| Self-Injury
Self-Injury, also commonly known as
self-harm; self-mutilation; self-abuse; and self inflicted violence.
Self-injury is
defined as the deliberate harming or alteration of one's body tissue
without the conscious intent to commit suicide.
Integral to this definition are several key
concepts.
- Self-injury
is an act done to the self.
- It is done by the self.
- It must include some type of physical
violence.
- Self-injury is not undertaken with the
intent to kill oneself.
- It is an intentional act.
How can you determine if an activity is
self-abusive?
Ask the following questions. If the answer to any is
"yes" then the activity in question is self-abusive.
A. Will this activity negatively affect my
health or safety?
B. Will this activity prevent me from functioning independently and
successfully?
C. Will this activity predictably result in me getting less of what
I need and want?
D.
Will this activity hurt my relationship with someone who is important in
my life?
Self-injury
cuts across the boundaries of race, gender, age, education, sexual
preference, and socio-economic brackets.
Self-injury
typically begins during adolescence. Many self-injurers have histories, or
current problems, of substance abuse, eating disorders, and compulsions.
They often lack the ability and skills to regulate their moods by other
methods.
Many
have a history of being abused (physically, sexually, and emotionally),
with a large proportion of the abuse starting in childhood.
Commonly,
people who self-injure have a history of psychological treatment through
admissions to psychiatric hospital and/or in seeking therapy.
Why do they Self-mutilate?
Relief from Overwhelming Emotions:
The immense internal psychic pressure felt from overwhelming emotions can
seem uncontrollable, frightening, and dangerous. People who self-injure
have not learned how to identify, express, or release their emotions. Most
have never developed the ability to feel and express emotions. They may
not have been allowed to show or release their true emotions. Yet their
feelings still exist, whether they show them or not. They may have adopted
self-injury as a strategy for getting relief from these intense feelings.
The relief gained from these emotions is rapid, but temporary. The
effectiveness of self-injury, at the moment, to provide relief and release
is one of the reasons why self-injurers find it so difficult to stop.
Physical
Expression of Emotional Pain:
This is one way for the self-injurer to provide evidence/confirmation of
their psychological suffering. Self-injurers speak of their wounds and
their scars as being a way to see the pain they feel inside. That by
causing these injuries they are bringing their pain out to be seen and
perhaps healed. Often, individuals who engage in self-injury tend to minimize
or doubt their own internal experiences. Physically expressing the
emotional pain allows them to have concrete evidence of intangible,
amorphous, or indefinable emotions. Self-injury speaks loudly of the pain
the individual feels long before they have the words to express it.
Dissociation,
Unreality and Numbness:
Dissociation is something that most of us have experienced, through such
breaks in consciousness as daydreaming or driving past your exit from the
motorway. Even though everyone dissociates to some degree at times, for
some it is a defense mechanism, protecting them in the face of intolerable
emotional pain. After a time, this too becomes intolerable, and
self-injury may become a means for reducing, preventing, or ending a
disturbing dissociative state. At times, the emotionally numb state may
extend to physical anesthesia, so that severe injuries may be inflicted
with a minimum of pain (Moskovitz 1996). Although we all dissociate, most
of us do not fear that we will physically and/or psychologically
disintegrate. What makes it different for self- injurers is that they feel
they are shattering - falling apart.
Self-punishment
and Self-hatred
Histories of childhood abuse (physical, sexual, and/or emotional) are
represented in a high proportion of individuals who self-injure. Common
with childhood abuse is the child erroneously blaming themselves for their
abuse. Many children believe that they deserved everything they got, they
somehow asked for it, and that they are innately bad. These lessons from
childhood often remain and influence their treatment of themselves. They
are unduly critical of themselves, leading to feelings of shame and blame,
which then leads to self-punishment for their perceived transgression.
Many self-injurers have been taught that many thoughts, feelings, and
emotions that we take for granted, such as feeling angry and having needs,
are bad and deserve punishment. When these are aroused in them their
self-hate is emphasized and they feel they have to pay. Many describe the
letting of their blood, the essence of their life force, as getting rid of
some of the badness.
Self-nurturing:
This may seem to be in conflict with the act of intentionally hurting
oneself, but self-injury has a self-nurturing component for some
individuals through the self-care they are able to give to themselves
afterwards, and through the making on internal wounds external there is
also an attempt to heal oneself. Feeling that they are alone and that no
one cares is common with self-injurers. A gain from their injuries is the
care they give to themselves. One self-injurer described it as 'an excuse
to take care of and be gentle with myself'. Self-mutilation may also be
therapeutic because of the symbolism associated with the formation of scar
tissue; scar tissue indicates that healing has occurred. Thus, with a few
strokes of a razor the self-cutter may unleash a symbolic process in which
the sickness within is removed and the stage is set for healing as
evidenced by a scar. The cutter, in effect, performs a primitive sort of
self-surgery, complete with tangible evidence of healing (Favazza 1996).
Shame:
Shame and self-injury are deeply related for most self-injurers. There
appears to be a cycle connecting shame with self-injury. Often
self-injurers feel a sense of shame, related to their past experiences,
before they hurt themselves and after the act they feel shame about what
they have done to themselves. This self-generating cycle often breeds
secrecy about the behavior. The shame self-injurers feel and the fear of
being judged by others leaves them isolated and this further perpetuates
the self-injury cycle. The shame and embarrassment that is felt due to the
self-injury can arise from different aspects of the self-injury. It can be
affected by the physicality of the wound, the type of injuries that the
individual engages in, the emotions that are experienced, sometimes a
feeling of not being in control and vulnerability.
