Psychology

Self-harm is also commonly referred to as self-abuse, self-injury or self- mutilation and is defined as the purposeful, deliberate and conscious harming of ones body with no intention to commit suicide. Other terms which are normally used to describe this behavior comprise self wounding, deliberate self-injury, superficial self-mutilation and parasuicide (Klonky, 2009). The most common types of self-harm include hitting, burning, skin-cutting, self-banging and scratching. The syndrome is normally found among individuals diagnosed with anxiety, eating disorders, substance abuse, psychotic disorders and borderline personality disorder. Self-harming behavior has been found to be rare among males and is frequently confused with difficulties in overcoming aggression. In reality, this behavior is an individual effort to manage feelings of anger, frustration and depression. Injurious behaviors, such as breaking windows or punching walls of a building are some of the indications of self-harm (Klonky, 2009). The purpose of this research paper is to explore the causes, symptoms, clinical issues and recommended treatment approaches for self-cutting among the teens.

Self-cutting behavior is a type of deliberate self mutilation devoid of suicide intentions. Teens usually use sharp objects like knives, needles, sharp stones, razors, broken glasses and needles to break their skins (Jacobs, 2005). However, in absence of all these items, they use other objects, such as pencil erasers for the same purpose. The body sites commonly injured by cutting include ankles, arms, lower legs and wrist. Other hidden sites may perhaps include the feet, abdomen, breasts, inner thighs and genitals. Cutting marks are normally kept as a secret by these teens and thus the behavior can go on for a long time with no interference. Besides, it ought to be noted that self-cutting is not a novel phenomenon, though it seems to be intensifying. Whist both females and males, and both youth and adults, purposely cut themselves, this behavior is most common among teens, especially adolescent girls. In all forms of self-injurious behavior, cutting is the most prevalent method and is frequently carried out repeatedly (Jacobs, 2005).

While there is inadequate research finding about the prevalence of parasuicide or self-mutilation among teens in the generic population, one research (Ross and Health in Jacob, 2005) involving four hundred and forty students from high schools found that approximately fourteen percent or 14 in every 100 students reported taking part in self-injurious behavior. The study further found that approximately twelve percent of these students started self-injurious behaviors during grade nine. 59 percent started during grade seven or grade eight, approximately 25 percent during sixth grade or earlier and about five percent did not remember when they commenced injurious behaviors. Additionally, 64 percent of girls and 36 percent boys reported to engage in self-harming behavior. Still in this study, 16 of the students reported utilizing various methods of self-mutilation, though cutting was established as the most prevalent method to self-injury (Ross and Health in Jacob, 2005).

Causes
While previous studies into the incidence of deliberate self-injury documented self-cutting among teens who were rigorously depressed, incarcerated, schizophrenic, or chemically reliant, the increased occurrence of self-cutting is among teens with no such factors. Cutting is primarily carried out by teens as one way of coping with stressful or painful emotions. According to research done by Ross and Health (2002), high school students who self-injured encompassed higher measures of depression and mental anxiety than their counterparts who never self-mutilate. Several students who self-injured described their sentiments prior to and during self injurious behavior with words, such as alone, lonely and sad. Thus, an individual who cuts himself or herself does this in an attempt to escape from intolerable emotional as well as psychological situation that he or she can never withstand. For teens, self-cutting offers a short lived relief from agitation and mental anxiety, or offers inspiration out of downer situations, such as emotional numbness, apathy, depression and hopelessness toward life (Jacobs, 2005).

