Self-injury (SI) or Self-harm (SH) is deliberate injury inflicted by a person upon his or her own body. Some scholars use more technical definitions related to specific aspects of this behavior. These acts may be aimed at relieving otherwise unbearable emotions, sensations of unreality and numbness. Self-injury is generally considered a social taboo. It is listed in the DSM-IV-TR as a symptom of borderline personality disorder and is sometimes associated with mental illness, a history of trauma and abuse, eating disorders, or mental traits such as low self-esteem or perfectionism. There is a positive statistical correlation between self-injury and emotional abuse.
Self-injury has traditionally been known as self-harm (SH), self-inflicted violence (SIV), self-injurious behavior (SIB), and self-mutilation,[3] although this last term has connotations that some people find worrisome, inaccurate, or offensive. A broader definition can also include the phenomenon of those who inflict harm on their bodies by means of disordered eating, or compulsive tattooing or body piercing or impulsive non-lethal injuring. When discussing self-injury with someone who engages in it, it is suggested that one use the same terms and words which that person uses, e.g. "cutting".[4] Self-injury is usually not associated with an attempt at suicide; the person who self-injures is not usually seeking to end his or her own life, but is instead hoping to cope with or relieve unbearable emotional pain or discomfort.[5]
A common form of self-injury involves making shallow cuts to the skin of the arms or legs. This is casually referred to as "cutting"; a person who routinely does this may be colloquially called "a cutter". Localized multiple cuts, especially those similar in appearance, are sometimes characteristic of cutting, but are not reliable indicators of self-injury. Less frequently, this behaviour may involve cutting other parts of the body, including the breasts and sexual organs. Other examples of self-injury include:
Punching, hitting and scratching
Choking, constricting of the airway
Self-biting of hands, limbs, tongue, lips, or arms
Picking at wounds, ulceration, sutures, or blemishes
Burning, including cigarette burns, and self-incendiarism (as well as eraser burns)
Stabbing self with wire, pins, needles, nails, staples, or pens
Ingesting corrosive chemicals, batteries, or pins[6]
Self-poisoning; for example by over-dosing on medication and/or alcohol, without suicidal intent[4]
A popular misconception of self-injury is that it is an attention seeking behavior. In truth, many people who self-injure are very self-conscious of their wounds and scars and go to great lengths to conceal their behavior from others. They may offer alternative explanations for their injuries or conceal their scars with clothing.[4][7]
In the strictest terms, self-harm is a general term for self-damaging activities (which could include alcohol abuse and bulimia), whereas self-injury refers more specifically to the practice of cutting, bruising, poisoning, over-dosing (without suicidal intent), burning or otherwise directly injuring the body.[8] Many people, including health-care workers, define self-harm based around the act of damaging one's own body. It may be more accurate to define self-harm based around the intent, and the emotional distress that the person wishes to deal with. An example of this form of definition is provided by the self-injury awareness charity, LifeSIGNS.[9]
Neither the DSM-IV-TR nor the ICD-10 provide diagnostic criteria for self-injury. It is often seen as only a symptom of an underlying disorder,[5] though many people who self-injure would like this to be addressed.[7]
Self-inflicted wound is a specific term associated with soldiers, where they inflicted harm on themselves (commonly a shot in the foot or hand) in order to obtain early dismissal from combat.[10][11]This differs from the common definition of self-injury as the damage is inflicted for a specific secondary purpose.
[edit] Demographics
Accurate statistics on self-injury are hard to come by since most self-injurers conceal their injuries.. Recorded figures tend to be based on hospital admissions, though more recently researchers have attempted to document the topography and correlates of the behavior in the general population. Studies based only on hospital admissions may hide the larger group of self-injurers who do not need or seek hospital treatment for their injuries.[5] Many of these statistics show that more women seem to self-injure than men, and that it is more common among young people.
One of the earliest studies into self-injury was carried out in 1986 by Conterio and Favazza, who estimated that 0.75% of the population exhibit self-injurious behavior. Half the sample had been hospitalised for the problem, and 97% of were female.[12] It should be noted that more recent studies show the numbers of self-injurers to be more evenly split between female and male.
