By: Andrew Levander, MFT
You'll hear it called many things -- self-inflicted violence, self-injury, self-harm, Para suicide, delicate cutting, self-abuse, self-mutilation (this last particularly seems to annoy people who self-injure). Broadly speaking, self-injury is the act of attempting to alter a perceived intolerable mood state by inflicting physical harm serious enough to cause tissue damage to the body.
There are many methods a self-injurer may use:
- The most common is cutting (using razor blades or broken glass, etc.)
- Interfering with wound healing
The reasons why someone self-injures are numerous and each time it is done, it does not necessarily have to be for the same reason. Some of the reasons are:
- Relief from psychological pain
- Release of mounting tension
- Inability to handle any kind of feeling-good or bad
- Wanting to feel something
- And sometimes self-injury is even used for getting attention-although in the majority of cases this is not true
Research
Researchers in the field and study of self-injury have for many years looked at the classification and types of self-injurious behaviors so that the clinical underpinnings of self-injury could emerge to best meet the therapeutic needs of the self-injurer.
Kahan and Pattison (1984; Pattison and Kahan, 1983) tackled these taxonomic problems. They began by identifying three components of self-harming acts: directness, lethality, and repetition.
Directness
Refers to how intentional the behavior is; if an act is completed in a brief period of time and done with full awareness of its harmful effects and there was conscious intent to produce those effects, it is considered direct. Otherwise, it is an indirect method of harm.
Lethality
Refers to the likelihood of death resulting from the act in the immediate or near future. A lethal act is one that is highly likely to result in death, and death is usually the intent of the person doing it.
Repetition
Refers to whether of not the act is done only once or is repeated frequently over a period of time It is defined simply by whether or not the act is done repeatedly.
Is Self Injury An Addiction?
Although self-injury may temporarily alleviate unwanted thoughts and or feelings, self-injurious behavior happens in the absence of healthy relationships with people. As a coping strategy, self-injury interferes with intimacy, educational successes, creativity and a person’s health and wellness.
Self-injury is not seen as an addiction, as the self-injurer is not viewed as powerless, however, self-injury is addiction-like, in that people engage in the repetitive or compulsive behaviors despite the consequences. The long-term goal in therapy is to create a master list of creative and relationally based alternatives that the self-injurer can utilize when the urge to act upon her/himself arises. It is important to note that children, adolescents and adults do stop injuring; they are all people in need of consistent, relationship-oriented support, nurturance and guidance.
Some of the Facts
Self-harm isn't a failed suicide attempt
Sometimes people injure themselves because they want to die. But often its more about staying alive. People may hurt themselves to help them get through a bad time. Its a way to cope.
People self-harm in different ways
Some cut their arms or legs; others bang or bruise their bodies. Self-harm also includes burning, scratching, hair pulling, scrubbing, or anything that causes injury to the body. Some people take tablets, perhaps not a big overdose, but enough to blot things out for a while.
It doesn't mean you're crazy
All sorts of people self-injure, even people in high-powered jobs. It's a sign that something is bothering and upsetting you, not that you are mad.
Lots of people self-harm
You may not have met anyone else who self-harms and may even think you are the only one who does it. There's a lot of secrecy about self-harm. But millions of people cope in this way.
It's not "just attention-seeking"
People self-harm because they are in pain and trying to cope. They could also be trying to show that something is wrong. They need to be taken seriously.
It can happen once, or many times
Some people attempt suicide or hurt themselves just once or twice. Other people use self-injury to cope over a long time. They might inure themselves quite often during bad times.
People do stop self-injury
Many people stop self-injury (when they're ready). They sort their problems out and find other ways of dealing with their feelings. It might take a long time and they might need help. But things can get better.
Other things can be 'self-injury' too
Things like starving, overeating, drinking too much, risk-taking, smoking and many others are also types of 'self-injury'. Some coping methods (like burying yourself in work) may be more acceptable, but can still be harmful.
Definitions of moderate/superficial self-injury:
Perhaps the best definition of self-injury is found in Winchel and Stanley (1991), who define it as:
...The commission of deliberate harm to one's own body. The injury is done to oneself, without the aid of another person, and the injury is severe enough for tissue damage (such as scarring) to result. Acts that are committed with conscious suicidal intent or are associated with sexual arousal are excluded.
Malon and Berardi (1987) summarize the process they believe underlies self-injury:
Investigators have discovered a common pattern in the cutting behavior. The stimulus...appears to be a threat of separation, rejection, or disappointment. A feeling of overwhelming tension and isolation deriving from fear of abandonment, self-hatred, and apprehension about being unable to control one's own aggression seems to take hold. The anxiety increases and culminates in a sense of unreality and emptiness that produces an emotional numbness or depersonalization. The cutting is a primitive means for combating the frightening depersonalization.
Incidence & onset
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. The behaviors often last for 5-10 years but can persist much longer without appropriate treatment.
Background of self-injurers
Though not exclusively, the person seeking treatment is usually from a middle to upper class background, of average to high intelligence, and has chronic feelings of low self-esteem. Nearly 60% 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.
Behavior patterns
Many who self-injure use multiple methods? Cutting arms or legs is the most common practice. Self-injurers may attempt to conceal the resultant scarring with clothing, and if discovered, often make excuses as to how an injury happened. A significant number are also struggling with eating disorders and alcohol or substance abuse problems. An estimated one-half to two-thirds of self-injurers have an eating disorder.
Reasons for behaviors
Self-injurers commonly report they feel empty inside, over or under stimulated, unable to express their feelings, lonely, not understood by others and fearful of intimate relationships and adult responsibilities. Self-injury is their way to cope with or relieve painful or hard-to-express feelings and is generally not a suicide attempt. But relief is temporary, and a self-destructive cycle often develops without proper treatment.
Dangers
Self-injurers often become 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 and quality of life.
Diagnoses
Self-injurious behavior can be a symptom of several psychiatric illnesses: Personality Disorders (esp. Borderline Personality Disorder); Bipolar Disorder (Manic-Depression); Major Depression; Anxiety Disorders (esp. Obsessive-Compulsive Disorder); as well as psychoses such as Schizophrenia.
Evaluation
If someone displays the signs and symptoms of self-injury, a mental health professional with self-injury expertise should be consulted. An evaluation or assessment is the first step, followed by a recommended course of treatment to prevent the self-destructive cycle from continuing.