Though the emotional, anxious and depressive mental states cannot be controlled, self-cutting still offers an instant but detrimental controlling means, as it allows a short lived escape from the reality of depressive thoughts, feelings and anxiety. Self-cutting has been identified to produce overwhelming relief from painful emotions among teens. A number of researchers have theorized that an individual who cuts may as well have a persistent desire to experience his or her body feel better due to the endorphins chemical released following cutting that provides high natural feeling. Whereas self-cutting is usually done due to earlier discussed reasons, teens as well cut themselves due to contagion factor, that is, by hearing and seeing peers, including friends cut themselves. Just as alcohol and drug use plus sexual behavior are influenced by peer pressure, so it is with self-cutting (Jacobs, 2005). Therefore, its clear that self-injurious behavior emanates from inability of teens to withstand deep psychological pains. For examples teenagers may perhaps have difficult time understanding, expressing or regulating their emotions. They opt for self-cutting behaviors in order to express their inner despair or distress and also to punish themselves for alleged faults.

Figure 1  Self-injury precursors
Source httpwww.selfharm.orgwhatprecursors.html
Signs, Symptoms and Behaviors Associated with Self-Cutting
Self-injurious or cutting behavior can be hard to identify, as those engaging in such behavior are aware of its abnormality. The detection is frequently accompanied by a sturdy feeling of shame, and thus those engaging in cutting behavior try to hide evidence. The physical signs and symptoms of self-cutting include scars and bruises on torso, legs, hands and arms. However, other hidden body sites, such as inner thighs, breasts, abdomen and genitals may be targeted by the self-injurers, thereby becoming difficult to detect. Whats more, most cases of self-cutting are repetitive and frequently lead to multiple bruises and scars to the self-injurers (Slekman, 2010). Therefore, the following are among the physical signs and symptoms of self-cutting
Bruising marks
Freshly made cuts
Multiple scars
Scabs and wound which are always reopened (Slekman, 2010)

Self-cutting is a mental associated disorder, and numerous signs and symptoms are behavioral or emotional in nature. Teens who commit self-cutting always have disorders of low self-esteem or additional diagnosed psychological illness. Several self-mutilators or cutters often have problems with relationships. Moreover, they have a tendency of withdrawing from their friends and parents and always portray isolation behaviors (Slekman, 2010). To hide signs or effects emanating from physical self-harm, teens who engage in self-injurious behavior may as well wear long pants and long sleeved clothes regardless of the warm climate. They may be unwilling to put on T-shirts, shorts or any other clothes that would expose their limbs. Other behavioral characteristic with self-injurers is that they are always in possession of items, such as sharp scissors, razors and small knives that are able to cause self-cut. The sheer presence of these sharp objects does not convincingly prove that an individual is actual a self-cutter, but is too evocative when observed in amalgamation with other discussed symptoms of self-cutting behavior (Slekman, 2010).

Course of the Self-Cutting Behavior
The course of self-cutting behavior in teens is dependent on the relentlessness and presence of other psychotic disorders as well as history of suicide attempt or sexual abuse (Ladd, 1997). Generally, teens devoid of other emotional disorders and history of any abuse usually have an excellent prognosis. Individuals diagnosed with the past record of attempted suicide and borderline personality disorders are considered to encompass worst prognosis. For instance in a study conducted on 2000 military recruit, with sixty percent males, approximately four percent reported having a history of self-mutilation. That four percent scored higher on psychological disorders, such as borderline, anxiety, schizotypal and intense emotions. Therefore, to fully understand the course of self-cutting behavior in teens or general population, it is imperative to appreciate comorbid disorders that may be precipitating factors, comprising dissociative disorder, bipolar disorder, borderline personality disorder and deficit disorder (Ladd, 1997).

Also, a study carried out by Paul et al (2002), indicated that teens with eating disorders, such as bulimia, anorexia and binge have the worst course of self-cutting plus other self harming behaviors. Out of 376 patients diagnosed as having self-cutting behaviors, 34.3 percent were found to have bulimia and approximately 35.5 were found to have other unspecified eating behavior. The study confirmed earlier findings which suggested that teens with eating disorders, especially bulimia have a worst prognosis of self-injurious behavior, including cutting, scratching and hitting. The study as well sturdily confirmed that sexual abuse to teens during childhood posed a poor course or prognosis to self-injuring behavior. 17.8 percent of the total 376 patients subjected to this study reported cases of sexual abuse prior to the age of thirteen years, while 20.7 percent of the total patients were sexually abused after the age of thirteen years (Paul et al., 2002). Thus, the empirical evidence shows that psychological disorders, such as personality disorders, eating disorders and sexual abuse play a major role in the course of self-cutting behavior, and self mutilation in general.

