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You'll hear it called many things -- self-inflicted
violence, self-injury, self-harm, para suicide, delicate cutting, self-abuse and
self-mutilation. Broadly speaking, self-injury is the act of attempting to alter
a perceived intolerable mood state by inflicting physical injury serious enough
to cause tissue damage to the body.
Types of
self-injury
- The most common is cutting (using razor blades or broken
glass, etc.)
- Burning
- Scratching
- Picking
- Interfering with
wound healing
- Head banging
- The breaking of bones.
There are many reasons people self-injure, some
include:
-
Relief from psychological pain
- Release of mounting
tension
- Inability to feel
- Feeling too much
- Wanting to feel
something
- Expressing anger
- And sometimes self-injury is even used
for getting attention-although in the majority of cases this is not true.
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. This
represents the main difference between self-injury and suicidality. Self-injury
is seen as a way to stay alive, and not die.
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. Definitions of moderate/superficial
self-injury: Perhaps one of 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 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.
Etiology
The most common question regarding
self-injury is “why”. Why would a person be driven to act upon themselves in a
way that causes physical trauma to the body? To forsake oneself to the point of
self-injury is the result of many different factors. Levenkron (1998) suggests;
Self-injury is a way of "being in control", a way to master an internal
sense of helplessness and anger. For these children,
self-injury becomes their coping mechanism in stressful situations. An example
of this is if a child was abused they are likely to have felt powerless in the
abuse. When this child becomes older they will often inflict pain upon
themselves when in a stressful situation thereby gaining a sense of mastery and
power.
From a psychoanalytic perspective self-injury is seen as a defense
mechanism masking or preventing repressed and or split off parts of the self or
object from entering consciousness. We sometimes deflect psychological pain and
distress into pain that seems understandable and controllable, like that of
self-injury. Subsequently, the self-injurer injures to distract or override
repressed feelings associated with unpleasant events from the past, such a
distraction keeps the individual feeling safe and in control.
A third
idea is that abused (verbal, sexual or physical) children often times received
the message that they are no good and bad, when feelings of “badness” are
internalized an act of self-injury externalizes those feelings making the sense
of impending doom more manageable. If Personal devaluation is followed by
physical or sexual abuse, when this child grows up they may recapitulate the
traumatic experiences in current relationships. This is done when a person is
experiencing real or imagined devaluing and inflicts injury to control and
fulfill the anticipation of punishment. Self-injurers, who are responding to
past abuse, have powerful negative messages running in their head, which
reinforces their thoughts and feelings of inferiority, badness, and their need
to be punished. A cycle that represents this thinking is; I am bad, because I am
bad I am unlovable, because I am unlovable, I am bad. Louise Kaplan writes in
Feminine Perversions (1991) that:
the self-injurer has learned that “action brings comfort,” while
“waiting long enough to think or speak only brings more tension and more
disorganization.”
Lader and Conterio wrote in Bodily Harm
that the use of the self-injury behavior is done to “master the traumatic
experiences.” “Self-injury permits control and predictability of the invasion of
boundaries.” This cycle of recapitulation is seen as unconscious to the
self-injurer and through the development of a therapeutic relationship
dependency needs surface, and if tolerated lead to the amelioration of the
cycle.
Levenkron (1998) also ads:
"self-injurers create pain as a medication to soothe their emotional
state.” The self-injurer will injure him or herself, and when this occurs, the
body will release hormones called endorphins. These are released to "fight
anxiety, agitation, and depression" (Levenkron,
1998).
These hormones have been described as the bodies
own narcotics, which causes a calming effect. When a self-injurer feels stress,
self-injuring behaviors release endorphins causing a temporary calming effect.
Thereby establishing self-injury as a mechanism for relief. This makes
self-injury a quick way to relieve unwanted stress, tension or emotional pain.
Due to the physiological effects that are potentially created through the act of
self-injury, the amelioration of the behavior is difficult to arrest.
Just as it's suspected that the 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 others. This tendency toward increased impulsive
aggression, combined with a belief that their feelings are bad or wrong, can
lead to the aggression being turned on the self. Once this
happens, the
self-injurer learns that harming behaviors reduce her level of distress, and the
cycle repeats. In other words, the self-injurer experiences a strong
uncomfortable emotion or thought, does not have alternative coping skills to
handle it, and based on prior experiences with self-injury come to choose
hurting themselves, as a way of gaining instant relief. They may still feel bad,
but without the panic and intense fear.
Defining the behaviors
characteristic of individuals who suffer from alienation, mistrust, loneliness,
self-hatred, hopelessness, and an impoverishment of expressive language for
their emotional pain, permits us to see them as persons seeking relief from
these feelings by the use of physical pain. The behaviors associated with
self-injury become more understandable to the injurer as well as the helper if
the behaviors are viewed in the context in which they live.
Please
let this information compliment what you already know and have lived through.
This information is being provided to help acquaint you with some of the
clinical understandings of self-injury.
For more information about
self-injury please visit our most recommended site on the web at http://www.palace.net/~llama/psych/injury.html
NOTE: The Healing House respects the personal experiences of all
those who have suffered or are currently suffering with self-injury. Our
clinical understandings are only possible through years of continued learning
and experience working with those of you who have trusted us enough to share
your stories and your time.
We would also like to thank S.A.F.E. Alternatives for their continued support
and guidance.
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