
                   Self-injury: a quick guide to the basics
                                       
   If the whole concept of a disorder in which people deliberately
   inflict physical harm on themselves confuses you, or if you've been
   doing this for a while and never realized that it's recognized as a
   valid psychological problem all by itself, then this page is a good
   place to start learning about self-injury.
   
What self-injury is -- and isn't

   You'll hear it called many things -- self-inflicted violence,
   self-injury, self-harm, parasuicide, delicate cutting, self-abuse,
   self-mutilation (this last particularly seems to annoy people who
   self-injure). Broadly speaking, self-injury is the act of attempting
   to alter a mood state by inflicting physical harm serious enough to
   cause tissue damage to your body. This can include cutting (with
   knives, razors, glass, pins, any sharp object), burning, hitting your
   body with an object or your fists, hitting a heavy object (like a
   wall), picking at skin until it bleeds, biting yourself, pulling your
   hair out, etc. The most commonly seen forms are cutting, burning, and
   headbanging. "Tissue damage" usually refers to damage that tears,
   bruises, or burns the skin -- something that causes bleeding or marks
   that don't go away in a few minutes. A mood state can be positive or
   negative, or even neither; some people self-injure to end a
   dissociated or unreal-feeling state, to ground themselves and come
   back to reality.
   
   It's not self-injury if your primary purpose is:
     * sexual pleasure
     * body decoration
     * spiritual enlightenment via ritual
     * fitting in or being cool
       
   The sort of self-injury this site discusses is repetitive self-harm.
   People learn that hurting themselves brings them relief from some
   kinds of distress and turn to it as a primary coping mechanism.
   
   Calling it self-mutilation often angers people who self-injure. Other
   terms (self-inflicted violence, self-harm, self-injury) don't speak to
   motivation. They simply describe the behavior. "Self-mutilation"
   implies falsely that the primary intent is to mark or maim the body,
   and in most cases this isn't so.
   
Why does self-injury make some people feel better?

   There are a few possibilities, and the answer is probably a mixture of
   them. Biological predisposition, reduction of tension, and lack of
   experience in dealing with strong emotions are all factors.
   
  It reduces physiological and psychological tension rapidly
  
   A section of the [1]causes page discusses this in more detail, but
   basically studies have suggested that when people who self-injure get
   emotionally overwhelmed, an act of self-harm brings their levels of
   psychological and physiological tension and arousal back to a bearable
   baseline level almost immediately. In other words, they feel a strong
   uncomfortable emotion, don't know how to handle it, and know that
   hurting themselves will reduce the emotional discomfort extremely
   quickly. They may still feel bad (or not), but they don't have that
   panicky jittery trapped feeling; it's a calm bad feeling.
   
   This explains why self-injury can be so addictive: It works. When you
   have a quick, easy way to make the bad stuff go away for a while, why
   would you want to go through the hard work of finding other ways to
   cope? Eventually, though, the negative consequences add up, and people
   do seek help.
   
  Some people never get a chance to learn how to cope effectively
  
   We aren't born knowing how to express and cope with our emotions -- we
   learn from our parents, our siblings, our friends, schoolteachers, --
   everyone in our lives. One factor common to most people who
   self-injure, whether they were abused or not, is invalidation. They
   were taught at an early age that their interpretations of and feelings
   about the things around them were bad and wrong. They learned that
   certain feelings weren't allowed. In abusive homes, they may have been
   severely punished for expressing certain thoughts and feelings. At the
   same time, they had no good role models for coping. You can't learn to
   cope effectively with distress unless you grow up around people who
   are coping effectively with distress. How could you learn to cook if
   you'd never seen anyone work in a kitchen?
   
   Although a history of abuse is common among self-injurers, not
   everyone who self-injures was abused. Sometimes, invalidation and lack
   of role models for coping are enough, especially if the person's brain
   chemistry has already primed them for choosing this sort of coping.
   
  Problems with neurotransmitters may play a role
  
   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 most people. This
   tendency toward impulsive aggression, combined with a belief that
   their feelings are bad or wrong, can lead to the aggression being
   turned on the self. Of course, once this happens, the person harming
   himself learns that self-injury reduces his level of distress, and the
   cycle begins. For technical details on the possible role of serotonin,
   see the causes page and the [2]psychopharmacology page.
   
What kinds of people self-injure?

