Medical: Self-injury seems to help reduce negative emotions in some

In some cultures and beliefs, ritualistic self-abuse is viewed as an act of contrition.

But in most of the world, doing physical harm to one's self is considered a sign of mental disorders ranging from deficiency in emotional regulation to depression.

Most therapists view self-injury to some extent as a coping mechanism, used to turn emotional pain into a temporary physical pain somewhat within the person's control.

However, recent brain-imaging studies reported by a team of German scientists document that painful stimuli actually do seem to help reduce negative emotions in some people with borderline personality disorders.

Scientists at the University of Heidelberg reported in the August issue of the journal Biological Psychiatry on their conducting of brain images on a group of people with personality disorder while the subjects were being shown pictures intended to induce negative, positive or neutral emotions. The researchers found that the amygdala and other elements of the brains' emotional circuits were unusually active compared with those of a control group.

But when the study group was given a painful heat stimulus, the level of activity in the amygdala was inhibited. This also occurred in the healthy control subjects' amygdalae, which the authors said presumably suppressed emotional reactivity.

Earlier research had shown that people with borderline personality disorders experience emotional hyperactivity, and the new findings suggest that pain suppresses that tendency in the brain, rather than simply distracting it from the disturbing emotions.

Although doctors have recently gotten better guidelines for screening the teens and young adults most likely to engage in self-harm as a result of emotional disorders, another new study, done by researchers at Stanford University and the Lucile Packard Children's Hospital, indicates that many don't always screen teens with an eating disorder for such behavior.

They looked at records of more than 1,400 patients ranging in age from 10 to 21 who were treated for eating disorders between 1997 and 2008. They found that nearly 41 percent had engaged in intentional self-inflicted injury -- about 85 percent of those cut themselves. Yet only about half the patients had been asked about this type of behavior by hospital staff when they entered care.

Dr. Rebecka Peebles, lead author of the report published online by the Journal of Adolescent Health, said it appeared that many providers had adopted a narrower profile for screening than the results showed, and that the hospital now inquires about self-harm behavior in all new patients at the eating-disorders clinic.

Other research has found that between 13 percent and 40 percent of all American adolescents engage in some form of self-injury. Those practicing the behavior are also at elevated risk for suicide.

Although cutting is considered the most common type of self-harm, wounds inflicted with heated metal objects and other materials also are regularly seen.

A report last month by researchers at Nationwide Children's Hospital in Columbus, Ohio, highlighted the practice of embedding foreign objects under the skin. According to findings in the journal Radiology, nearly 2 percent (11 of 600) patients included in an injury survey were found to have self-embedded objects.

In most of the cases, parents and pediatricians had no idea that the children had put the objects under their skin themselves, It required additional imaging to reveal any implanted glass or plastic items or the extent of the embedding.

In all, the 11 patients -- nine of them girls, and an overall average age of 15 -- had embedded a total of 76 objects, including paper clips, staples, pencil leads, and glass and plastic fragments. They were found to be suffering from mental-health conditions, including bipolar disorder, depression, anxiety disorders, panic disorders and post-traumatic stress disorder.

One of the authors of the study, radiologist Dr. William Shiels, noted that radiologists may often be the first doctors to see the items and understand what they imply.

He also noted that using advanced X-ray and ultrasound technology allow surgeons to remove the objects using forceps and other minimally invasive methods to avoid physical scars for children as they're trying to heal emotionally.