Demi Lovato enters rehab

Disney Channel star Demi Lovato checked herself into rehab over the weekend. The 18 year old had been on an international tour as a special guest of the Jonas Brothers. The young starlet is probably best known for her roles in the “Camp Rock” movies and the sitcom “Sonny With a Chance.” An official statement from her representatives reports that “Demi has decided to take personal responsibility for her actions and seek help…She is doing just that. Demi and her family ask that the media respect her privacy during this difficult time.” A source close to the Lovato family told People magazine that Demi has “… fought through eating disorders and has struggled with cutting. [She] is taking control by getting help.”

In a 2009 interview with The Associated Press, Lovato said she had to leave middle school at one point because she was bullied so badly. “It was more verbal harassment than physical abuse, but that’s actually more scarring than anything,” she said. “And I had to leave because I just couldn’t deal with it. And I’ve home-schooled ever since.”

We don’t the exact reason Lovato has now entered rehab, however, whatever the reason, we wish her well. As we just talked about the topic of anorexia nervosa in our story on Portia De Rossi, we can use this opportunity to talk a little about cutting and other forms of non-suicidal self-injury.

What is cutting?

Cutting is one variation of a spectrum of self injury disorders. Although the most common manifestation of self-injury involves cutting oneself with any sharp or jagged object, self-injury includes a wide range of other destructive behaviors, such as burning, wound interference/picking, hitting, hair-pulling—even something called self-embedding- where foreign objects are inserted under the skin.  Self-injury often becomes a ritualistic pattern of behaviors- for instance,  using the same tool, cutting  in the same locations, and so on. For these individuals, self- injury is a way of coping with painful feelings such as worthlessness, anger, guilt, helplessness, rejection, and self-hatred.  It becomes a physical expression of overwhelming internal emotions for some,  and serves to temporarily relieve stress and anxiety caused by these emotions in others.

Who are cutters?

  • Experts estimate the incidence of habitual self-injurers is nearly 1% of the population with a higher proportion of females than males.
  • The typical onset of self-harming acts is at puberty.
  • Though not exclusively, the person seeking treatment is usually from a middle to upper class background, of average to high intelligence, and has low self-esteem.
  • Nearly 50% report physical and/or sexual abuse during his or her childhood.
  • Many report (as high as 90%), that they were discouraged from expressing emotions, particularly anger and sadness.

Is cutting a suicide attempt?

Self-injury is their way to cope with or relieve painful or hard-to-express feelings, and is generally not a suicide attempt, or “cry for help”. In fact, cutters typically often fiercely try to hide their cutting.   Unfortunately, the relief with cutting is temporary, and a self-destructive cycle often develops without proper treatment.
Self-injurers may feel desperate about their lack of self-control and the addictive-like nature of their acts, which may lead them to true suicide attempts. The self-injury behaviors may also cause more harm than intended, which could result in medical complications or death. Eating disorders and alcohol or substance abuse intensify the threats to the individual’s overall health.

What the warning signs that someone may be cutting?

Warning signs that someone is injuring himself or herself include:

  • Unexplained frequent injury including cuts and burns
  • Wearing long pants and sleeves in warm weather
  • Low self-esteem
  • Difficulty handling feelings
  • Relationship problems
  • Poor functioning at work, school or home

How is self- injury treated?

If  someone displays the signs and symptoms of self-injury, a mental health professional with self-injury expertise should be consulted. The effective treatment of self-injury is most often: a combination of medication, cognitive/behavioral therapy, and interpersonal therapy, supplemented by other treatment services as needed. Medication is often useful in the management of depression, anxiety, obsessive-compulsive behaviors, and the racing thoughts that may accompany self-injury.

For more information about cutting and non-suicidal self-injury (NSSI), see our related story on MedPageToday and click here to go the Resounding Health Casebook on the topic. Some support organizations are listed among the bookmarks.

Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.

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