On Wikipedia, the causes of self-harm are listed as mental illness, psychological disturbances, genetic factors and substance abuse. But evidence is now emerging that ordinary young people with none of these predisposing factors are taking to inflicting cuts, burns and other injuries on themselves. It appears that self-harm is a more generalised phenomenon in modern society than was previously thought.
A recent study of students in the Danish capital has corroborated this view. It was conducted by Bo Møhl, a clinical psychologist at Copenhagen University Hospital. Møhl is convinced that the self-injuring teenagers seen in his study cannot all be disturbed.
"They cannot all have borderline personality disorder, or have alcoholic parents, or be the targets of sexual abuse,” says Møhl. “Many of them are perfectly normal students. It [self-harm] has cultural associations."
Students at six institutions offering general upper secondary education in Copenhagen were given a questionnaire concerning their experiences with self-harm. The researchers collected 3,000 useable answers from students with an average age of 17 years (the range was 15-19 years).
The questions were based on a precise definition of self-harm, which excluded suicide attempts and more indirect forms of self-harm such as eating disorders, alcohol abuse or substance abuse.
The study showed that:
These figures show that self-harm has become a fashion in today's culture, not only among young people with psychiatric problems, but also ordinary teenagers. And just like other fashion phenomena, its influence spreads.
"Many cut themselves because they see others do it and gain from it," says Møhl. "There are also many celebrities who talk about their self-harm experiences, and that too has an enormous influence.”
Examples of the latter include Princess Diana, Angelina Jolie, Amy Winehouse and Johnny Depp.
In modern society, identity has become a constant preoccupation. We cannot get an identity just by being a family member or by having a role in society. We constantly need to profile and position ourselves as 'somebody' and we fear being regarded as a 'nobody'.
Newspapers, magazines and adverts broadcast relentless recipes for achieving 'somebody' status. We are told how to dress, how to look, which car to drive, what to do in our spare time and how to furnish our homes. For most people, fulfilling these exacting demands on how to be seen as the right kind of person is an impossible quest. And their sense of identity suffers as a result.
"Many young people feel uncertain about their identity," says Møhl. "They constantly seek confirmation of their personal importance and they fear failure and the feelings it produces. Those who engage in self-harm are often perfectionists who have difficulty dealing with such feelings."
People who cannot live up to demands from themselves and others can experience strong feelings of shame, self-hate and depression. Self-harm can then perform the same function as alcohol. It is a way to relieve stress and emotional tension.
And just as alcoholics have difficulty in saying no to a drink, it can be difficult to refrain from self-harm because of the physical and mental dependence that is known to be associated with it.
"Once self-harm develops into a coping strategy, it becomes less and less easy to cope with conflicts and other stresses in a non-self-harming way," says Møhl.
The difference between attempted suicide and self-harm is that the former is an attempt to escape from life, while self-harm is an attempt to escape from unbearable feelings. However, people who have engaged in self-harm are more likely to attempt suicide if self-harm no longer works as a coping strategy.
Self-harm also has physiological effects on the body, since endorphin production is activated when the body is injured. Endorphins are naturally occurring narcotics, so self-harm gives some people a kick. And just like other narcotics, it can also create physical dependence.
But the rush of positive feelings is quickly replaced by feelings of shame, guilt, depression and regret. A vicious circle then begins, since these feelings stimulate more self-harm to relieve them (see diagram).
It is commonly thought that females engage in self-harm more than males, but Møhl's study shows that male teenagers are not only just as likely to engage in self-harm as their female counterparts, but also use self-harm more persistently and intensely.
The study also shows that while self-harm among the females eased over time, it became more persistent among the males. And once they started, it was more difficult to stop.
The results of Møhl's study highlight the need to focus on self-harm both among girls and boys. Teachers and social workers, who are often the first to discover the problem, have to be trained in handling young people who do self-harm.