Articles by Our Staff
Self Injurious Behavior (SIB) increasing among young women
by Dr. Chris E. Stout
In recent years, parents have had to add more anxieties to their list of worries when sending their children off to college.
As if sex, drugs and alcohol weren't enough. Now it's tattoos and piercings as well. Usually, these represent a parental irritant on par with what long hair was for the grandparents of today's college kids, albeit more permanent.
For many, they're nothing more than a fashion statement – one that parents hope will be as discreet as possible. But for some young women, they can be a sign of more serious psychological problems. For these kids, tattooing and body piercing are passive forms of self injurious behavior, or SIB, that includes a particularly gruesome and often hidden practice commonly called "cutting."
"Cutting" can include behaviors like excessive scratching; shallow cuts on limbs; self-biting of the hands, limbs, tongue, lip, or arms; self-inflicted cigarette burns; and puncture wounds using pins or nails. Often, women who self-harm create "kits" containing blades, needles, glass shards, jigsaw blade bits or other tools to abuse themselves. Some of the tools may have symbolic meaning, and still others may be used during special situations or moods.
About 20 percent of women report that they have cut, burned, carved or harmed themselves in other ways according to a recent study by Cornell and Princeton University researchers. I once treated a young woman who said " .. the physical pain (of cutting) is nothing compared to the emotional pain ..." she was experiencing.
Often, this kind of behavior is linked to eating disorders. The Cornell study also found students who admitted to repeated self-harming behavior were twice as likely to suffer from the eating disorders anorexia or bulimia. In fact, eating disorders themselves are considered by some as a method of SIB.
Anorexia is a condition that goes beyond out-of-control dieting and approaches starvation. Bulimia is characterized by episodes of secretive excessive eating (binging), followed by self-induced vomiting (purging) as a way to control weight. Both can lead to long-term biological damage and even death.
Although eating disorders can start in early teens (and, in some cases even younger), studies indicate that by their first year of college, up to 18% of women have a history of bulimia and as many as 19% of college-aged women in America are bulimic.
And the trend line is not comforting for parents.
While the incidence of anorexia has remained fairly constant, the incidence of bulimia appears to be increasing. One study showed a fivefold increase in bulimia from 1988 to 1993, and there's no reason to think that trend has not continued. In fact, the Cornell study showed that "cutting" and other forms of SIB are also on the increase.
From our own experience, it seems many of the psychological disorders associated with SIB – eating disorders, obsessive compulsive disorder, impulsivity disorders, anxiety disorders and borderline personality disorder – have increased significantly during the past five years, and more often occur together. For instance, young women who have an eating disorder can also suffer from obsessive compulsive disorder and exhibit SIB.
What can a parent do?
First of all, don't panic or start assigning blame. The tattoo and body piercing she comes home with at Thanksgiving could simply be a fashion statement or the results of peer pressure. And the diet and exercise could well be a laudable attempt at self-improvement.
But do be on the look-out for behavioral cues that could indicate a clinical problem:
- Does she weigh less than what is normal while having an intense fear of gaining weight?
- Does she skip most meals or eat alone?
- Does she eat food in odd ways (such as only cranberry juice for days or entire heads of lettuce)?
- Have you found food hidden in strange places like her bedroom closet or in drawers?
- Does she make frequent trips to the bathroom, especially after meals, and have you noticed the smell of vomit in the bathroom or on her breath? (Some women will attempt to hide the smell by opening the bathroom windows and using a breath freshener.)
- Does she exercise excessively with multiple trips to the gym?
- Does she have repetitive behaviors she feels a need to perform such as counting or washing in a precisely organized way (and overreacts if her routine is disrupted)?
- Does she prefer to be alone and avoid social situations?
If you see these kinds of behaviors, your daughter may need help, in spite of her denials for needing it. Your first call should be to her pediatrician, family doctor, or trusted behavioral healthcare provider to help you take the first step on the road to recovery.