Two more essential factors toward the course and psychopathology of self-cutting behavior in teens are aggression and impulsivity. Rao et al (2008) found that greater aggression amalgamated with indigent impulse control cause poor prognosis. Impulsivity was found to be prominent in behaviors, such as oversleeping, overspending, promiscuity, overeating and gambling and thus rarely influence the course of self-cutting among teens. Based on these findings the course of self-injurious behavior falls in the aggression factor together with pyromania, pathological gambling, intermittent explosive illness and trichotillomania.

Course of Treatment
Treatment of self-cutting behavior in teens is tailored toward definite issues as well as associated mental health disorder, such as anxiety or depression. Treatment alternatives for self-cutting behavior include medication, psychiatric hospitalization and psychotherapy (Mayo Clinic Staff, 2008). There is no medication that is purposely known to treat self-injurious behavior, such as cutting in teens, hitting or burning. However, a physician may suggest antidepressant treatments together with psychiatric medications, which may assist to lessen anxiety, borderline personality disorder, depression and other psychotic disorders commonly linked with self-injurious behavior. Kerr et al (2010) reported a triumphant treatment of seven women (self-injurers) using oral naltrexone. These patients received 50milligrams of naltrexone that was administered daily. Abstinence from self-mutilation was noted in six out of seven patients for a period of over ten weeks. However, 2 of the patients resumed self-injurious behavior when naltrexone medication was briefly terminated and again abstained from these injurious behaviors on commencement of naltrexone therapy (Kerr et al., 2010).

Besides, teens who injure themselves repetitively or severely are usually recommended for psychiatric hospitalization by the physician. This offers an enhanced environment and extra intensive treatment until they get out of crisis (Mayo Clinic Staff, 2008).

Psychotherapy as well referred to as counseling or talk therapy can assist the counselor to detect and address the underlying issue, which exacerbate self-cutting behavior among the teens. Therapy may as well assist self-cutter to learn better ways to regulate emotions, tolerate stress, enhance relationship with others and boost self image. Various psychotherapy types may be essential, including cognitive behavioral therapy, dialectic behavior therapy, and psychodynamic psychotherapies. Cognitive behavioral therapy was developed as a cost friendly, brief intervention or treatment for self-injurious behavior in teens and the general population. It combines two to six treatment sessions of person cognitive behavioral plus solution based psychotherapy with individual directed bibliotherapy.

However, in a study carried out by Kerr et al (2010) cognitive behavioral therapy was found to be less significant in attenuation of self-injurious behavior. In a six month assessment on 480 outpatients with cognitive behavioral therapy reveal no noteworthy changes in self-injurious behavior. Thus, this finding indicated that cognitive behavioral therapy is not the best recommendation for self-cutting treatment.

Conversely, when the same participants were subjected to dialectic behavior therapy for a minimum period of one year their episodes of self-mutilation lessened substantially. Additionally, during one year follow up course, patients subjected to dialectic behavior therapy showed no signs of resuming self-deleterious behavior within the first six months than were the cognitive behavioral therapy patients. Thus, dialectic behavior therapy was found to be very efficient at lessening self-injurious behavior and can be recommended for treatment of self-cutting behavior in teens (Kerr et al., 2010).

Similarly, in a study conducted to evaluate the efficiency of psychotherapy with self-injurious patients revealed that patients who received 4 sessions psychodynamic therapy offered by a therapist were less expected to depict self-injurious behaviors. Out of 58 patients participated in the study only five reported self-mutilation during the follow up course. This therefore confirmed that psychodynamic therapy could be recommended as an intervention for a number of self-injurious behaviors, self-cutting in teens included (Kerr et al., 2010).