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Expert calls self-injury a drug and treats it as such

November 6, 2013
by Gary A. Enos, Editor
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Misinformation abounds regarding cutting, burning, and other self-injurious behaviors in young people, and because of that professionals often do exactly the opposite of what they should be doing when working with these individuals, a psychologist and addiction treatment specialist told an audience of professionals Nov. 1 at a continuing-education seminar in Danbury, Conn.

Perhaps the greatest misconception about self-injury, said Patrick DeChello, PhD, MSW, is that it signals suicidal intentions. In fact, the behavior often serves as a manifestation of a will to live despite severe emotional pain, he said.

“Death is the way to change the channel—self-injury is the way to stay in the game,” DeChello said in a keynote presentation at the daylong “Innovations in Addiction with Young People: What Works and Why” event sponsored by Newport Academy.

DeChello, who called self-injury a “hidden epidemic” with a prevalence outpacing anorexia and bulimia combined, authored a book on the subject that was based on interviews with around 2,000 individuals who self-injure. During his talk, accompanied by visuals of many of his interviewees, he described how some young people carve words such as “Pain” and “Fat” into themselves as a way to let go of these burdens.

A quote from one of his interview subjects stated, “I hurt myself on the outside to make the hurt on the inside stop.”

DeChello added, “Self-injury is a drug and I treat it as a drug.”

There are also many misconceptions about the characteristics of young people who cut (cutting is the most prevalent form of self-injury, with burning a secondary “drug of choice” for many of these individuals). These young people are usually of average to above average intelligence, DeChello said. While self-injurious behavior is more common among young women, with prevalence estimates of 1 in 200 in the 13-to-19 age group, DeChello said these behaviors have been vastly underreported in young men.

He added that a good many of these individuals begin cutting in their teen years, are able to stop for many years in young adulthood, but then resume in their 40s. He said many come from perfectionistic families in which at least one parent is alcohol- or drug-dependent.

Treatment options

DeChello told the seminar audience that he believes the greatest mistake occurs when professionals simply try to get individuals to stop the behaviors, with no replacement behaviors suggested.

“The assumption is that if you take it away, they’d act normally,” he said. “But the alternative could be a total loss of control, and suicide.”

These individuals have difficulty regulating emotion (or “changing the channel,” as DeChello put it). They lack the ability to tolerate strong affect, to maintain a sense of self-worth, and to maintain connection with others. The new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has defined these problems under the diagnostic classification “non-suicidal self-injury.”

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