Why do some people hurt themselves on purpose?

What is self-injury, where does the behavior come from, and how common is it? In this episode, Cristen and Caroline examine different forms of self-injury, intervention and treatment.

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Episode Transcript

Speaker 1 (00:00):
Brought to you by the reinvented two thousand twelve camera.
It's ready. Are you welcome to Stuff Mom Never told you?
From how Stuff Works dot Com. Hello, and welcome to
the podcast. I'm Kristen and I'm Caroline, and today we

(00:21):
are talking about a very sensitive topic. UM. We've gotten
some request from listeners to cover this before, and I
also wanted to offer a trigger warning just to the
top of the podcast because it is a sensitive topic.
If we're not going to get graphic or gruesome, but
we are going to be talking about non suicidal self

(00:44):
injurious behavior and that's often better known as cutting or
self injury, self harm, self mutilation, paras suicide. So it
is one of the tougher topics to cover, but it's
something that isn't talked about that much, but it is
happening a lot, especially among adolescent populations. So we definitely

(01:07):
felt like it was worth, um, maybe having a potentially
uncomfortable conversation about a very real issue. Yeah. I was
really taken by the fact as Kristen and I were
doing research for this episode. I mean, every almost every
study you come across about this is dealing with the
age factor. Um, that it is so common among young people,

(01:29):
especially young people who are just hitting puberty, but it
does have the very real potential to carry over into
young adulthood and then adulthood. Yeah. And there are also
questions out there of whether or not UM self injury
and self mutilation is becoming more prevalent among younger populations,
which we will get to as well. But first off, UH,

(01:53):
let's just go ahead and offer a definition of what
we were talking about. This is coming from the Virginia
commiss Sin on Youth and they define non suicidal self
injurious behavior as deliberate indirect destruction or alteration of body
tissue without conscious suicidal intent, but resulting an injury severe
enough for tissue damage to occur. And that is an

(02:17):
important delineation to make. These are not suicide attempts. A
lot of times it's the opposite of a suicide attempt.
You're hurting yourself to feel better. Um. And the types
of behavior is involved um and this is coming from
the Mayo Clinic, might include severe scratching, cutting, burning, uh,
intentionally poisoning yourself, carving words or symbols onto your skin,

(02:38):
breaking bones, hitting yourself, punching, yourself, piercing the skin with
sharp objects, headbanging, biting, pulling out your hair, UM, interfering
with wound healing UM. Also one thing that is not
considered self harm behavior tattooing. UM. Yeah, things like piercing
and tattooing are not necessarily UH self harm behaviors unless

(02:59):
you are doing them for the sake of the pain
that comes with them UM. And the Mayo Clinic also
points out that it's this is typically a way to
cope with emotional pain. Kristen pointed out that a lot
of people are doing it to feel better in a way,
it just happens that it's a definite unhealthy way to
cope with any intense anger or frustration you're feeling. It's,

(03:21):
as one site pointed out, an external way to express
internal feelings. So who is practicing this? Who is intentionally
engaging in this kind of self harm? Um? The Virginia
Commission on Youth again UM says that n s I B,
which is the self injury behavior, occurs without regard for age, gender, ethnicity,

(03:45):
or socio economic status. But as we have mentioned already,
h younger populations are especially at risk, and especially younger girls.
Some of the risk factors, A lot of it has
to do with age. Most of those who self injure
our teams. Other risk factors are life issues or substance abuse.

(04:07):
So if you have this this toxic combination of a
of a troubled teen who's dealing with life issues, maybe
this team was abused or neglected, maybe they are self
injuring under the influence. That is someone that would definitely
need professional help, right. UM, So, just to put some
numbers around this. According to a November two thousand eleven

(04:29):
study published in The Lancet and this was reported on
by ABC News one in twelve teens engages in self
harm or self mutilation. UM and community samples have found
a range of prevalence rates. It can be hard to
uh to sort of extrapolate one community sample across the
entire population, but it branches between four and its high

(04:52):
at thirty eight per cent. And that's coming from the
Cornell Research Program on Self Injurious Behavior, which was something
that will be aiding often throughout this podcast. UM and
even further studies among high school populations in the US
and Canada specifically will typically find the range between thirteen,
which is a very large population to and it does. Yeah,

(05:17):
it does depend on age, UH, and it also depends
on self reporting, because if people aren't coming forward with
their injuries or their mental and emotional issues, how are
you supposed to find these kids. There were some studies
that were done at schools, so that's a more general
broad population to sample from. Um. Dr Moran, who who

