Casey Lorusso is a seemingly happy, adjusted college junior - but she remembers a time in her life when cutting herself was the only way she knew how to deal with overwhelming depression and anxiety.
Twenty-year-old Lorusso, a student at Stonehill College in Massachusetts, said she was in seventh grade when she began cutting herself in an attempt to deal with her feelings.
“In one magazine, I came across an article about self-injury. I thought I had tried everything to make myself feel better, aside from talking to people,” Lorusso said. “I didn’t quite know what was causing my depression. I figured cutting might help, even though the article talked very negatively about self-injury, and how you shouldn’t do it because it would cause more problems.”
Many teens engage in self-injurious behavior, like cutting, burning or interfering with wound healing, in order to achieve an emotional release or, in some cases, to replace a feeling of numbness with pain, according to experts.
These behaviors are thought to help decrease emotional intensity.
Research suggests that one in four people have self-injured at some point in their lives, and that the majority of them are adolescents.
It wasn’t until her freshman year of high school that Lorusso realized she needed professional help, when one of her self-inflicted cuts required stitches.
The night her parents took her to a hospital was the night she realized she could hurt herself more than she thought she was capable of – and that she had lost control over the habit.
“I knew I needed to find somebody to help me because I was completely out of control, and it had become an addiction,” Lorusso said. “You are not weak if you get help. It is an incredibly brave and strong thing to do.”
Lorusso’s mother, Leslie, said she thought her daughter told her everything until she uncovered Casey’s cutting.
“Casey kept her cutting hidden for a long period of time,” Leslie Lorusso said. “I couldn’t understand why the child we saw as the most loving, kind, compassionate and happy girl was destroying her body and finding comfort in it.”
Dr. Jennifer L. Hartstein, a family psychologist in New York City, said the increase in the self-mutilation trend is difficult to attribute to one cause, but one reason may be an increase in access to information on the Internet where people can research ways to engage in self-injurious behavior.
“Often, they hear about it once or twice and then want to learn more about it,” Hartstein said. “We are more aware of it, and thus, are more focused on learning about it and understanding it. Therefore, the number goes up.”
It is important to realize that self-injury does not mean someone is suicidal, Hartstein added, noting that often, when there are cuts, the automatic assumption is that it is a suicide attempt – which is not always true. Non-suicidal self injury is an emotion-regulation strategy, and is not necessarily death intentioned.
“I think something that's a little more understandable for people is the whole idea of addiction,” Lorusso said. “You think the issue is under control. When you first do it, you do not need to do it a lot to get the desired effect. When you do it more and more, you need more and more.”
Lorusso’s cutting got so out of control, she ended up taking a month off from school and finally sought help through dialectical behavioral therapy – a program she credits with saving her life.
According to Hartstein, who did not treat Lorusso, dialectical behavioral therapy (DBT) is indeed helpful for modifying self-injury.
DBT consists of three components: weekly individual therapy, group skills training and phone consultation.
During the individual therapy sessions, the therapist coaches the patient about everyday use of the skills that they are learning, interweaving this reinforcement while discussing the client's experiences over the previous week, and in their past, Hartstein said.
The skills training sessions can be run as a group, individually, or with parents, depending on the situation.
The group model allows for clients to feel less lonely during the process, and to learn from the experiences of others, according to Hartstein.
In the third component of DBT, phone consultation, provides an opportunity for skill generalization. Life does not exist in a therapy office, and crises come up between sessions. Patients can call their therapist for coaching in between appointments, so that they can get help utilizing the skills in the moment. The combination of the three components has been found to be effective in decreasing suicidal thinking and self-injurious behaviors, Hartstein said.
Lorusso’s mother noted that the teen must want to recover in order to make therapy successful. Leslie Lorusso advises parents to let their children know they are there for them, unconditionally – and to be aware that self-injury is an addiction over which the afflicted has no control.
According to the Mayo Clinic, here are some signs to look out for to indicate your child may be self-injuring:
*Scars, scratches or bruises
*Keeping sharp objects on hand
*Spending a great deal of time alone
*Having trouble with relationships
*Wearing long sleeves or long pants, even in hot weather
*Claiming to have frequent accidents
Many experts believe self-injury is often underreported, so it’s difficult for teens to ask for help.
Peter Adler, professor of sociology at The University of Denver, and Patti Adler, professor of sociology at the University of Colorado, Boulder, have studied the behavior for the past 10 years, conducting in-depth interviews with people who self-injure, and analyzing nearly 40,000 blogs and chats on the topic.
What they found was that 72 percent of participants had cut themselves, 35 percent had burned themselves, 30 percent engaged in self-hitting, and the remaining broke bones, pulled hair or interfered with wound healing. And a whopping 78 percent self-injured in multiple ways.
According to the study, girls are more prone to practicing self-injury, but the Adlers suspect many males are doing it in silence – and not seeking help.
“I think there's still a lot of misunderstanding of the phenomenon out there, and my goal is to let the voices of the self-injurers who shared their life stories speak,” Adler said. “Our people and Peter's and my goal would be for there to be a greater understanding of self-injury and more resources available in communities to help them.”
For Lorusso, recovery was not easy.
“I learned why I cut, and what's happening in my life that starts my cycle,” Lorusso said. “I learned to accept emotions as they come.”