By Julia Madden Bozarth, MA, MS, LCPC
As OPTIONS (our adolescent and family counseling program) continues to evolve, our counselors see an increasing number of teens who self-harm. Self-Harm Syndromes include cutting, scarring, slashing, and burning. The degree of severity is closely related to the client’s perception of emotional pain. These behaviors provide relief from psychological pain.
Our most common example is the teenager who scratches, picks or rubs erasers – to the point of small burn spots – on arms, legs, and stomach. Some of these teens burn and cut themselves in non-lethal ways. This behavior may protect the client from a sense of abandonment, loneliness and isolation.
It is not usually recommended that these particular clients be hospitalized. The hospital may provide the social group and support the client is looking for, thereby increasing the potential for more self-harming behaviors. These behaviors usually dissipate with age. Our office provides an emotionally validating environment in which to express pain and explore healthy ways of coping with social and emotional pressures.
More extreme forms of self-harm may include extensive use of razors, glass, or lighters for control of negative emotions. These clients risk addiction to the particular method of self-harm. They often find it impossible to self-soothe and see coping skills as outside of themselves (externalized). In many of these cases, clients have experienced trauma in childhood that they were unable to understand and formed maladaptive behaviors as a way of managing their rage. This client requires consistency and often responds well to Dialectical Behavior Therapy combined with Cognitive Behavior Therapy. Often, medications are part of the ongoing treatment for clients experiencing this level of self-harm.
All of these self-harm behaviors may increase if the client experiences an increase in anxiety or depressive symptoms. Because of the potential for addiction, medications prescribed by physicians or psychiatrists are usually in the form of SSRIs (antidepressants) such as wellbutrin or lexapro. Generally, tranquilizers and anti-anxiety agents are not recommended. The goal of therapy is to provide coping and self-soothing techniques that work with anti-depressants for the management of symptoms.
Our goal – our technique – is to “go to the pain.” The behavior serves a purpose. Please note: serving a purpose does not mean that the client does it ‘on purpose.’ The validating environment in our office provides the atmosphere for the client to explore alternatives and painful triggers.
Finally, in some rare cases, the situation can be life threatening. In cases of psychosis, the client may “hear voices.” These voices may be what are called command persecutory delusions. Command persecutory delusions (voices) may tell the client to walk into traffic or cause serious permanent damage to their bodies. In these cases, hospitalization and medical stabilization is mandatory.
For more information or questions about someone you may suspect of self-harming behaviors, contact CSI.