   Self-injurers come from all walks of life and all economic brackets.
   People who harm themselves can be male or female; gay, straight, or
   bi; Ph.D.s or high-school dropouts (or high-school students); rich or
   poor; from any country in the world. Some people who SI manage to
   function effectively in demanding jobs; they are teachers, therapists,
   medical professionals, lawyers, professors, engineers. Some are on
   disability. Their ages range from early teens to early 60s, maybe
   older and younger. In fact, the incidence of self-injury is about the
   same as that of eating disorders, but because it's so highly
   stigmatized, most people hide their scars, burns, and bruises
   carefully. They also have excuses to pull out when someone asks about
   the scars (there are a lot of really vicious cats around).
   
Aren't people who would deliberately cut or burn themselves psychotic?

   No more than people who drown their sorrows in a bottle of vodka are.
   It's a coping mechanism, just not one that's as understandable to most
   people and as accepted by society as alcoholism, drug abuse,
   overeating, anorexia, bulimia, workaholism, smoking cigarettes, and
   other forms of problem avoidance are.
   
Okay, then isn't it just another way to describe a failed suicide attempt?

   NO. People who inflict physical harm on themselves are often doing it
   in an attempt to maintain psychological integrity -- it's a way to
   keep from killing themselves. They release unbearable feelings and
   pressures through self-harm, and that eases their urge toward suicide.
   And although some people who self-injure do later attempt suicide,
   they almost always use a method different from their preferred method
   of self-harm. Self-injury is a maladaptive coping mechanism, a way to
   stay alive. Unfortunately, some people don't understand this and think
   that involuntary commitment is the only way to deal with a person who
   self-harms. Hospitalization, especially forced, can do more harm than
   good.
   
Can anything be done for people who hurt themselves?

   Yes. This site has a variety of [3]self-help ideas, as well as some
   advice for [4]family and friends of those who self-injure. Research
   into medications that stabilize mood, ease depression, and calm
   anxiety is being done; some of these drugs help people stop their
   self-harm. Many therapeutic approaches have been and are being
   developed to help self-harmers learn new coping mechanisms and teach
   them how to start using those techniques instead of self-injury. They
   reflect a growing belief among mental-health workers that once a
   client's patterns of self-inflicted violence stabilize, real work can
   be done on the problems and issues underlying the self-injury.
   
   This does not mean that patients should be coerced into stopping
   self-injury. Any attempts to reduce or control the amount of self-harm
   a person does should be based in the client's willingness to undertake
   the difficult work of controlling and/or stopped self-injury.
   Treatment should not be based on a practitioner's personal feelings
   about the practice of self-harm.
   
   Self-injury brings out many uncomfortable feelings in people who don't
   do it: revulsion, anger, fear, and distaste, to name a few. If a
   medical professional is unable to cope with her own feelings about
   self-harm, then she has an obligation to herself and to her client to
   find a practitioner willing to do this work. In addition, she has the
   responsibility to be certain the client understands that the referral
   is due to her own inability to deal with self-injury and not to any
   inadequacies in the client.
   
   People who self-injure do generally do so because of an internal
   dynamic, and not in order to annoy, anger or irritate others. Their
   self-injury is a behavioral response to an emotional state, and is
   usually not done in order to frustrate caretakers. In emergency rooms,
   people with self-inflicted wounds are often told directly and
   indirectly, that they are not as deserving of care as someone who has
   an accidental injury. They are treated badly by the same doctors who
   would not hesitate to do everything possible to preserve the life of
   an overweight, sedentary heart-attack patient.
   
   Doctors in emergency rooms and urgent-care clinics should be sensitive
   to the needs of patients who come in to have self-inflicted wounds
   treated. If the patient is calm, denies suicidal intent, and has a
   history of self-inflicted violence, the doctor should treat the wounds
   as they would treat non-self-inflicted injuries. Refusing to give
   anesthesia for stitches, making disparaging remarks, and treating the
   patient as an inconvenient nuisance simply further the feelings of
   invalidation and unworthiness the self-injurer already feels. Although
   offering mental-health follow-up services is appropriate,
   psychological evaluations with an eye toward hospitalization should be
   avoided in the ER unless the person is clearly a danger to his/her own
   life or to others. In places where people know that self-inflicted
   injuries are liable to lead to mistreatment and lengthy psychological
   evaluations, they are much less likely to seek medical attention for
   their wounds and thus are at a higher risk for wound infections and
   other complications.
   
    Copyright 1998, Deb Martinson. Reproduction and distribution of this page
    is enthusiastically encouraged, especially distribution to medical
    personnel.
    
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  [5]return to main SI page

References

   1. file://localhost/usr/home/llama/Web/psych/cause.html
   2. file://localhost/usr/home/llama/Web/psych/pharm.html
   3. file://localhost/usr/home/llama/Web/psych/fself.html
   4. file://localhost/usr/home/llama/Web/psych/ffriend.html
   5. http://www.palace.net/~llama/selfinjury
