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Dr. Paul Latimer: Self-mutilation a coping mechanism for emotional painPeople who deliberately cut themselves with razors, burn themselves with lit cigarettes or pick their skin until it bleeds have often been viewed as attention-seekers – people who simply want to make a statement or frighten others enough to get a rise out of them.

Sadly, self-mutilating behaviours such as these are not simply a cry for attention. People who repeatedly harm themselves on purpose are often using the only coping mechanism they can think of to deal with anxiety or emotional pain.

When life seems out of their control, those who practice self-mutilation are trying to find one thing they can control.

More than anything else, this behaviour is a coping mechanism. When they cut, burn or pick themselves, they feel a release of built up negative feelings such as anger, hurt or frustration.

Part of this can be a psychological feeling that they are ‘bleeding out’ their problems, but physiologically endorphins are released when we are injured that are designed to help us out of danger – and this can create a feeling like relief. Most who practice self-mutilation are not suicidal.

Cutting, burning and other similar behaviours are probably more common than you think. Self-mutilation is more common among females than males and usually begins in early adolescence. Most often, those who are doing this go out of their way to hide it. They wear clothing that covers wounds and they may refuse to wear bathing suits or change for gym class where people might see them.

This secrecy can make self-mutilation difficult to detect and deal with. If you suspect your child may be practicing self-abusive behaviours, there are a few signs you can look for.

If your teen has frequent or unexplained injuries, wears long pants or sleeves even in hot weather or wants to be alone all the time, this may be a reason. Also, if the child wants to do his or her own laundry or if you notice blood stains on the inside of clothing, these may be signs of self-abuse.

Self-mutilation is not a diagnosis but a symptom and may not always have the same significance. An individual assessment is necessary to understand the origins and function of the symptom in each case.

This behaviour can occur in conjunction with family problems, drug abuse, depression, anxiety, borderline personality disorder or some combination of these. Treatment will depend on the diagnosis and other elements that are detected.

Although self-mutilation is not the same as suicidal behaviour and usually does indicate a wish to die, one per cent of those who harm themselves commit suicide in the following year and up to 10 per cent commit suicide at some time. It is a very common feature of borderline personality disorder which does carry an increased risk of suicide.

Counseling will always be an important part of treating self-mutilating behaviour. Those who do this need to learn more effective ways to deal with the emotional turmoil and stress that life offers.

If someone you know is self-mutilating talk to them and encourage them to get help. Talking about it will not make it worse.

Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.

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