Ask An Expert: Teenagers and Self-mutilation

Content provided by the Faculty of the Harvard Medical School

Ask An Expert: Teenagers and Self-mutilation

Question:

Could you provide some information on self-mutilation, specifically teenagers cutting themselves?

Answer:

Cutting is probably the most common form of self-mutilation, but people sometimes burn, scratch or hit themselves, too. This behavior is most often seen as part of borderline personality disorder.

Here is the most common way people describe the experience: They have a rising feeling of tension (for example, anxiety or anger), but at the same time they feel detached or depersonalized. They then mutilate themselves in order to "feel real."

There has been a longstanding debate about what such behavior says about suicide risk. People who mutilate themselves probably are at some increased risk for committing suicide, but more often than not the behavior is not performed with death in mind.

Repetitive self-mutilation is like an obsessive and compulsive symptom. The person has intrusive thoughts about it and has a hard time resisting the impulse. The mutilation actually provides relief from the underlying tension. The person usually does not feel the pain, does it in secret, and cuts or burns areas of the body that are not exposed.

In the teen years, it is much too early to make a diagnosis of borderline personality disorder. Cutting sometimes is associated with another psychiatric diagnosis, like depression, substance abuse, an eating disorder or psychosis (where a person has trouble with his or her reality sense). Diagnosis aside, teens with this behavior often feel discouraged, bad about themselves, or insecure in relationships.

So the most important task in responding to people who mutilate themselves is not primarily to stop the behavior, but to figure out what the underlying problem is. Treatment with psychotherapy and medication can be very helpful.

Michael Craig Miller, M.D., is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

E-mail This | Print ThisSee All Ask An Expert Articles

Last updated:	January 24, 2007