Self-harm

Self-harm (SH) is injury inflicted by a person upon his or her own body, whether conscious or unconscious. Some scholars use more technical definitions related to specific aspects of behavior. This injury may be aimed at relieving otherwise unbearable emotions, sensations of unreality and numbness, or for other reasons. Self-harm is generally a social taboo. It is sometimes associated with mental illnesses such as Borderline Personality Disorder, with a history of trauma and abuse, with eating disorders, or with mental traits such as perfectionism.

Definition

Self-harm is also known as self-injury (SI), self-inflicted violence (SIV), self-injurious behavior (SIB), and self-mutilation¹, although this last term has connotations that some people find perturbing. When discussing self-harm with someone who engages in it, it is suggested to use the same terms and words which that person uses, e.g. "cutting", rather than insisting on labeling it "self-harm".

A common form of self-injury is shallow cuts to the skin of the arms or legs, or less frequently to other parts of the body, including the breasts and sexual organs. Since this is the most well-known, it is casually referred to as "cutting", though it may also involve punching, slapping, or burning oneself as well. The usual thought process behind self-injury is not to attempt suicide, but to relieve unbearable emotional pressure, or some kind of discomfort. Self-injury is seen by some as attention seeking behavior, though 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 alternate explanations for their injuries or conceal their scars with clothing.

Strictly, self-harm is a general term for self-damaging activities (which could include alcohol abuse, bulimia, etc). Self-injury refers to the more specific practice of cutting, bruising, self poisoning, over-dosing (without suicidal intent, at first), burning or otherwise directly injuring the body. Self-harm is also a way for people to relieve the emotional pain of everyday life, especially in the case of teenagers, but not exclusively. People who self harm may hurt themselves with a favourite 'tool' or by whatever means available to "wipe out" the emotional distress that they feel inside.

It should be noted that many people, including Health Care Workers, define self harm based around the act of damaging one's own body, whereas it may be more accurate to define self harm based around the intent and the emotional distress that the person wishes to deal with.

Demographics

The average European rate of self-harm and attempted suicide for persons over 15 years is 0.14% for males and 0.193% for females. For each age group the female rate exceeds 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.² It has also been speculated that there is a significant amount of unrecorded cases among men, which never surface because males tend to feel more guilty and ashamed of showing signs of "weakness", or else feel they should cope alone.

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.³

Psychology

One theory states that self-injury is a way to "go away" or dissociate, separating the mind from the feelings that are causing the anguish. This is done 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 may also act as a distraction from emotional pain, similar to the way a hot water bottle reduces the pain of a stomach ache. The sexual organs may be deliberately hurt as a way to deal with unwanted feelings of sexuality.

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." ⁴

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, 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’." ⁵

A flow diagram of these two theories is available here.

Self-harm may also give a feeling of being in control of one's own body, which could be especially important for survivors of sexual abuse.

Self-injury may also be a means of communicating distress. This motivation is sometimes dismissed as "attention seeking" and has often been seen as the primary motivation. However, for many, the act of self-harm fulfils a purpose in itself and is not a means of communicating with or influencing others. Many who self-injure keep their injuries secret, while those who do disclose their injuries may be embarrassed and ashamed of their actions.

Those who engage in self-harm face the contradictory reality of harming themselves whilst at the same time obtaining relief from this act. 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. A similar rush of endorphins is triggered when someone receives a tattoo. In this way, one can become addicted to getting tattoos. Similarly, those who self injure may also become addicted to the endorphin rush.

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.

A lesser form of this extreme act is, for example, hitting one's head on the table or pulling one's hair out. Although this is often used euphemistically, for those who do it serves the same purpose of deferring the stress experienced by the major cause by the pain from this secondary option.

Culture / Community

It has been said, usually in a derogatory fashion by the Media, that there is a 'culture of self injury' within schools, colleges and on the web.

There are certainly communities that are based around the subject of self harm, and they tend to focus around a message board with or without a main website. But there is not 'a community', there is not one Umbrella organisation that represents or speaks for people who self harm. There are many community sites of varying sizes that offer peer-support, emotional discussion, philosophical and psychological discussion, and general chit-chat.

