So say young people who deliberately and repeatedly injure their own bodies. The disturbing and hard-to-treat phenomenon is increasing among adolescents, college students and young adults, writes Jane Brody in New York Times.
A history of childhood sexual, and especially emotional, abuse has been reported by half or more of self-injurers. Some seek relief from the resulting emotional pain. Others self-inflict pain to punish themselves for what they perceive as their role in inviting the abuse.
Low self-esteem is common among self-injurers. Childhood neglect, social isolation and unstable living conditions have also been cited as risk factors. In about 25 percent of self-injurers, there is a history of eating disorders, as well as an overlap with risky drinking and unsafe sex.
The families of self-injurers commonly suppress unpleasant emotions. Children grow up not knowing how to express and deal with anger and sadness, instead turning emotional pain on themselves. Depression, for example, is often described as anger turned inward.
Experts urge parents, teachers, friends and doctors to be more alert to signs of this behavior and not accept without question often spurious explanations for injuries, like "I cut myself on the countertop," "I fell down the stairs" or "My cat scratched me."
The sooner the behavior is detected and treated, the experts maintain, the more quickly it is likely to end without leaving lasting physical scars.
Janis Whitlock, a psychologist who has interviewed about 40 people with histories of self-injury and is participating in an eight-college study of it, says the Internet is spreading the word about self-injury, prompting many to try it who might not otherwise have known about it.
Celebrities, too, have contributed to its higher profile. Common self-injuries include carving or cutting the skin, scratching, burning, ripping or pulling skin or hair, pinching, biting, swallowing sub-lethal doses of toxic substances, head banging, needle sticking and breaking bones. The usual targets are the arms, legs and torso, areas within easy reach and easily hidden by clothing.
Self-injury can become addictive. Experts theorize that it may be reinforced by the release in the brain of endorphins that result in a natural high and emotional relief. Endorphins
are chemicals produced in the body during strenuous exercise, excitement or orgasm; and they resemble the opiates in their abilities to provide pain relief and also induce a sense of well-being.
Dr. Whitlock, director of the Cornell Research Program on Self-Injurious Behavior in Adolescents and Young Adults, said in an interview that self-injury mainly seemed to function to "self-regulate feelings and help people cope with overwhelming negative emotions they have no other way to dispel."
Self-injury makes some people feel part of a group. Teenagers who self-injure often report that there is no adult they could talk to who accepts them for who they are.
"A 13-year-old can go on the Internet and instantly find community and get hitched to this behavior," Dr. Whitlock said. "When they don't want to self-injure anymore, it means they have to leave a community."
Self-injury can be manipulative, an effort to make others care or feel guilty or to drive them away. More often, though, it is secretive. Self-injurers may try to hide wounds under long pants and long sleeves even in hot weather, and may avoid activities like swimming.
Although 60 percent of self-injurers have never had suicidal thoughts, self-injury can be a harbinger of suicidal behavior. It can also accidentally result in suicide.
Although there are no specific medications to treat self-injury, drugs that treat underlying emotional problems like depression and anxiety can help. Most effective in general is a form of cognitive behavioral therapy called dialectical behavior therapy. People learn skills that help them better tolerate stress, regulate their emotions and improve their relationships.
The therapy also helps them see themselves not as victims, but as powerful agents, Dr. Whitlock said.
In addition, self-injurers can learn more wholesome ways to relieve stress like practicing meditation or yoga, engaging in vigorous physical activity or reaching out to a friend.
Some self-injurers have noted that they can sometimes avoid the behavior, Dr. Whitlock said, simply by doing something else for several minutes when the urge arises.