Definition
Self-Injury, also commonly known as self-harm; self-mutilation; self-abuse; and self inflicted violence, 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. First, self-injury is an act done to the self. Second, it is done by the self. Third, it must include some type of physical violence. Fourth, self-injury is not undertaken with the intent to kill oneself. And fifth, it is an intentional act.
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.
*Explaination*
Self-injury cuts across the boundaries of race, gender, age, education, sexual preference, and socio-economic brackets. There is no 'typical' self-injurer, however, through the compilation of the traits of known self-injurers it is possible to build an image of the 'typical' self-injurer. A self- injurer is typically female, although recent statistics put the number of males and females who self- injure as roughly equal. 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.
*The Purpose Self-Injury Serves*
The alteration or destruction of body tissue may be regarded on its surface (both literally and figuratively) as a morbid behaviour on the one hand, and as a self-help behaviour on the other We all have methods of coping with stress, whether it be emotional, physical or psychological. Coping is a behaviour which an individual utilizes to get through stressful and difficult times as best they can. And sometimes the methods we use are extreme, perhaps excessive in comparison to the original stressor. Self-injury is an example of an extreme method, but a method that, nonetheless, serves it's purpose. Mentally ill self-injurers have an increased risk of suicide, although self-injury itself in not a failed attempt at suicide. It is frequently mistaken for a suicidal gesture, but there is a clear distinction between repetitive self- injury and suicide attempts. Self-injury is intended not to kill, but rather to relieve unbearable emotional pain and many survivors regard it, paradoxically, as a form of self-preservation The reasoning behind self-injury is diverse and by no means the same for all self- injurers. Self-injurers may give a single reason for their behaviour, but, more commonly, their reasons are multiple and sometimes, on the surface, seemingly conflicting.
*Which Reason Do You Self Injur?*
RELIEF FROM OVERWHELMING EMOTIONS is one of the reasons given most often for self-injury. The immense internal psychic pressure felt from overwhelming emotions can seem uncontrollable, frightening, and dangerous. People who self-injure have often not learned to identify, express, or release their emotions. Most have never developed the ability to feel and express emotions as others do. 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 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 minimise or doubt their own internal experiences. Physically expressing the emotional pain allows them to have concrete evidence of intangible, amorphous, or indefinable emotionsSelf-injury speaks loudly of the pain the individual feels long before they have the words to express it.
UNREALITY, NUMBNESS, AND DISSOCIATION are experienced by many self-injurers. 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 defence 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 anaesthesia, so that severe injuries may be inflicted with a minimum of painAlthough 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. One woman uses the analogy of a magician taking a dollar and tearing it into many pieces. He waves his wand, mumbles some words and 'presto' the dollar is whole again. She says she feels like that dollar, ripped up into may pieces, she cuts and 'presto' she feels whole again.
SELF-
PUNISHMENT AND SELF-HATE may well be the simplest and most easily understood explanation of self-injury. 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 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.
*Why The Docs Don't Get It*
The Nature of Self-Injury
Self-injury has been, and still is to a large degree, perceived by mental health professionals and people in general as repulsive, frightening, and senseless. It many times engenders reactions of anger and hopelessness by those who work with self-injurers. In great part, for these reasons, despite the relatively high prevalence of deviant self-injury, this behaviour still remains somewhat mysterious. It has largely been ignored by the professionals that the self-injurer turns to for help. Although the 1990's has seen a large increase in the reporting of self-injury and research into the condition is increasing, it is still not well understood by professional mental health workers.
*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 behaviour. 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. This shame explains the excuses that are offered for the injuries, such as cat scratches, accidents in the kitchen, and so on.
RITUALS IN SELF-INJURY can relate to the environment that self-injury is carried out in, the instruments the individual uses to cause the injuries, and the procedure that the individual will follow. The most highly ritualised behaviours are those of cutting and burning. Other behaviours, such as hair-pulling; skin picking; and hitting oneself, tend to be less likely to follow a ritual. One of the reasons for this is that they are usually done without the use of any other instruments and tend to be more impulsive. Many self-injurers have specific places where they will carry out their self-injuring. The typically choose a place where they will be alone. This most likely is because alienation and isolation often precipitate self-injury and these emotions are more likely to occur when the individual is alone. Many also arrange their environment in certain way, such as with the use of candles; burning incense; drawing curtains; and so on. If there was a pattern to the occurrence of childhood abuse, self-injurers may find themselves following this pattern with their self-injuring. The use of instrument, such as a single edge razor blade rather than a double edged one, is also important to many. If their instrument of choice is not available they may not engage in the self-injurious behaviour until it is available. Many self-injurers have a procedure that they feel they must follow in performing their self-injury. It may involve laying out all the objects required to inflict the injuries and to then care for them, it may the use and arrangement of objects not to be used in the act of injuring, such as music and candles, or it may pertain to the order that everything is to be done in.