(05:38):
did the study, said that the window of vulnerability for
this experience of self harm appears to open at around puberty.
And the writer of the article calls it a perfect
storm of surging hormones, immature brains, and unfamiliar emotions. So
these are kids who are having a lot of trouble
dealing with their own emotions and expressing them to people
around them. Yeah, the the window that this usually will

(06:02):
start as between twelve and fifteen years old, but an
early onset around the age of seven is not that
uncommon either. And we talked about girls being at higher
risk of this as well. UM That study from the
Lancet again UH followed kids for fifteen years, starting at
ages fourteen and fifteen, and in every stage when the

(06:22):
researchers would go back and check in, more girls reported
self harm than boys and then again, uh. In juneteen
thousand eleven, there was a study published the Journal Pediatrics
which found that ninth grade girls in that fourteen fifteen
year old range, ninth grade girls were three times more
likely to be engaging in self harm compared to ninth

(06:42):
grade boys. And to get a picture, that Lancet study
describes that teens at particular risk are quote on a
fast track to adulthood, those kids who are at the
margins of school, who are engaged in early sexual activities,
who are using alcohol and drugs at a young age,
and they're also familial risk factors involved. And researchers are

(07:04):
wondering whether there is a genetic component to this, because
they found that relatives of individuals who have engaged in
self mutilation are three times more likely to engage in
the same behavior, and so they're wondering if there's something
in the genes prompting this impulsive, depressive behavior. Um And
it's also been linked to things like family violence, family

(07:28):
alcohol abuse, childhood separation and loss, physical abuse, and childhood
sexual abuse. Right, yeah, there's a link. This is a
two thousand eight Journal of Consulting Clinical Psychology study that
pointed out a link between childhood sexual abuse and self harm,
but a two thousand eight analysis in the British Journal
of Psychology found the link between the two to be

(07:49):
pretty weak and could have more to do with the
two being correlated with the same psychiatric risk factors. Right,
we're broadly it's UM, like you've touched on before, UH,
issues with not being able to to process and express
emotions UM. For instance, there is a very strong correlation

(08:11):
with borderline personality disorder, and a lot of times the
therapy that's involved UM with self harm is teaching UM
people how to how to deal in a healthy way
with negative and depressive emotions. Right. And you know, Kristen
touched on that genetic link, and it isn't proven. It

(08:32):
is something that they are looking into because of just
the way these conditions develop. UM patients diagnosed with borderline
personality disorder often grow up in environments where emotional expression
goes unrecognized or is punished. So, like I said earlier,
you know kids who are having trouble expressing their emotions
and dealing with them. And this two thousand ten UH

(08:54):
studying the Journal of Nervous and Mental Disease points out
that invalidating childhood environment put youth at risk for non
suicidal self injurious behavior. So these things are definitely overlapping.
Whether there's a definite genetic link, we're not sure yet. Yeah,
there might be. Probably is an interaction between the nature
and nurture there because it's often accompanied with anxiety disorders,

(09:18):
depression oppositional defiant disorder UM. And then when when it
comes down to the actual self harm behaviors, while UM
girls are more likely to engage in it, the specific
behaviors UM are different a lot of times between boys
and girls, which might be one of the reasons why UH.
The statistics indicate that that girls it might actually be

(09:40):
artificially inflated in a way UM because according to the
Journal Pediatrics that June two eleven study that I referenced earlier,
UM girls are more likely to report cutting and carving behavior,
whereas boys reported hitting themselves more often and UM. Because
of that, it might not be UM as a parent

(10:01):
that self harm is going on. And not only is
the behavior itself different, but the motives are different. Two
thousand five study in Psychiatric Times found that females who
self harm are more likely than males to explain it
by saying that they wanted to punish themselves. They're also
more likely to say that they were trying to get
relief from a terrible state of mind. And so they

(10:22):
point out the depression and anxiety are much more noticeably
associated with girls, whereas males have typically received far less
attention for this. Yeah and um, when it comes to
how this behavior starts, um, you know, we've we've ticked
off all of these risk factors, but sometimes it's also
something that seems to a behavior that happens without almost

(10:47):
without someone even meaning to um over. At Exo Jane
blogger S. E. Smith talks about her experience as um
a cutter and as she's I should say, used to
be a cutter. Um. She said, I started cutting largely
by accident. I have trouble remembering what the catalyst was,
but there was a moment when I realized that there