A study of self-injurious behavior in college students published by Cornell University researchers in 2006 found that the most common methods of self-injury reported by both male and female subjects were scratching or pinching with fingernails or other objects to the point that bleeding occurred or marks remained on the skin (51.6%), banging or punching objects to the point of bruising or bleeding (37.6%), cutting (33.7%), and punching or banging oneself to the point of bruising or bleeding (24.5%). Female subjects were 2.3 times more likely to scratch or pinch and 2.4 times more likely to cut. Male subjects were 2.8 times more likely than female subjects to punch an object with the intention of injuring themselves. Male subjects were 1.8 times more likely to injure their hands, whereas female subjects were 2.3 times more likely to injure their wrists and 2.4 times more likely to injure their thighs. Self-injury is popularly assumed to represent a female phenomenon, and although there is some disputed support to this claim, the authors of the study believe that the popular association of self-injury with cutting may account for this belief.[13]
The WHO/EURO Multicentre Study of Suicide estimated that the average European rate of self-injury for persons over 15 years is 0.14% for males and 0.193% for females. For each age group the female rate exceeded that of the males, with the highest rate among females in the 15-24 age group and the highest rate among males in the 12-34 age group. Recently, however, it has been found that the female to male ratio, previously thought to be around 2:1, is diminishing – in Ireland it has been close to parity for a number of years.[14]
The Mental Health Foundation estimates the rate in the UK to be 0.77%,[15] and that the majority of people who self-harm are aged between 11 and 25 years, with between 1 in 12 and 1 in 15 young people self-harming .
A 2003 study commissioned by Samaritans found that more than 1 in 10 15-16 year olds in the UK have deliberately harmed themselves, and that girls of this age were nearly four times more likely to have self-harmed than boys.[16]
In a study of undergraduate students in the United States, 9.8% of the students surveyed indicated that they had purposefully cut or burned themselves on at least one occasion in the past. When the definition of self-injury was expanded to include head-banging, scratching oneself, and hitting oneself along with cutting and burning, 32% of the sample said they had done this. This suggests that this problem is not associated only with severely disturbed psychiatric patients but is not uncommon among young adults.[17]
In a study of psychiatric morbidity carried out in the UK, respondents were asked the question: "Have you ever harmed your-self in any way, but not with the intention of killing yourself?" This survey found an overall lifetime prevalence of 2.4%, this being 2.0% of males and 2.7% of females.[1]
About 10% of admissions to medical wards in the UK are as a result of self-harm, however the majority of these are for drug overdoses, with only 5 to 15% of this number being caused by cutting.[15]
In New Zealand, more females are hospitalised for intentional self-harm than males. Females more commonly choose methods such as self-poisoning that generally are not fatal, but still serious enough to require hospitalization.[18]
[edit] Risk factors
A number of social or psychological factors can be seen to have a positive statistical correlation with self-injury or its repetition.
People experiencing various forms of mental ill-health can be considered to be at higher risk of self-injuring. Key issues are depression,[1][19] phobias,[1] conduct disorders[20] Substance abuse is also considered a risk factor[5] as are some personal characteristics such as poor problem resolution skills, impulsivity, hopelessness and aggression.[5] Many self-injurers grew up in an environment that discourages expression of anger[citation needed]. Abuse during childhood is accepted as a primary social factor,[21] also losing a parent or loved one,[15] along with troubled parental or partner relationships.[5].[2] Factors such as war, poverty, and unemployment may also contribute.[1][22][23]
However, some people who self-injure have no experience of these factors
Attempts to understand self-injury fall broadly into either attempts to interpret motives, or application of psychological models.
Motives for self-injury are often personal, often do not fit into medicalised models of behaviour and may seem incomprehensible to others, as demonstrated by this quote:
“ "My motivations for self-harming were diverse, but included examining the interior of my arms for hydraulic lines. This may sound strange."[24] ”
Assessment of motives in a medical setting is usually based on precursors to the incident, circumstances and information from the patient[5] however the limited studies comparing professional and personal assessments show that these differ with professionals suggesting more manipulative or punitive motives.[25]
The UK ONS study reported only two motives: “to draw attention” and “because of anger”.[1] Many people who self-injure state that it allows them to "go away" or dissociate, separating the mind from feelings that are causing anguish. This may be achieved by tricking the mind into believing the pain felt at the time is caused by self-injury instead of the issues they were facing before: the physical pain therefore acts as a distraction from emotional pain.[4] The sexual organs may be deliberately hurt as a way to deal with unwanted feelings of sexuality, or as a means of punishing sexual organs that may be perceived as having responded in contravention to the persons well being.(e.g., responses to child sexual abuse)[citation needed]
To complement this theory, one can consider the need to 'stop' feeling emotional pain and mental agitation. "A person may be hyper-sensitive and overwhelmed; a great many thoughts may be revolving within their mind, and they may either become triggered or could make a decision to stop the overwhelming feelings."[26]
Alternatively self-injury may be a means of feeling something, even if the sensation is unpleasant and painful. Those who self-injure sometimes describe feelings of emptiness or numbness (anhedonia), and physical pain may be a relief from these feelings. "A person may be detached from himself or herself, detached from life, numb and unfeeling. They may then recognise the need to function more, or have a desire to feel real again, and a decision is made to create sensation and ‘wake up’."[26] A flow diagram of these two theories accompanies this section.
