Demonstrates, manipulates, or needs help – what to do when a teen cuts his hand, where does this desire come from, how scary it is and how to provide competent care – says the doctor-psychotherapist, lead specialist at Mental Health Center Dmitry Pushkarev.
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He needs help and react to it
— How to describe a situation in which people cause themselves a variety of cuts or other injuries?
– It makes sense to separate the concepts of self-harm and suicidal behavior. First, there is self-harm without suicidal intentions (eng. non-suicidal self-injury). In English it is also called self-harm — the term has migrated into the culture of teenagers who use the anglicism — “selfharm”. Is suicidal behavior. These are two different things. In our case, we are talking about selfharm.
And why this happens?
– Self-harm, like any behavior, as a rule, there is a certain function.
There are several models explaining campbridge behavior. One of them, which is the closest to me, says that this behavior most often is two things. The first is self-regulation. When I’m in a bad mood, I, like all people, usually doing something to make yourself feel better — go play a computer game or eat a delicious dinner, chat with friends. This we learn from childhood. That’s what our parents do to us in early childhood: the child cried, the mother in the head patted, said look, a bird flew, and now let’s go on a scooter ride.
And when parents do that with us over and over again, we adjust, we learn and adjust themselves in a certain way — learning to ask for help to other people supported us, or we comfort ourselves doing some pleasant things for us.
Now, the harm has such an interesting mechanic: at the moment it can help a person to handle. How? When a person injures themselves in the brain allocated to the so-called endogenous opioids — endorphins, the substances from the point of view of biochemistry is similar to morphine and heroin. They are distinguished every person, it’s pain relief system — you pretty freaked out, you have a very stressful situation, you can severely hurt yourself and not even notice it at first, too you captured the situation, the pain will come later. Is work such a pain system in the brain.
People who use opioid drugs, abusing this system, externally introduced substances which create a sense of peace, comfort, and lack of physical and emotional pain. And now there’s research that shows that when a person intentionally damages his body, it induces the production of endorphins. Paradoxically, but when people (I speak in the masculine, but it works for both sexes equally) specifically is causing himself pain, he may experience a General feeling of relief from suffering. People who do this often say, I do so when experiencing strong emotional pain, and it makes me feel better.
The other distraction. When I am very upset, I make myself hurt, and my attention is diverted instead to worry about parting with the young person, dismissal from work, I can focus on the pain.
In the same Treasury – self-punishment and self-motivation. This is especially characteristic of children raised in strict families with rather violent parents. They inserted it in their world — what is there a way to force me to do something? To shout, to threaten, as I was forced by adults in childhood. If I’m not doing something I should be punished. If I’m not punished, I will feel like a complete nonentity, as if I myself was punished — like already easy. That is all, if you generalize about subjective impossibility emotions.
And the second function?
– Generally people usually have a mixture of reasons and functions, and it is impossible to clearly identify only one. But not always. For some — often teenagers — is still communicative function.
For example, a child grows up in a family where his interests are for some reason not very effectively met. Maybe the kid just quite vicious and can’t talk about the problem. Perhaps the parents of other temperament — and they just don’t understand such problems. The quiet teenager at school being bullied or no one with him not talking, he comes to my parents, they never had no such problems, and they say, hmm, what’s the big deal, well, go talk to someone or just give back. Thus, requests for assistance or support do not work. Or the parents have their own problems, fired from work, divorce, more things which they can’t pay the teenager’s attention and resources.
And teenagers, in principle, tend to emotionally deregulirovania — nervous system changes, hormones change, emotions become stronger, and the majority of teenagers feels emotions stronger than they themselves wish and what they would be comfortable. And at some point a teenager can be cut. Spied somewhere in the classroom, on the Internet, in books — anywhere, for this was now many. Don’t need to have any special pathology or problem to try to do it.
Recent statistics in Western countries — about 30% of adolescents now have at least a single experience of self-harm.
And that’s a teenager for one reason or another, cut themselves, well, boiling, parents see the cuts, clutching his head — my God, our baby turns out to be a problem! They become extremely careful, start some active actions, transferred him to another class or school. It is clear that such things do not happen for a long time — a month or two, and then everything is back to how it was.
But a child’s brain remembers that there is a way he can get what you can’t achieve any other way. And then self-harm may be repeated. And if the people around him behave in this way: to harm, ignore and do not support, and after — warm, affectionate, and helping — is some training, and self-harm becomes a learned way of communication.