(11:09):
was something, one thing in my life that I could control.
I could creep off into the corners and darkness and
master something in my environment. It started quietly, and it
got bigger and bigger over time, as these things often do.
And that is such a good point that she makes,
UM because according to research out of Cornell University. Among

(11:30):
respondents in a Too College study, one in five students
who had engaged in self harm indicated that they had
hurt themselves more than they intended to. It's like, once
it starts, it becomes an addictive cycle. And we should
point out that not all of these experiences do become addictive. Um,

(11:52):
if you have borderline personality disorder, a lot of times
it will continue to get worse and or carry over
her as you get older. But according to psychiatrist Nile,
boys of these self injury cases do resolve on their
own as the boys and girls get older. Yeah, and
a lot of times that that window is within about

(12:13):
five years. And I'm also referencing that Lancet study. Uh,
they noticed that the proportion of the participants who reported
self injury declined with age. But at the same time,
obviously we can't brush this off and say, well, yeah,
just just let it go. This will resolve on its own. Um.
For instance, this is also the third most common form

(12:36):
of adolescent suicide, and behaviors may crop up again even
if it goes away for a while. That's one thing
that se Smith over at Exo Jane talks about. She
says that you know, she has not cut herself in
a very long time, but she would be lying if
she said she never thought about it. And it's scared
that at some point it might happen again because it

(12:56):
does become such a strong coping mechanism a lot of times.
And there's also the potential danger that comes along with
UM infection and infection that could possibly lead to unintentional death.
And one other potential complication for this really is worsening
feelings of guilt or shame UM. A lot of people

(13:19):
who have reported their self injury talk about how it
is a coping mechanism there it brings relief UM, but
it's usually followed by feelings of guilt or shame, and
so there is this link to suicide. This Cornell study
that Krista mentioned earlier site studies that show people who
engage in this behavior are nine times more likely to

(13:42):
report suicide attempts and seven times more likely to report
a suicide gesture YEAH and UM. And in addition to
these concerns about the underlying roots of the behavior, such
as psychological issues or prior trauma or inability to cope
UM with emotions UM Researchers are also concerned with how

(14:07):
this behavior might be spreading as well. UM there's concerned
that it has a contagious effect among peer groups, especially
because it tends to affect UM younger groups that we
talked as, we've talked about that twelve or fifteen year
old window, and there have been UM studies examining whether

(14:27):
or not it's something that actually spreads by kids talking
about it, it being something that that they do as
almost together. I mean, obviously it's a private thing, but
as a still a form of bonding. Yeah, I mean
we've talked about and this isn't exactly the same thing,
but we've talked about on the podcast before, like if
your social group is doing something whatever, that's something is

(14:51):
it normalizes the behavior in your mind. So if a
couple of people you know at school or doing this,
it might seem more normal, you might be more willing
to experiment with it. And clinicians have also been concerned
over the rise of like self harm videos that are
on YouTube UM and also talking about it on social media.

(15:13):
It's just it's in UM there our conversation more often
than it used to be in getting that attention in
a negative way might be compelling more kids to to
do this as a cry for help. Right, But a
lot of people will point out a lot of people
who have gone through this will point out that, yes,
a lot of people say that, well, that's just a

(15:34):
cry for help. She needs therapy, she wants attention from
her parents. But there is a large portion of this
population who say, you know, I was going off into
you know, my bedroom and doing this like I didn't
want anybody to know about it. This was for me
to feel better, and so I guess you know, it's
obviously unique to to everybody, but it definitely isn't necessarily

(15:56):
a cry for help or a cry for attention. Right,
but nevertheless, us, what do you do when you, um,
you know, if you if you discover that a friend
is hurting themselves on purpose, well you shouldn't keep it
to yourself, no, no, um, that's you should try to
talk to your friend if possible, but be non judgmental

(16:16):
and non threatening about it. You know, don't get up
in anybody's face who might be in a fragile condition
and be like, you know, you really need to cut
this out. This is really bad for you. You have
to try to be sympathetic to your friend and let
them know that you're very concerned for their safety. Right,
And one thing that you could do to help them
is UM help them seek out resources, therapists, helpful adults,

(16:39):
someone who could help resolve this kind of behavior. And
they're also organizations out there such as Safe Alternatives which
stands for Self Abused Finally ends, which you can find
its Self Injury dot com UM and there there's also
the Self Injury Foundation Mental Health America, and also, as
we've referenced before, the Cornell Restart Program on self injurious Behavior,

