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Why Aren’t There More Resources for Adult Self-Injurers?

Even getting adults to commit to group therapy can be a challenge. Adults are burdened with more responsibility than adolescents and may have trouble finding the time and effort to make the commitment for their own healing, even when resources are available.

Why Aren’t There More Resources for Adult Self-Injurers?

By Renée Fabian 03/21/17
Over time, self-injury itself can become a habitual, nearly addictive behavior, and 8.7 percent of self-injurers are also addicts.

Erin Hardy, a Wisconsin-based therapist, found herself in a quandary when an uptick of people who self-injured came to her about five years ago. This was a new area to her practice, so Hardy sought consultation with her colleagues on resources, but they came up empty. An internet search left Hardy with unsatisfactory results.

“All the sudden I had this flood of individuals that were engaging in self-harm,” says Hardy. “There is really nothing [online] about self-harm other than the theme of, ‘Anybody who self-injures has borderline personality disorder,’ and … ‘there’s no cure, nobody can get better.'”

Undeterred, Hardy kept searching until she found S.A.F.E. Alternatives, an organization co-founded by Wendy Lader and Karen Conterio in the mid-1980s dedicated to self-injury recovery with the belief, “people can and do stop injuring with the right kinds of help and support.” Through their S.A.F.E. Focus program, Hardy got the training and materials she needed to lead a dedicated self-injury support group in her city.

Today, a similar internet search for self-harm resources yields information focused on adolescents. As one PsychForums member put it, “I have been online searching for several hours today regarding finding help for self-harm, and I’m 40. I have been seeing that it is mostly in young people, and feeling pretty embarrassed and ashamed that I’m an adult dealing with it. I feel like I should have grown out of this long ago.”

The pervasive idea that self-injury is a behavior relegated to emo teenagers is simply false. Self-injury affects 4 to 5.5 percent of adults, yet the stigma persists, leaving millions of self-injurers to struggle in silence and feel invisible.

Defined as intentionally harming the body without suicidal intent through behaviors such as cutting, burning or hitting oneself, self-injury serves as a maladaptive coping skill to deal with difficult emotions, experiences and feeling states.


CBT most effective treatment for repeat self-harm

CBT seems to be effective in patients after self-harm. Dialectical behavior therapy did not reduce the proportion of patients repeating self-harm but did reduce the frequency of self-harm.

CBT most effective treatment for repeat self-harm
Hawton K, et al. Lancet Psychiatry. 2016;doi:10.1016/S2215-0366(16)30070-0.

Recent findings showed cognitive behavioral therapy after self-harm was effective while dialectical behavior therapy did not reduce repeat self-harm but reduced frequency of self-harm.

“Self-harm (intentional acts of non-fatal self-poisoning or self-injury) is common, particularly in young adults aged 15 to 35 years, often repeated, and strongly associated with suicide. Effective aftercare of individuals who self-harm is therefore important,” Keith Hawton, FMedSci, of the University of Oxford, and colleagues wrote.

To assess efficacy of psychosocial interventions for self-harm in adults, researchers conducted a Cochrane systematic review and meta-analysis of 29 randomized controlled trials with three independent trials of the same intervention for adults with recent self-harm.

There is much to learn about self-injury

Rejection and Pain

Rejection and Pain

Of note is that Non-Suicidal Self-Injury (NSSI) people say they actually feel better after hurting themselves.

There is much to learn about self-injury

Michael Kulla, For the Poughkeepsie Journal 12:56 p.m. EST March 4, 2016

This article is about young people who cut, scratch, burn, carve, interfere with wound healing or bang their heads against a solid object.

Tattooing and piercing are usually not considered maladaptive because they are culturally sanctioned forms of expression. The intent of harming oneself per se is not suicidal and is referred to as Non-Suicidal Self-Injury (NSSI). NSSI is especially prevalent among adolescents with approximately 1 in 6 engaging in this behavior at least once. About 15 percent of college students have participated in it. Overall about 1.3 percent of kids 5 to 10 self-inflict, though rates climb greatly if the child has marked anxiety or chronic mental stress. Reported self-abuse among adults is about 5 percent.

Previously it was thought to be a behavior engaged in by young women, but recently NSSI was found to be equally prevalent among young men. Women, though, may be more likely than men to cut themselves, while men are more likely to engage in burning their skin.

Individuals with a history of NSSI report more borderline personality disorder (BPD) characteristics than those without a NSSI background. BPD is marked by such tendencies as emotional instability, unstable relationships and chronic feelings of emptiness.


