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People Who Cut Themselves and Why   
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Cutting with razors and other sharp objects is a troubling trend among women, especially teenagers. Disney starlet Demi Lovato sought treatment for the disorder earlier this year, along with bulimia and bipolar disease. Why do young women engage in such self-destructive behavior, and are these disorders connected? One of the nationís top psychiatrists, Mark Hyman Rapaport, M.D., explains people who cut themselves and whyÖ

Often, people who cut themselves hide their injuries out of shame and embarrassment.

But some of that stigma faded in January, when fresh-faced teen singer and actress Demi Lovato, then just 18, admitted she has wrestled with cutting and bulimia since she was 11 years old.

"It was a way of expressing my shame on my body," she told "20/20," ABCís newsmagazine.

"There were times where my emotions were just so built up, I didn't know what to do,Ē she says. ď[Cutting was] the only way I could get an immediate release."

While undergoing treatment last winter at an Illinois rehabilitation center, Lovato was also diagnosed with bipolar disease. Now she is speaking publically about all these issues.

Lifescript decided to dig deeper to understand why a beautiful young woman like Lovato Ė who seems to have it all Ė would engage in such self-destructive behavior. So we turned to Mark Hyman Rapaport, M.D., chairman of the department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center in Los Angeles.

In this exclusive Lifescript interview, Rapaport explains self-harm and cutting and what may cause these painful disorders.

Why would someone engage in self-harm or cutting behavior?
It can be [a sign] of someone under tremendous pressure and distress. Theyíve found this sort of dysfunctional behavior releases that.

Itís also a behavior that some people outgrow.

Are bipolar disorder, bulimia and cutting connected?
There are certainly adolescent people who have bipolar disorder and manifest it by a variety of different behaviors, but cutting doesnít mean somebody has bipolar disorder. It can be a sign of a variety of different dysfunctions.

How can parents spot signs of self-harm or cutting?
The first thing is to have a good enough relationship with your children that you know theyíve got a problem. [It's] important that thereís enough trust that the child is willing to work both with the family and outside experts to get help.

Thatís very difficult with adolescents Ė to have an open and non-judgmental relationship so they can come to you when theyíre in distress.

Should parents nose around more in their children's lives?
More than nosing around, [we should develop] the best relationship we can with our children and not take things for granted.

Our lives are all so busy [that] itís easy to say, ĎThere has been a change in my childís behavior, but since itís not creating a problem within the family now, I donít have time to deal with it.í

We need to address [the problem].

What are the top warning signs of people who cut themselves? What questions should parents ask?
1. Has there been a precipitate change in this personís friends, the types of people theyíre hanging out with? Have they withdrawn from them?

2. School performance and grades: Has that person also withdrawn from activities they used to enjoy and be part of? Have they gotten out of playing in the band. Are they no longer interested in participating in theater at school? Has there been a change in those activities and behaviors?

3. [Has there] been a change in their sleep-wake cycle, eating patterns [or other] day-to-day behaviors?

4. Is the child much more withdrawn, aggressive or assertive? Are we seeing more angry outbursts or tearfulness?

These are all [behaviors] that suggest that children are drifting [toward trouble] Ė whether itís mood, eating or alcohol- or substance-use disorders.

Why is it so difficult for children and teens to talk about cutting?
Many times, kids, by nature, want to try and handle it on their own. They feel ashamed about it, and donít want to be controlled by their parents at this point. Theyíre trying to be more independent.

Thatís why open communication and acceptance is good.

What happens to people who cut themselves if you donít deal with it head on?
Other [harmful] behaviors are experimentation with drugs and alcohol. It's a major problem [that] can begin as early as junior high school and increase in high school.

Frequently, there are issues around eating disorders, particularly with young women. That was the case [with Lovato]. She had been teased about her weight and developed eating disorders.

If teen girl has bulimia, is she more likely to practice self-harm or cutting?
One frequently sees [an array] of behaviors when someone has an eating disorder. Itís not just either binging or purging, food restriction or over exercising. It can be more basic or primitive behaviors, such as cutting.

Is peer pressure a cause?
We really donít know how much of it is [due to] the pressure these young children are under Ė the pressure to grow up faster, to succeed in school [or] act more [grown up] than they may be developmentally ready to do.

How tough is it for people who cut themselves to accept their diagnosis?
For anyone to come to grips with this Ė let alone an adolescent whose body is changing, and who still doesnít have the wisdom or experiences adults have had Ė is tough.

Healing takes a long time. A young person needs to get used to the fact that they have a chronic disease.

That is a tremendous burden to bear suddenly. Your friends donít have a disease, but you do. You feel very different [and] stigmatized.

How can adults minimize the shame people who cut themselves feel?
Itís important to realize that these are disorders of circuitry in the brain. Theyíre the same types [disorders] we see in the rest of the body. They just manifest differently.

The brain is the most complex system in the body. The mind and the body are connected Ė thatís why God made the neck.

What sort of treatment is best for people who cut themselves?
Intervention, whether through psychotherapy, medication or a combination of those approaches.

Can doctors treat people who cut themselves without medication?
Yes, sometimes, it can be very effectively treated by psychotherapy, depending on the reasons for the cutting, because Ė remember Ė cutting is a symptom. Itís not necessarily a disorder.

What kind of psychotherapy is most effective for people who cut themselves?
[Dialectical behavioral therapy or DBT] can be a very effective treatment for these types of destructive impulses. [DBT uses cognitive-behavioral techniques and meditation to teach patients to cope with stress, regulate emotions and improve relationships.]

Have there been advances in drug and other treatments for these disorders?
Weíve made tremendous progress and will continue to make it. Not just in terms of new compounds and medications, but even more importantly, weíre beginning to understand the basic biology behind [such self-destructive behavior].

What have you learned?
Weíre beginning to understand the role of stress and early-life trauma in [the development of] brain disorders later in life. Weíre beginning to understand the role of chronic perceived stress in triggering events and changing the biology of people.

Through our works in genetics and epigenetics [the study of how environment and choices can influence genes], we're learning individual factors that put someone at greater risk or resilience. This will allow us eventually to better tailor treatments.

Should we be optimistic about the future of treating brain diseases?
I want to emphasize the importance of hope. Just because somebody has a symptom of something like cutting or a brain disorder, itís not necessarily going to negatively impact the rest of their lives. Many people with brain disorders have wonderful lives.

What do people who cut themselves need to know most?
If theyíre cutting, they shouldnít be ashamed Ė they should realize people understand that itís because theyíre in distress. They need to know itís OK to get help.
Source: Lifescript

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