There is some consternation as to whether such communities encourage and support self harm, however, such communities are known as Pro-SI and are separate from general SI Awareness communities.

There is anecdotal evidence⁶ that by being free to express feelings and SI related thoughts, that a person can understand their emotional world and reasons for self harming; people who no longer hurt themselves often continue to be members of SI Awareness Message Boards for some time after 'quitting' and offer support to those people who wish to move away from self harm.

Treatment

Self-harm is a syndrome, and may be an indicator of depression and / or other psychological problems. It is worth noting that whilst self-injury is emphatically not a failed or half-hearted suicide attempt, there is a non-causal correlation between self-injury and suicide. While self harming behaviour may seem alarming and appear dangerous, for most of the people engaged in self injurious behaviour, self-injury serves a purpose, allowing them some degree of control over their feelings. Identification of the cause of emotional distress and subsequent therapy (e.g. behavior modification through Cognitive Behavioral Therapy [i.e. the learning of new coping mechanisms]), A person who is injuring themselves may be advised to do something when they have the urge to harm themselves. They might be told to write in a journal or address their feelings in another safe manner. They may also be told to avoid having the objects they use to harm themselves within easy reach. Diagnosis and treatment of the causes is thought by many to be the best approach to self-harm; some clinicians, however, take a behavioral approach in order to reduce the behavior itself. People who rely on habitual self-harm are sometimes psychiatrically hospitalised.

See also

• List of self-harmers

External links

Alphabetical

• American Self-Harm Information Clearinghouse
• Helpguide: Self-Injury: Types, Causes and Treatment
• LifeSIGNS: Self Injury Guidance & Network Support
• Lysamena Project: A Christian Viewpoint on SI
• Psyke: Self-Injury Information and support
• Recover Your Life (formerly Ruin Your Life): A Self Harm Support Community
• SAFE
• Samaritans
• Self-Injury Abuse/Trauma Directory
• Self Injury; a Struggle: Self-Injury Support Site
• Showing Our Scars
• Sirius Project: Self-Help for Self-Harm

Further reading

• Favaro, A. & Santonastaso, P. (2000). Self-injurious behavior in anorexia nervosa. The Journal of Nervous and Mental Disease, 188(8), 537-542.
• Favazza, A.R. & Rosenthal, R. J. (1993). Diagnostic issues in self-mutilation. Hospital and Community Psychiatry, 44, 134-140.
• Levenkron, S. (1998). Cutting. New York, NY: W. W. Norton and Company.
• Stanley, B., Gameroff, M. J., Michalsen, V., & Mann, J. J. (2001). Are suicide attempters who self-mutilate a unique population? American Journal of Psychiatry, 158(3), 427-432.
• Suyemoto, K. L. & MacDonald, M. L. (1995). Self-cutting in female adolescents. Psychotherapy, 32(1), 162-171.
• Zila, L. M. & Kiselica, M. S. (2001). Understanding and counseling self-mutilation in female adolescents and young adults. Journal of Counseling & Development, 79, 46-52.
• Strong, Marilee (1999). A Bright Red Scream. G P Putnam's Sons

References

1. LifeSIGNS Self Injury Awareness Booklet, Version 2 Mar. 01, 2005 from Self Injury Awareness Booklet, LifeSIGNS
2. World Health Organisation Europe Multicentre Study of Suicide, retrieved Jul. 20, 2004 from Women and Parasuicide: a Literature Review, Women's Health Council
3. Retrieved Jul. 20, 2004 from Hospitalisation for intentional self-harm, New Zealand Health Information Service
4. Retrieved Jul. 28, 2005 from LifeSIGNS: Precursors to Self Injury
5. Retrieved Jul. 28, 2005 from LifeSIGNS: Precursors to Self Injury
6. LifeSIGNS Self Injury Awareness Booklet, Version 2 Mar. 01, 2005 p.33-43 from Self Injury Awareness Booklet, LifeSIGNS