It is also important to note that some self-injurers report feeling very little to no pain while self-harming.[21]
Those who engage in self-injury face the contradictory reality of harming themselves whilst at the same time obtaining relief from this act. It may even be hard for some to actually initiate cutting, but they often do because they know the relief that will follow. For some self-injurers this relief is primarily psychological whilst for others this feeling of relief comes from the beta endorphins released in the brain (the same chemicals responsible for the "runner's high"). These act to reduce tension and emotional distress and may lead to a feeling of calm.
As a coping mechanism, self-injury can become psychologically addictive because, to the self-injurer, it works; it enables him/her to deal with intense stress in the current moment. The patterns sometimes created by it, such as specific time intervals between acts of self-injury, can also create a behavioral pattern that can result in a wanting or craving to fulfill thoughts of self-injury.
Another possible source of self-injury can be self-loathing, often as a means of punishment for having strong feelings that they were expected to suppress when they were children, or because they feel bad and undeserving, having previously been physically or emotionally abused and feeling that they were deserving of the abuse.[27]
Another often overlooked area that can result in self-injurious behavior is processing disorders. Autistic-spectrum disorders, especially when undiagnosed, or misdiagnosed, can result in severe depression, anxiety and fluctuating behavior. The rising depression rates in the UK teenage population could be accounted for by the fact that there is no testing being carried out on the NHS for such disorders. If a person is diagnosed with depression and anxiety, the help available is most often medication and (arguably pre-scientific) therapy (such as psychodynamic therapy). This could mean that a large proportion of people with various processing disorders are unable to be diagnosed as such. It is arguable that the stress resulting from living with no support for an undiagnosed disorder, or being given inappropriate therapy, could lead to self-injurious behavior.
Often, people with disorders such as autism are unable to feel certain stimulation, such as temperature, hunger and pain, in the same way as someone without a processing disorder usually would. In his book The Ultimate Stranger: The Autistic Child, Carl Delacato (1974) classified each sensory channel as being either hyper (too much stimulation gets in through the sensory channel for the brain to cope with) hypo (too little stimulation gets in through the sensory channel causing the brain to be deprived) and "white noise" (the faulty channel creates its own stimulus).
A person with autism often displays behaviors to balance their sensory dysfunction. If, for example, a person was hypo-tactile, they may attempt to stimulate themselves by using methods that could be categorized as self-injury.
In some cases, the person who is self-harming may be obsessed with testing themselves. The self-harming is seen by them as a way to test their limits of pain.[citation needed]
[edit] Self-injury awareness
There are many movements among the general self-injury community to make self-injury itself and treatment better known to mental health professionals as well as the general public. SIAD (Self Injury Awareness Day) which is set for March 1 of every year, is one such movement. On this day some people choose to be more open about their own self-injury, and awareness organizations make special efforts to raise awareness about self-injury. Some people wear ribbons to show awareness; commonly orange ribbons are used for this. Sometimes a red and black ribbon is also used, generally signifying a person who self-injures.[28] Sometimes orange is used to represent those who self-injure, white for those who don't injure but show support and white and orange together show someone who is trying to stop or has stopped self-injury.[29] A single white bead on an orange bracelet may sometimes be used for those who want to stop and several mixed white and orange beads is for those who have stopped.[30]
[edit] Treatment
Self-injury may be an indicator of depression and / or other psychological problems. Therapy and skills training can be very useful for those who self-injure. The therapy module used will vary depending on the person's diagnosis and their individual needs.
DBT, or Dialectical behavioral therapy can be very successful for those with a personality disorder, and could potentially be used for those with other mental illnesses who exhibit self-injurious behavior. Cognitive Behavioral Therapy is generally used to assist those with axis 1 diagnoses, such as depression, schizophrenia, and bipolar disorder. Diagnosis and treatment of the causes is thought by many to be the best approach to self-injury; but in some cases, particularly in clients with a personality disorder, this is not very effective, which is why more clinicians are starting to take a DBT approach in order to reduce the behavior itself. A person who is injuring themselves may be advised to use coping skills, such as journaling or taking a walk, when they have the urge to harm themselves. They may also be told to avoid having the objects they use to harm themselves within easy reach. People who rely on habitual self-injury are sometimes psychiatrically hospitalised, based on their stability, and their ability and especially their willingness to get help.
Self Injury Information
