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Self Injury
What is self-injury?
It's called many things - self-inflicted violence, self-injury,
self-harm, parasuicide, delicate cutting, self-abuse, self-mutilation (this last particularly seems to annoy people who
self-injure).
Self-injury is also called the "new age anorexia," the practice of self-abuse or mutilating
behavior is on the rise.
Broadly speaking self-injury is the act of attempting to alter a mood state by inflicting
physical harm serious enough to cause tissue damage to one's body.
Approximately 1% of the United States population
uses physical self-injury as a way of dealing with overwhelming feelings or situations, often using it to speak when no
words will come.
The forms and severity of self-injury can vary, although the most commonly seen behavior is cutting,
burning, and head-banging.
Other forms of self-injurious behavior include:- carving
- scratching
- branding
- marking
- burning/abrasions
- biting
- bruising
- hitting
- picking, and pulling skin and hair
It's not self-injury if the primary purpose is:
- sexual
gratification
- body decoration (e.g., body piercing, tattooing)
- spiritual enlightenment via ritual
- fitting
in or being cool
Why does self-injury make some people feel
better?
- It reduces physiological and psychological tension rapidly.
- Studies have suggested that when people who self-injure get emotionally
overwhelmed, an act of self-harm brings their levels of psychological and physiological tension and arousal back to a bearable
baseline level almost immediately. In other words, they feel a strong uncomfortable emotion, don't know how to handle it
(indeed, often do not have a name for it), and know that hurting themselves will reduce the emotional discomfort extremely
quickly. They may still feel bad (or not), but they don't have that panicky jittery trapped feeling; it's a calm bad feeling.
- Some people never get a chance
to learn how to cope effectively.
- One factor common to most people
who self-injure, whether they were abused or not, is invalidation. They were taught at an early age that their interpretations
and feelings about the things around them were bad and wrong. They learned that certain feelings weren't allowed. In abusive
homes, they may have been severely punished for expressing certain thoughts and feelings. At the same time, they had no
good role models for coping. You can't learn to cope effectively with distress unless you grow up around people who are
coping effectively with distress. Although a history of abuse is common about self-injurers, not everyone who self-injures
was abused. Sometimes invalidation and lack of role models for coping are enough, especially if the person's brain chemistry
has already primed them for choosing this sort of coping.
- Problems with neurotransmitters may play a role.
- Just
as it's suspected that they way the brain uses serotonin may play a role in depression, so scientists think that problems
in the serotonin system may predispose some people to self-injury by making them tend to be more aggressive and impulsive
than most people. This tendency toward impulsive aggression, combined with a belief that their feelings are bad or wrong,
can lead to the aggression being turned on the self. Of course, once this happens, the person harming himself learns that
self-injury reduces his level of distress, and the cycle begins. Some researchers theorize that a desire to release endorphins,
the body's natural painkillers, is involved.
What kinds of people self-injure?
Self-injurers come from all walks of life and all economic
brackets. People who harm themselves can be male or female; gay, straight, or bisexual; Ph.D.'s or high-school dropouts
or high-school students; rich or poor; from any country in the world. Some people who self-injure manage to function effectively
in demanding jobs; professors, engineers. Some are on disability. Their ages range from early teens to early 60s.
In fact, the incidence of self-injury is about the same as that of eating disorders, but because it's so highly stigmatized,
most people hide their scars, burns, and bruises carefully. They also have excuses ready when someone asks about the scars.
Aren't people who would deliberately cut or burn themselves psychotic?
No more than
people who drown their sorrows in a bottle of vodka are. It's a coping mechanism, just not one that's as understandable
to most people or as accepted by society ad alcoholism, drug abuse, overeating, anorexia and bulimia, workaholism, smoking
cigarettes, and other forms of problem avoidance.
Okay, then isn't it just another way to describe a failed
suicide attempt?
NO. Self-injury is a maladaptive coping mechanism, a way to stay alive. People who
inflict physical harm on themselves are often doing it in an attempt to maintain psychological integrity - it's a way to
keep from killing themselves. They release unbearable feelings and pressures through self-harm, and that eases their urge
toward suicide. And, although some people who self-injure do later attempt suicide, they almost always use a method different
from their preferred method of self-harm.
Can anything be done for people who hurt themselves?
Yes. Many new therapeutic approaches have been and are being developed to help self-harmers learn new coping mechanisms
and teach them how to start using those techniques instead of self-injury. These approaches reflect a growing belief among
mental-health workers that once a client's patterns of self-inflicted violence stabilize, real work can be done on the problems
and issues underlying the self-injury. Also, research into medications that stabilize mood, ease depression, and calm anxiety
is being done; some of these drugs may help reduce the urge to self-harm.
What problems may be encountered when getting
professional help?
Self-injury brings out many uncomfortable feelings in people who don't do it: revulsion, anger,
fear, and distaste, to name a few. If a medical professional is unable to cope with her own feelings about self-harm, then
he/she has an obligation to the client to find a practitioner willing to do this work. In addition, the therapist has the
responsibility to be certain the client understands that the referral is due to the practitioner's own inability to deal
with self-injury and not to any inadequacies in the client.
People who self-injure do generally do so because
of an internal dynamic, and not in order to annoy, anger or irritate others. Their self-injury is a behavioral response
to an emotional state, as is usually not done in order to frustrate caretakers.
What problems may be encountered in
the emergency room?
In emergency rooms, people with self-inflicted wounds are often told directly and indirectly, that
they are not as deserving of care as someone who has an accidental injury. They are treated badly by the same doctors who
would not hesitate to do everything possible to preserve the life of an overweight, sedentary heart-attack patient.
Doctors in emergency rooms and urgent-care clinics should be sensitive to the needs of patients who come in to have self-inflicted
wounds treated. If the patient is calm, denies suicidal intent, and has a history of self-inflicted violence, the doctor
should treat the wounds as they would treat non-self-inflicted injuries. Refusing to give anesthesia for stitches, making
disparaging remarks, and treating the patient as an inconvenient nuisance simply further the feelings of invalidation and
unworthiness the self-injurer already feels.
Although offering mental-health follow-up services is appropriate,
psychological evaluations with an eye toward hospitalization should be avoided in the emergency room unless the person is
clearly a danger to his/her own life or to others. In places where people know that self-inflicted injuries are liable to
lead to mistreatment and lengthy psychological evaluations, they are much less likely to seek medical attention for their
wound infections and other complications.
Why do adolescents self-injure?
Adolescents
who have difficulty talking about their feelings may show their emotional tension, physical discomfort, pain and low self-esteem
with self-injurious behaviors. Although they may feel like the "steam" in the "pressure cooker" has
been released following the act of hurting themselves, teenagers may also feel hurt, anger, fear, and hate.
What
can parents do about self-injury?
Parents must listen to their child and acknowledge their child's feelings.
(In other words, parents should validate feelings - not necessarily the teen's behavior.)
Parents should also
serve as role models in the way they deal with stressful situations and traumatic events, in how they respond to other people,
by not allowing abuse or violence in the home, and by not engaging in acts of self-harm.
Evaluation by a mental
health professional may assist in identifying and treating the underlying causes of self-injury. A mental health professional
can also diagnose and treat the serious psychiatric disorders that may accompany self-injurious behavior.
Feelings
of wanting to die or suicidal plans are reasons for parents to seek professional care for their child immediately.
Author: Deb Martinson
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