many of today's self-injurers do not meet criteria for any of the aforementioned disorders (Peterson, Freedenthal, Sheldon, and Anderson, 2008). As such, current research on self-injury highlights the importance of understanding the function this behavior serves.
So what function does it serve? Specifically, what function is it serving now that it wasn't serving before or how has the function changed over time?
There is a fair amount of data to suggest that self-injury is often used to affect mood or manage upsetting thoughts (Klonsky, 2007). Self-harm has also been shown to decrease physiological arousal, most notably, heart rate (Novak, 2003). In addition, research suggests that self-injury may increase feelings of excitement and control, while decreasing emotions such as numbness or emptiness (Gratz, 2003).
None of these reasons account for the increased rates of self-injury we are seeing today. In other words, self-injury didn't all of a sudden become a potent means of temporarily decreasing distress or managing negative thoughts, it's always potentially served those functions. So what's changed?
I suspect there are a couple of factors at play here.
First, self-injury seems to be more culturally accepted now relative to past generations. As such, the attention one receives for self-injury could inadvertently reinforce or increase this behavior. That is not to say that self-injury is a cry for attention or that self-injury always serves a social function. Nor does it mean that because someone gets attention for self-injury then that's why they do it. This simply means that the culture surrounding this issue has changed in ways that could theoretically reinforce, and therefore increase, the behavior.
Second, because self-injury is more prevalent, adolescents are more likely to be exposed to it and are thus more likely to experiment with it. Intentionally hurting one's self may not seem like an obvious way to manage stress. It's not something one might even think to try. If, however, you have several friends who cut, this seemingly foreign coping mechanism might be more likely to come to mind, especially if you are trying to manage overwhelming emotions.
Finally, and I don't have much science to support this, but as a confidant to many adolescents I can attest to the fact that being a teenager today is unbelievably difficult! Between cyber bullying, unrealistic academic expectations, and the maturity that comes with growing up alongside the internet, it's amazing today's kids can see straight. In light of all they are up against, it's perhaps not so surprising that many of them are struggling to effectively cope or manage their emotions.
I intend to follow this post up with some thoughts on what parents, teachers, and friends can do if they know, or think they know, someone who is self-injurious. Please thus feel free to leave any specific questions or points below so that I can address them in the follow-up post. In the interim, please consider responding with compassion, validation, and sensitivity to anyone who shares these problems with you or about whom you are concerned.