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Getting a Handle on Self-Harm

Self-injury, particularly among adolescent girls, has become so prevalent so quickly that scientists and therapists are struggling to catch up. About 1 in 5 adolescents report having harmed themselves to soothe emotional pain at least once, according to a review of three dozen surveys in nearly a dozen countries, including the United States, Canada and Britain. Habitual self harm, over time, is a predictor for higher suicide risk in many individuals, studies suggest.

But there are very few dedicated research centers for self-harm, and even fewer clinics specializing in treatment. When youngsters who injure themselves seek help, they are often met with alarm, misunderstanding and overreaction. The apparent epidemic levels of the behavior have exposed a structural weakness of psychiatric care: Because self-injury is considered a “symptom,” and not a stand-alone diagnosis like depression, the testing of treatments has been haphazard and therapists have little evidence to draw on.

In the past few years, psychiatric researchers have begun to knit together the motives, underlying biology and social triggers of self-harm. The story thus far gives parents — tens of million worldwide — some insight into what is at work when they see a child with scars or burns. And it allows for the evaluation of tailored treatments: In one newly published trial, researchers in New York found that self-injury can be reduced with a specialized form of talk therapy that was invented to treat what’s known as borderline personality disorder.

Few people who self-harm once stop there, said Dr. Whitlock, an author of “Healing Self-Injury: A Guide for Parents.” “About 3 in 4 continue, and the frequency tends to go up and down, as people go in and out of various stages,” she said. “It’s absolutely crazy-making for parents, because it’s hard to know what’s happening.”

In psychiatry, self-injury is considered a symptom, not a stand-alone disorder. As a result, people who habitually injure themselves often receive an underlying diagnosis, like depression, attention-deficit disorder, post-traumatic stress, borderline personality, bipolar or some combination, which may change from doctor to doctor.

The one treatment that appears to be most effective for breaking the habit of self-harm is a specialized talk therapy, originally invented for people with a diagnosis of borderline personality disorder, who are highly suicidal. Habitual self-injury is a risk factor for later suicide, and those who engage in it, like people diagnosed with borderline, endure gusts of dark emotion.

Through one-on-one and group therapy sessions, at least once a week for two months or more, people who injure themselves learn a series of coping skills to weather troughs of misery. These skills include mindfulness techniques and opposite action, in which patients act opposite to the way they feel in order to alter the underlying distress. The therapy is called dialectical behavior therapy, or D.B.T., and was developed by Marsha Linehan, a psychologist at the University of Washington.

Excerpted from “Getting a Handle on Self-Harm” in The New York Times. Read the full article.

Source: The New York Times | Getting a Handle on Self-Harm, https://www.nytimes.com/2019/11/11/health/self-harm-injury-cutting-psychology.htmls |© 2019 The New York Times Company

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