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Self-cutting
linked to risky behavior
(July 2008
Issue)
By Ami Albernaz
Teenagers who cut themselves repeatedly are more likely to expose
themselves to greater HIV risk than are teens that have cut themselves
no more than three times, new research suggests.
The study, led by Larry K. Brown, M.D., of the Bradley Hasbro Children's
Research Center in Providence, R.I., is the first to examine differences
between frequent and infrequent cutters. Self-cutting, though common
among adolescents in psychiatric inpatient programs, is not well
understood. Previous research has tended to lump together frequent
and infrequent cutting.
Brown and a team of psychologists found that repeat cutters - teens
who had cut themselves four or more times - had lower degrees of
self-restraint and a greater likelihood of past sexual abuse than
those who had tried it fewer times. Frequent cutters were also more
likely to engage in unprotected sex and to share cutting instruments.
"[Infrequent cutters] might try it a couple of times and decide
that's enough," says Brown, whose study appeared in the June issue
of the Journal of Developmental and Behavioral Pediatrics and included
105 adolescent cutters. "It doesn't seem to serve the same need
for them as it does for those who cut frequently."
Teens who repeatedly cut themselves might have more difficulty
managing their emotions than infrequent or non-cutters, Brown says.
Cutting might be a way to soothe strong feelings and release tension,
similar to the effects of risky sex suggested in earlier studies.
"We don't know for sure if that's what's going on with the kids,
but it's plausible," Brown says.
John O'Brien, Ph.D., a Portland, Maine psychologist who has worked
with teenage cutters, says that research on cutting is "an important
reminder for psychologists.
"I don't think people understand how widespread cutting is," he
says, adding that the problem is particularly prevalent among young
women. (In Brown's study, girls made up the majority of frequent
cutters). "Psychologists need to be talking to [cutters] about other
impulsive behaviors that could lead to harm, like substance abuse
and reckless, unprotected sex."
O'Brien says that cutters not only see their behavior as a way
to handle intense emotions, but also might recommend it to other
teens as a stress reliever. Yet "for kids who go back to it, there's
likely something pre-existing, a lack of impulse control that precedes
the cutting."
Therapists should be aware of the signs that someone is cutting,
O'Brien says. These include other self-destructive behaviors, such
as substance abuse and unprotected sex, and wearing long-sleeved
shirts in hot weather to conceal marks.
"It's certainly something you have to ask about, even repeatedly,
because someone might not open up about it the first time," O'Brien
says.
Brown adds that clinicians might alter their approach in working
with teen cutters. They might focus on helping teens develop strategies
to better manage their emotions, rather than concentrating on the
reasons for their feelings. Therapists should also not shy away
from discussing sexual practices that might place teens at risk,
he adds. "For example, if someone is anxious about using a condom,
[a therapist] can help deal with that anxiety," he says.
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