More and more young peo­ple are cut­ting them­selves as a way of cop­ing with stress. Child psy­chother­a­pist Louis We­in­stock ex­am­ines the rea­sons why

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A14-year-old girl feels so over­whelmed by thoughts and feel­ings about her fa­ther’s sud­den death that she starts to cut her arms with a pair of scis­sors. Why? Be­cause each cut brings an in­stant but tem­po­rary re­lief from her heart-shat­ter­ing grief. It may be dif­fi­cult to un­der­stand, but this teenager’s be­hav­iour is far from unique. More young peo­ple than ever be­fore are turn­ing to self-harm: in­ten­tion­ally dam­ag­ing or in­jur­ing their bod­ies by cut­ting, burn­ing, stran­gu­la­tion, head-bang­ing, skin-pick­ing, hair-pulling and self-poi­son­ing as a way of deal­ing with the unique stresses of 21st-cen­tury life.

Sec­ondary schools have wit­nessed a surge in cases, with 70,000 in­ci­dents es­ti­mated in the past year alone, and NHS Eng­land fig­ures show that the num­ber of girls treated as hospi­tal in­pa­tients af­ter cut­ting them­selves quadru­pled be­tween 2005 and 2015, while the num­ber of boys ad­mit­ted had more than dou­bled. These fig­ures are shock­ing. And yet they show how more and more young peo­ple – typ­i­cally ado­les­cents, and three times more girls than boys – are turn­ing to self-harm as a cop­ing mech­a­nism. Dan­ger­ous though it is, it can bring a sense of re­lief or con­trol to a sit­u­a­tion (in­ter­nal or ex­ter­nal) that feels con­fus­ing, over­whelm­ing and be­yond con­trol.

So why do peo­ple de­lib­er­ately harm them­selves? We all do things that dam­age us, from smok­ing and drinking too much to binge-eat­ing. We hu­mans some­times choose things we know aren’t good for us to bring tem­po­rary re­lief to the thoughts and feel­ings in­side our­selves. Psy­chi­a­trist Ar­mando Favazza de­scribes self-harm as a ‘mor­bid form of self-help’. Stud­ies tend to con­firm this: that the main rea­son peo­ple re­port en­gag­ing in self-harm is to re­duce emo­tional dis­tress. An­other com­mon rea­son is self-pun­ish­ment, al­though ei­ther mo­ti­va­tion can lead to a tem­po­rary sense of re­lief.

One of the most in­cred­i­ble re­cent neu­ro­science dis­cov­er­ies was that we ex­pe­ri­ence phys­i­cal pain and the emo­tional pain of so­cial re­jec­tion in the same parts of the brain, in­clud­ing the an­te­rior cin­gu­late, a hook-shaped piece ly­ing an inch be­hind the fore­head. Parac­eta­mol was proven in a sim­i­lar study to re­lieve the pain of so­cial re­jec­tion, and it seems, from the clients I have worked with, that self-harm can also pro­vide this kind of emo­tional ‘pain re­lief ’. There is some ev­i­dence that af­ter self-harm­ing, en­dor­phins are re­leased which cre­ate a mini-eu­phoric state. This ex­plains why some ado­les­cents self-harm at the end of a stress­ful day. These dis­cov­er­ies chal­lenge the idea that self-harm is just at­ten­tion-seek­ing be­hav­iour.

A client of mine started self-harm­ing – first with nail scis­sors, then burn­ing her­self with a lighter – when she was 11 years old as a way to cope when her par­ents were fight­ing. Self-harm­ing, she said, was a way of ‘an­chor­ing’ her in­ner tur­moil. She showed me a graphic novel about a les­bian girl who self-harmed, with a bril­liant de­pic­tion of the girl be­fore and af­ter she had cut her­self. The ‘be­fore’ im­age was cap­tioned: ‘dif­fi­cult to un­der­stand’, next to the ‘af­ter’ im­age, of the girl’s cut arms,


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