Often, the communicative function and self-regulation go hand in hand: I can’t handle, so I feel bad and therefore in need of help, I cut and the environment reacts in such need. So cut, it turns out, effectively. It is important to understand that this is not necessarily reflexively by a teenager, often the man himself does not understand why so irresistibly want again and again to do it, scolding myself for “bad behavior”, even trying to punish myself… Sometimes, too, through ways that worsen the feelings of emotional pain and provoke new episodes of self-harm.
Fun in the midst of pain — but if this pain away
— Often systematic behavior originates in adolescence?
– Yes, at this age, emotions become strong, and these deficits — the inability to calm or comfort in other ways — are particularly pronounced. Therefore, adolescents are experimenting with new ways — alcohol, drugs, computer games, impulsive purchases, overeating, diet, many more.
These methods sometimes help, Yes, but they have a negative flip side, everything is clear: life will pass by, will become an alcoholic and addict. At the same time, drink – and feel more confident in the company; don’t know where to go, bored and have no one to walk, because you dislike the classmates went to the computer to play it cool.
It becomes working methods, when you already have a pretty powerful emotional needs, but there are no other obvious ways to satisfy them.
Most of it passes or fades into the background — they find other more environmentally friendly ways to deal. Some do not find and continue to do — for example, drink too much or continue to cut.
— There is about stats — what proportion of people this behavior persists into adulthood, when it is already causing social discomfort?
– Self-harm – a rather unpleasant process. If you ask people: imagine you are feeling well, you don’t have to imagine any serious complaints, you are quite satisfied with the kind of person you are, you have a sense of self-esteem, understanding and you are satisfied with relations with family and friends, you are sufficiently in control of yourself and your behavior, know when you need to calm down, you are able to entertain themselves and lead the life that you would like. If this is all you had, would you engage in self-harming? I have not seen the person who answered in the affirmative with this formulation.
But if asked simply — do you like it? – many say: Yes, I enjoy it, I like it. But it is fun on the contrast: it makes me feel better, I feel strong, I have the scars to show other people how I suffer.
That is, it is a pleasure in the midst of pain — if this pain away… Recent data suggest that a clinically significant disorder throughout life is seen in 4-6% of people in the General adult population in younger groups the percentage is higher: for young adults — 10% of adolescents – about 20-30%.
— People usually hurt themselves in inconspicuous places?
Very different and depends on the context. Someone cuts herself where no one might notice, is important to someone that other people saw that he has this inner pain, it’s such a part of identity.
You have something to say, and they will shmonat your backpack
— That can make the person dealing with self harm, if he is aware that he is probably wrong?
– First, it’s therapy — it’s for. In addition, there is a very good guide for self-help is usually such texts with a fairly simple skills of “how to calm yourself”, “what to do if you have an emotional crisis.”
There are two commonly recommended practices. First, it is different ways to escape, to switch during the crisis. It’s not deep stuff — how to change style of thinking, and simple ways: to squeeze into the ice cube, it causes a strong physical sensations, but does not hurt in this. Or, for example, to eat a lemon.
The second is to choose the loved ones, which can be accessed and which will support and will not scold. To be able to call someone and had the opportunity to share in a time when there is a desire to cut. That is, in addition to therapy, social support and ways of distraction.
Sometimes the recommendations of this round seem pretty primitive, but it does not mean that they are obvious to all. Here is an example: at school age I went to the section on karate and accidentally discovered that when I get angry and many times I do pushups, my anger reduced. Then I grew up, and when you were pissed off at someone, went to another room to do push-UPS. This is a working strategy, and to me now it seems obvious – but if I didn’t have this experience in school sections, I would probably never have occurred. About the ice cube, for example, I learned only when I started the topic of self-harm professionally.
But it is important to understand that self-help has its limitations, and often, of course, need systematic support and assistance of others, including professionals, to learn how to cope with such things.
— Relatives or partners of such person unable to do something? How correctly to respond?
– If we talk about loved ones — tips on how to do the right thing, to give easily, much harder to fulfill them. Experimenting with self-harm many young people, but in a systematic behavior that goes not at all, and usually just those people, surrounded by which there are not sufficient resources to adequately respond and maintain. That is often family and friends just do not have the ability to respond exactly as needed, by the way — if I could, I would have done it already.
