How do we stop the cutting?

17th September 2004 at 01:00
Britain is facing an epidemic of self-harm. More than 170,000 people a year - most of them teenagers and young adults - visit hospital casualty departments after deliberately hurting themselves in expressions of despair.

The shocking trend is exposed by figures collated by the Government's drugs and treatment assessment body, the National Institute for Clinical Excellence. It's the first time such statistics have been compiled and highlights mounting apprehension over the rising numbers of young people who cut, burn or mutilate themselves in an attempt to relieve mental anguish. Experts suggest that in the UK only heart disease and cancer take more lives than self-harm and suicide. And because self-harm is largely a problem that afflicts young people, it takes away a huge number of quality life years compared with diseases that strike when we are older - as most physical illnesses tend to.

Many people often think of self-harmers as attention-seekers; that the act of hurting themselves is a dramatic cry for help. As a result, when patients get to hospital, they may get short shrift from casualty staff who prefer to devote scarce resources to illnesses which are not self-induced.

Yet the latest medical research suggests that self-harm is just the start of a journey which can end in suicide. Psychiatric studies show that many men commit suicide 12 months after first harming themselves: the average interim period for women is 42 months.

There is no single reason why self-harming is becoming more common. The Centre for Suicide Research at Oxford University recently reported that self-harm rates among 15 to 24-year-olds in the UK are among the highest in Europe; those for men are second only to Finland, and those for women are second only to France. The centre has also shown that in the past two decades the number of young people who self-harm has risen by a third, while the number of those who repeatedly self-harm has climbed by almost two-thirds. Other surveys have found that young Asian women have become a risk group, perhaps because of alienation from their parents over issues such as arranged marriages.

In my clinical experience, patients referred from casualty departments say that cutting themselves, or taking an overdose, makes their suffering concrete and physical. It's difficult to get attention for despair while it remains a mental phenomenon, but a physical wound is tangible, something that can be understood and considered by others. It seems self-harm might be a mechanism for externalising anguish that otherwise would be ignored.

But the reasons someone starts self-harming may be different from why they keep doing it; chronic self-cutting seems to be strangely addictive.

When we feel pain, our bodies release endorphins, natural morphine-like substances that regulate discomfort. So self-harming could become repetitive because sufferers get addicted to their own endorphins. Indeed, they typically describe a sense of euphoria and release when they cut.

Given that the young are particularly prone to addictions, this is yet another reason self-harming should be vigorously treated and prevented. Yet the growing incidence suggests it is another example of how growing up today is getting tougher. We need to remember this next time we hear a grumpy adult tell us that "the young have never had it so good".

Professor Raj Persaud is a consultant psychiatrist at the Maudsley hospital and senior lecturer at the Institute of Psychiatry in London. He is this year's visiting Gresham professor for public understanding of psychiatry and will give three free public lectures at Barnard's Inn Hall, London EC1 on September 29, October 20 and November 29. See www.gresham.ac.uk for more details. Email: rajpersaud@tes.co.uk

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