(17:02):
which is more takes more of a clinical approach, but
it still has a lot of information for what to
do and how to cope or if you are finding
yourself doing this, uh, you know, seek out the resources.
There is a lot out there and a lot of
ways to cope. And UM. One thing we haven't talked
about much is treatment for it. There is no medication

(17:24):
that's just going to take this behavior way. Sometimes antidepressants
will be prescribed probably if there if the doctor finds
out that there is um anxiety or clinical depression going
on with that, But a lot of it revolves around psychotherapy,
right because Oftentimes there are those underlying um conditions that
people are dealing with. It might have driven them in
the first place to experimenting with this behavior. So, you know,

(17:48):
going to psychotherapy to learn healthier coping mechanisms, learn how
to communicate and express emotions, basically undo all of those
well not undo, but try to get to the root
of all of those behaviors that you started in the
first place. You know, why, why are you having trouble
expressing emotions or why do you feel like you need
this release right? And that's actually how um Se Smith,

(18:11):
the blogger that we referenced, was able to stop that behavior,
was that she finally got to a point she knew
that some people knew what was going on, and no
one ever said anything to her, and um what she
wishes that someone had, But she finally got to a
point where she had to talk to a therapist. And

(18:33):
gradually it's establishes accountability as well of setting up like
signpost in a way of saying, Okay, we don't engage
in this for a week, don't you know, almost weaning
yourself off of this behavior and learning how to channel
that all of that emotional energy into something healthier and

(18:55):
safer exactly. So I feel like in a way we've
only thrown out tons of statistics, but it is such
a complex behavior. UM. You know, I hope that we
were able to offer an overview of of what it
is and also um a word of hope out there
for people who might be dealing with us or know

(19:16):
people who are dealing with us, that there is hope
for recovery and treatments out there to help people get
better and not and not hurt themselves. So, if you
would like to write to us about um cutting, self mutilation,
self harm, uh, we would love to hear from you. Mom.

(19:38):
Stuff at Discovery dot com is where you can send
your letters. If you're looking for advice or resources, we
will do our best to point you in the right direction. UM. Again,
I recommend heading over to self injury dot com. UM.
It seems like that's a uh good go to if
you're looking for more information on this kind of behavior. Uh.

(20:02):
And in the meantime, we do have a couple of
listener letters to share and this is both in relation
to our episode on clothing donations. And this first one
comes from Karen and she works at a domestic violence
shelter and then they take in a lot of clothing donations.

(20:23):
But she talks about how a lot of times they
can't keep much of many of the clothes that are
donated because they are in such poor conditions. So she
offers a few tips for listeners who are planning on
donating items. Tip one, when collecting items to give to donate,
stop and put yourself in the recipient's position. Ask yourself
if the item would be something you would enjoy if

(20:45):
you were in their shoes. Tip to call her, email
the charity and ask them if they need the items.
You can also ask if there is a local thrift
store that they partner with where you can donate it,
and do this before you go drop off your items
so you don't lug things around. It will of view
you and the agency time. That's also a great time
to ask if there's anything needed on their wish list.

(21:06):
Those items can be small and toothbrushes or shampoo and
make a big impact. And Chip three, do not be
offended if a charity won't take the item. There typically
are so many factors and accepting donations. If you're still
looking for a good home for an item and you
live in the US give to one one a call.
It's a toll free number like one or four one
one that connects people who need help or want to help.

(21:29):
So thanks for those suggestions, Karen. Okay, this one's from Cali,
also about our donated clothing episode, and she has two
suggestions for people. She says. One is an organization called
Dress for Success, which receives professional clothing and gives it
to low income women looking for work. Each Dress for
Success client receives one suit when she has a job
interview and can return for a second suit or separates

(21:51):
when she finds work. Participants also receive help in the
job search process to prepare for interviews and develop their resumes.
Another organization and is called ever After, which is a
nonprofit that provides young women with new and gently used
formal gowns, shoes, and accessories to be warned to their
high school prom. Guests are pre selected by their high
school guidance counselors based on financial need, and the items

(22:12):
they choose are theirs to keep forever free of charge,
and she provides two websites. First is for Dress for Success,
which is Dress for Success dot org. The second is
ever After gowns dot org. So thanks for that info, Kelly. Yeah,
and thanks to everyone who has written in mom Stuff
at Discovery dot com is where you can send your letters.

(22:33):
You can also find us on Facebook, leave us to
comment or message there, and you can follow us on
Twitter at mom Stuff Podcast. And if you'd like to
feed your brain during the week, you can head over
to our website, it's how stuff works dot com for
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(23:00):
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