Self-harm (SH) is deliberate injury to one's own body. 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; and with mental traits such as perfectionism.
Self-harm is also known as self-injury (SI), self-inflicted violence (SIV), self-injurious behaviour (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 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. A more rare form of self-injury involves swallowing dangerous objects or substances. The usual purpose of self-injury is not to attempt suicide, but to relieve unbearable emotional pressure. However, self-injury is a strong predictor for future suicide or suicide attempts. A self-injurer is significantly more likely than people of other diagnoses to attempt or complete suicide in the year after an incident of self-injury. Self-injury is seen by some as attention seeking behavior, though many self-injurers are ashamed and embarrassed, going to some lengths to conceal their behavior from others.
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. They may cut themselves with scissors or use whatever means available to "wipe out" the emotional distress that they may be feeling inside.
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".
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 hospitalisation.3
Psychology
One theory states that self-injury is a way to "go away" or disassociate, 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.
Alternatively self-injury may be a means of feeling something, even if the sensation is unpleasant. Those who self-injure sometimes describe feelings of emptiness or numbness, and physical pain may be a relief from these feelings. Self-harm may also give a feeling of being in control of one's own body, which could be especially important for victims 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 contradicting reality of harming themselves while at the same time feeling a relief from this act. 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 mentally addictive because, to the self-injurer, it works; it enables him/her to deal with intense stress in the current moment.
Treatment
Self-harm is a syndrome, and may be an indicator of depression and/or other psychological problems. While it is alarming and possibly dangerous, for most victims it serves a purpose, allowing them some degree of control over their feelings. Identification of the cause of emotional distress and subsequent therapy (e.g. behaviour modification through Cognitive Behavioural Therapy [i.e. the learning of new coping mecahnisms]), 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. Self-injurers are sometimes psychiatrically hospitalized, but there is controversy [edit: there is always controversy, is this statement necessary?] over whether inpatient treatment is helpful for them.
See also
External links
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
- LifeSIGNS Self Injury Awareness Booklet, Version 2 Mar. 01, 2005 from Self Injury Awarness Booklet, LifeSIGNS
- World Health Organisation Europe Multicentre Study of Suicide, retrieved Jul. 20, 2004 from Women and Parasuicide: a Literature Review, Women's Health Council
- Retrieved Jul. 20, 2004 from Hospitalisation for intentional self-harm, New Zealand Health Information Service
Last updated: 09-03-2005 18:37:12