The main recommendation, of course, that we should not react immediately after an episode of self-harm, you need to behave calmly, without fuss, not thus exacerbating the situation.
I knew a girl who when misunderstanding or quarrel with a young man damaged hands and brought it to him. He was gentle, kind, she realized how she badly bandaged.
So — you do not need. This increases the chances that the next time the person feel bad or he will need the support of the harm will become an instrumental method to get it. The feeling of care should not increase immediately after self-harm. You need to provide physical assistance, if necessary, call an ambulance, for example. But in practice, not everybody can do this — how can I not regret my little child of the native.
— Would you, as a partner or parent, such behavior seem a man cold and distant?
– That speech, so many people find it hard to do it. And this is a big problem: not to be cold and distant, you need to take more care before self-harm.
The systematic problem arises where the environment is not able to ensure it is not in extreme mode. Watch: mother single-handedly raising a teenage daughter, works 12 hours a day, the girl feels abandoned. Mother: let her feel that her daughter you want, spend more time with the child — for example, bake a cake together. And mom comes home at midnight, she wants to fall into bed and die, and she say bake a cake. The problem is often this — how to find and get these resources.
Anyway, the point is this: before you invest your resources, you need to understand what is the function of when harm in a particular case. One it could be — “I need to took care of me because I was bullied in school, and provided some security.” Someone, on the contrary, need freedom — because 10 groups and sections, each step is painted, “I feel like I’m in prison, and when cut, gain inner freedom.”
Another really need to make it clear that you love him. That is, until we figure out what the person needs in fact, what is the function of this behavior, by behavior, something difficult to do. You need to understand or independently, or with a specialist — what’s going on at all? Such a behavior of each person are specific and unique needs.
And there is another problem is often very difficult to understand, because the teenager doesn’t want to talk. Or he would like, but is not able. Here is an example: a religious mother, an unbeliever or is in a crisis of faith daughter suddenly emerge, let her candid photos that someone is threatening to merge in the Internet. The girl feels horrible, but you think she’s gonna tell your mom? The mother, who has long been terrified out loud only the sins of youth.
Therefore, the most important prevention is to build relationships with loved ones so that people were not afraid to tell what is really bothering him.
Remember, a few years ago was the story of “blue whales”, and many parents rushed to check the correspondence of their children.
And made it worse?
– Well, of course. This is the story: you say something, and you then arrive, will shmonat your backpack and so on. That is, there must be an atmosphere, giving to understand — after you something frankly, not going to happen consequences, which you did not want.
Therefore, experts and psychologists here in a comfortable position — they are neutral, they are not personally interested people. And they often tell things not to say to parents, husband, loved one.
It is important that the therapist had experience with this problem
— If parents or partner do not cope accurately, and offer close therapy, what it should be — who to go to?
– There are nuances. It is important to understand that the stage of development of psychotherapy is such that the identity of the specialist is often more important than the model in which it operates. There are universal things that make good professionals working in different therapeutic schools and different modalities.
In principle, there is a therapy specifically designed to help people with self-harm is dialectical behavior therapy, which I do. It was originally designed for women with self-harm, specifically “sharpened” for this topic, then it “dokrutili” for men. Protocols for working with self-harm there is in cognitive behavioral therapy. It is a broader term, and dialectical behavior therapy is its narrow branch. But this does not mean that other therapies are not effective.
There are problems with the research, there is the problem of the so-called verdict of the Dodo — by analogy with “Alice in Wonderland”, where the characters played croquet and the Dodo bird then said, ‘ all have won and all must receive prizes.
About the way things are going now in psychotherapy we can find studies proving the effectiveness of almost every type of therapy. All have won and all must receive prizes. And now in the professional community trying to figure out where a particular method is really effective, and where it just stronger or is he lobbied for historical reasons, has proved popular in a particular country or in certain professional boards that are responsible for recommendations. Many copies broken on this topic.
It is important that the therapist had experience with this range of problems, in whatever modality it worked — that is, experience with self harm, not just panic or anxiety, for example.
Plus when choosing a psychotherapist is important recommendation and reputation, indicating that this is a sane expert, who would not speak anything of the series: “And about your mother did you think?”
Because sometimes, the physicians sometimes recoil from self-harm or suicidal attempts and thoughts. Not all have, on the one hand, sufficient courage, and on the other sufficient training to work with such things.