Self-Injury Awareness Day: March 1
Self-harm (SH) or deliberate self-harm (DSH) includes self-injury (SI) and self-poisoning and is defined as the intentional, direct injuring of body tissue most often done without suicidal intentions
Mosby’s Medical, Nursing, and Allied Health Dictionary (1994) contains the following definition:
- “A state in which an individual is at high risk to injure but not kill himself or herself, and that produces tissue damage and tension relief. Risk factors include being a member of an at-risk group, inability to cope with increased psychological/physiological tension in a healthy manner, feelings of depression, rejection, self-hatred, separation anxiety, guilt, and depersonalization, command hallucinations, need for sensory stimuli, parental emotional deprivation, and a dysfunctional family.”
In 1998 Favazza states that:
- “Self-mutilation is distinct from suicide. Major reviews have upheld this distinction . . . A basic understanding is that a person who truly attempts suicide seeks to end all feelings whereas a person who self-mutilates seeks to feel better.”
Types of Self-Injury
There are many ways a person self-injures:
- Cutting with knives, razor blades, broken glass, needles, nails, paper clips, pins, scissors, and tacks
- Banging your head against walls
- Punching walls till your hand goes all bruised and bloody
- Throwing yourself through panes of glass
- Setting your hair and/or skin on fire
- Swallowing batteries, broken glass, razor blades, or needles
- Hitting yourself with objects
- Punching yourself in the stomach, legs, and/or head
- Breaking your own bones
- Purposely exposing yourself to extreme weather conditions without wearing protective clothing so you’ll get frostbite or sunburn or chills and fevers
- Staring directly into the sun until it nearly blinds you
- Pulling out your hair
- Biting or scratching yourself
- Interference with the healing of wounds
Self-injury is separated into three types:
- Major self-mutilation (including such things as castration, amputation of limbs, etc.) is fairly rare and usually associated with psychotic states.
- Stereotypic self-injury comprises the sort of rhythmic head-banging, etc., seen in autistic, mentally retarded, and psychotic people.
- The most common form of self-mutilation is called superficial or moderate. This can include cutting, burning, scratching, skin-picking, hair-pulling, bone-breaking, hitting, interference with wound healing, and virtually any other method of inflicting damage on oneself. Both in clinical studies and in an informal survey, the most popular act was cutting, and the most popular sites were wrists, upper arms, and inner thighs. Many people have used more than one method, but even they tend to favor one or two preferred methods and sites of abuse.
- Three subtypes of superficial/ moderate self-mutilation:
o Episodic: cutting, burning, bone breaking. To relieve anger, regain a sense of self-control, and terminate states of emotional deadness. May be driven by a variety of psychological and medical conditions including post-traumatic stress disorder, depression, dissociative disorder, and personality disorder.
o Repetitive: same as episodic, but they cut themselves chronically and develop a fixed identity around cutting.
o Compulsive: most repetitive and ritualistic of the three subtypes. (Ex. Trichotillomania). These are more subconscious than cutting and operate more like an OCD. Relieves mounting anxiety.
Why Do People Self-Injure?
- Escape from emptiness, depression, and feelings of unreality.
- In order to ease tension.
- Relief: when intense feelings build, self-injurers are overwhelmed and unable to cope. By causing pain, they reduce the level of emotional and physiological arousal to a bearable one.
- Expression of emotional pain.
- Escaping numbness: many of those who self-injure say they do it in order to feel something, to know that they’re still alive.
- Obtaining a feeling of euphoria.
- Continuing abusive patterns: self-injurers tend to have been abused as children. Sometimes self-mutilation is a way of punishing oneself for being “bad.”
- Relief of anger: many self-injurers have enormous amounts of rage within. Afraid to express it outwardly, they injure themselves as a way of venting these feelings.
- Biochemical relief: there is some thought that adults who were repeatedly traumatized as children have a hard time returning to a “normal” baseline level of arousal and are, in some sense, addicted to crisis behavior.
- Obtaining or maintaining influence over the behavior of others.
- Exerting a sense of control over one’s body and/or life.
- Grounding in reality, as a way of dealing with feelings of depersonalization and dissociation.
- Maintaining a sense of security or feeling of uniqueness.
- Expressing or repressing sexuality.
- Expressing or coping with feeling of alienation.
- Self-injury produces endorphins (the body’s natural opiates). This is the body’s way to prepare for injuries. This chemical alleviates the emotion pain and produces a feeling of calmness.
The majority of cutters are women, between the ages of 13 and 30, but there are cutters of every age and gender. The majority tends to be middle- or upper-middle-class. Often times they have been sexually molested and/or physically abused during their childhood.
Self-injurers are usually people who:
- Are well-educated
- Extremely intelligent, sensitive, and creative people who strongly dislike/invalidate themselves
- Are hypersensitive to rejection
- Are chronically angry, usually at themselves
- Tend to suppress their anger
- Have high levels of aggressive feelings, which they often suppress or direct inward
- Are more impulsive and more lacking in impulse control
- Tend to act in accordance with their mood of the moment
- Tend not to plan for the future
- Are depressed and suicidal/self-destructive
- Suffer chronic anxiety
- Do not see themselves as skilled at coping
- Do not have a flexible repertoire of coping skills
- Do not think they have much control over how/whether they cope with life
- Tend to be avoidant
- Do not see themselves as empowered
- They had low self-esteem and low optimism about life
- Bright, talented, perfectionists who push themselves beyond all human bounds
- People-pleasers who cover their pain with a happy face