Self-Injury Affects ALL Aspects of the
Self.
a) Body
direct damage to the skin and other body parts
the inappropriate use or overdose of prescribed medications and "over
the counter" drugs
the use of street drugs, alcohol and tobacco
the inappropriate consumption of too much or too little food
binging, purging and vomiting
b) Mind
negative self-talk which constitutes internal verbal self-abuse
self-criticism and harsh judgment
put-downs, insults to self
rejecting one's self
c) Spirit
"hanging-on" to shame and unnecessary guilt
d) Social Aspects of Life
setting himself or herself up for loss, rejection and abandonment
activities both verbal and physical which negatively affect family
and friends.
misusing
financial resource.
Types of Self-Injury
Favazza (1996) separates self-mutilation
into two major groups. The first being culturally sanctioned
self-mutilation, which is subdivided into rituals and practices, and the
second deviant self-mutilation, which is subdivided into major
self-mutilation, stereotypical self-mutilation, and superficial or
moderate self-mutilation. It is the second group, deviant self-mutilation,
and more specifically the subdivision of superficial or moderate
self-mutilation, that is the subject of this research.
Major self-mutilation acts, such as
castration; amputation; and eye enucleation, are most commonly associated
with psychotic states. They tend to occur suddenly, with major tissue
damage and profuse bleeding. Stereotypic self-injury is repetitive and the
pattern of acting out can be rhythmic. It is most commonly seen amongst
the autistic, mentally retarded, and psychotic populations. The most
typical behaviour is that of head-banging. Superficial or moderate is the
most frequently performed act of self-injury. The prevalence of
self-injurious behaviour is put in the range of 750 to 1,400 cases per
100,000 population. The most common methods of injury are cutting,
burning, skin-picking, hair-pulling (trichotillomania), bone-breaking,
hitting, and interference with wound healing.
Favazza (1996) has further subdivided
superficial or moderate self-injury into three types: compulsive,
episodic, and repetitive. Compulsive self-injury is repetitive and
ritualistic and has multiple occurrences in a day. The most common
behaviours are hair pulling (trichotillomania) and skin picking. Episodic
self-injury occurs every so often and without the self-injurer identifying
themself as a 'cutter' or 'burner'. It may be a symptom, or associated
feature, of many disorders. Among them being anxiety, dissociative
disorders, depression, and personality disorders. Episodic self-injury
becomes repetitive when the self-injurer becomes overwhelmingly
preoccupied with the behaviour and identifies with being a 'cutter' or
'burner'. A repetitive self- injurer may describe themself as being
addicted to their self-harm. It is not the number of injuries that,
therefore, marks the difference between episodic and repetitive
self-injury, but rather the person's identity with their behaviour.
Repetitive self-injury is best considered an impulse control disorder, not
otherwise diagnosed.
Who Self-Injurers?
Self-injury cuts across all boundaries of
race, gender, age, education, sexual preference, religion and
socio-economic brackets.
Self-injury typically begins during adolescence, peaks during the
twenties, and declines or disappears in the thirties.
Many self-injurers also have histories, or current problems, of substance
abuse, eating disorders, and compulsions (obsessive/compulsive or
compulsive alone).
They often lack the ability and skills to regulate their moods by other
methods. Many have a history of being abused (physically, sexually, and
emotionally), with a large proportion of the abuse starting in
childhood.
Commonly, people who self-injure have a history of psychological treatment
through admissions to psychiatric hospital and/or in seeking
therapy.
There also appears to be a significant relationship between self-injury
and the lack of social-support systems.
What do Self-Injurers say about Why they
do it?
'to run away from my feelings'
'to feel pain on the outside
instead of the inside'
'to cope with my feelings'
'to express my anger toward
myself'
'to feel like I'm real'
'to turn off emotions and hide
from reality'
'to tell people that I need help'
'to get people's attention'
'to tell people I need to be in
hospital'
'to get people to care about me'
'to make other people feel
guilty'
'to drive people away'
'to get away from stress and
responsibility'
'to manipulate situations or
people'
What can be done to help?
a) GET PROFESSIONAL HELP
This is not a problem to try to fix at home. Immediate, regular and
consistent care is crucial.
b) Hope.
Hope for improvement and for control over their lives is the
ingredient identified as most important in reducing and eventually
discontinuing self-abuse. Self-abusive
behavior is supported by an environment in which people feel worthless,
powerless and hopeless. They react to these feelings by lapsing into
increasingly self-abusive behaviors and in the process alienate family,
friends and professionals.
c) Non-judgmental acceptance.
People who self-abuse are sensitive to the feelings of those around
them. They are able to "pick up on" the frustration, anger and
rejection of others. They expect this and are looking for it.
People who will be able to help are those who are able to understand that
self-abuse does not constitute a flaw of character but is a
problem-solving device that soothes the painful feelings but makes life
more difficult at the same time.
d) Understanding the behavior.
Both helpers and clients need to accept the fact that self-abuse is
soothing. It is also a way to maintain some sense of control over painful
experiences and problems of living.
e) Learning healthy ways of self-soothing.
Since people who self-injure have never learned how to soothe
themselves in healthy ways they need to be shown that a variety of
strategies can be used effectively. They need to be helped to create a
list of such strategies to use when urges to self-abuse come.
When first introduced to this concept they will often resist, saying
"that doesn't work".
They need to be encouraged to keep trying, to work through several of
their strategies before they "give up" and self-abuse.
f) Dealing with "trigger" events.
Raising to conscious awareness the cycle of response to a trigger
event gives opportunities
to discover what "triggers" the individual
to challenge the cognitive distortions
to identify and deal with the emotional reactions
to formulate a variety of alternative strategies to deal with the
trigger event
to choose one of these alternatives and act on it
Consistent use of this process will allow
the person to feel more positive about their abilities to solve problems.
They will feel stronger and more competent.
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