Self-Injury: Raising the Profile of a Dangerous Behavior

“By applying one type of pain,” he says, “they get rid of a different type of pain,”

Self-Injury: Raising the Profile of a Dangerous Behavior

A Rutgers researcher appeals to the medical community for better treatment tools and insurance coverage

By Rob Forman

Self-injury so often occurs in private, an important reason why solid statistics are hard to come by. But researchers estimate between 10 and 40 percent of adolescents, and up to 10 percent of adults, harm themselves physically – usually by cutting or burning their skin.

Yet, the condition – known as nonsuicidal self-injury – is not officially recognized by the American Psychiatric Association (APA) as a mental disorder, which means insurance may not cover treatment.

“The mental health system is failing patients who have a clear problem for which they need help,” says Edward Selby, an assistant professor of psychology in Rutgers’ School of Arts and Sciences in New Brunswick.

Selby, who recently published a paper in Clinical Psychological Review on the topic, is among a growing number of psychologists who believe that non-suicidal self-injury should be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard compilation of psychiatric disorders used by mental health practitioners and insurers.

Continue reading Self-Injury: Raising the Profile of a Dangerous Behavior

Her brain tormented her, and doctors could not understand why

The young woman — and her family — were exhausted and confused by the barrage of treatments and medications. How were they supposed to cope with her nightmarish outbursts, her self-mutilation and suicide attempts, her destructive behavior?

Her brain tormented her, and doctors could not understand why
By Aleszu Bajak September 14 at 2:38 PM

“I hate myself, and my brain,” Pam Tusiani wrote in her journal while under 24-hour watch on the fourth-floor psychiatric ward of Baltimore’s Johns Hopkins Hospital. “Nothing is worse than this disease.”

When Tusiani wrote those words in 1998, doctors had little understanding of the disorder that was troubling her, and all these years later they have little more.

Trying to understand how the illness works — in hopes of finding a cure — strikes at the heart of psychiatry, indeed medicine in general. How does one replicate at the basic research level what one sees in a patient? How do you find the chemical root of a disease, especially one as complex and multifaceted as borderline personality disorder, or BPD?

Just as a smile takes dozens of facial muscles to execute, a particular emotional response to a stimulus requires a web of brain activity. The brain isn’t a series of one-way streets. It’s a hive of superhighways, and we can barely make out the cars, much less figure out where they came from, where they’re headed, what they’re carrying and why they’re on the road. We barely understand a healthy brain, so how are we to understand one haunted by psychoses?

Some days Tusiani, a New Yorker who was attending Loyola University in Baltimore when she was hospitalized, would cut herself, usually on the arms and hands, not so much to inflict pain but rather to relieve inner turmoil. “Bleeding enough that I felt good,” she wrote. One day she’d be curled up in the fetal position, unable to eat or speak; the next, she’d be pacing her house, berating anyone within reach and seeking drugs and alcohol — or a razor — for relief.


How Borderline Personality Disorder Put an End to My Party Days (#BPD)

The negative emotions I have are immobilizing. They crash over me like huge waves, knocking the wind out of me and forcing me underwater.

How Borderline Personality Disorder Put an End to My Party Days
August 10, 2015
by Harriet Williamson

In the summer of 2010, just before I turned 19 and in my first year of university, I attempted suicide with a month’s supply of my antidepressants and ended up in intensive care, breathing on a machine. By my second year, my good-time friends had had enough of me. I was no longer invited out, and became very isolated and increasingly unhappy. I got into an abusive relationship and attempted suicide another two times. I was also bulimic—vomiting everything that touched my lips.

During the first year of my undergraduate degree I reduced my calorie intake to 250 a day—about two and a half slices of bread or five medium apples—and started to go slowly insane. I drank, took drugs, and went to clubs with a religious fervor. My body started to cave in. I was starving and my hair started to fall out. My nails went blue. My skin turned to flaking scales. I once ate a burger after a night out and forced myself to run up and down the stairs until I actually passed out to “make up for it.” I went to my campus GP and told him I needed help. At five and a half stone (less than 80 pounds), he said I wasn’t sick enough to warrant eating disorders treatment, and borderline personality disorder (BPD) was never even mentioned.

People couldn’t keep up with my impulsive behavior, the manic phases and the fits of crying. The labels of “drama queen,” “attention seeker,” and “total fucking mess” followed me around like a bad smell. I tried to conceal it, but being called those things hurt. I didn’t know how to explain that all the stuff I was doing was an attempt to manage my out-of-control emotions, because when I’m going through a bad patch it feels like being on a sickening roller coaster—only, I can’t get off.