
                               Who self-injures?
                                       
Psychological characteristics common in self-injurers

   The overall picture seems to be of people who:
     * strongly dislike/invalidate themselves
     * are hypersensitive to rejection
     * are chronically angry, usually at themselves
     * tend to suppress their anger
     * have high levels of aggressive feelings, which they disapprove of
       strongly and often suppress or direct inward
     * are more impulsive and more lacking in impulse control
     * tend to act in accordance with their mood of the moment
     * tend not to plan for the future
     * are depressed and suicidal/self-destructive
     * suffer chronic anxiety
     * tend toward irritability
     * do not see themselves as skilled at coping
     * do not have a flexible repertoire of coping skills
     * do not think they have much control over how/whether they cope
       with life
     * tend to be avoidant
     * do not see themselves as empowered
       
   People who self-injure tend not to be able to regulate their emotions
   well, and there seems to be a biologically-based impulsivity. They
   tend to be somewhat aggressive and their mood at the time of the
   injurious acts is likely to be a greatly intensified version of a
   longstanding underlying mood, according to Herpertz (1995). Similar
   findings appear in Simeon et al. (1992); they found that two major
   emotional states most commonly present in self-injurers at the time of
   injury -- anger and anxiety -- also appeared as longstanding
   personality traits. Linehan (1993a) found that most self-injurers
   exhibit mood-dependent behavior, acting in accordance with the demands
   of their current feeling state rather than considering long-term
   desires and goals.
   
   In another study, Herpertz et al. (1995) found, in addition to the
   poor affect regulation, impulsivity, and aggression noted earlier,
   disordered affect, a great deal of suppressed anger, high levels of
   self-directed hostility, and a lack of planning among self-injurers:
   
     We may surmise that self-mutilators usually disapprove of
     aggressive feelings and impulses. If they fail to suppress these,
     our findings indicate that they direct them inwardly. . . . This is
     in agreement with patients' reports, where they often regard their
     self-mutilative acts as ways of relieving intolerable tension
     resulting from interpersonal stressors. (p. 70).
     
   And Dulit et al. (1994) found several common characteristics in
   self-injuring subjects with borderline personality disorder (as
   opposed to non-SI BPD subjects):
     * more likely to be in psychotherapy or on medications
     * more likely to have additional diagnoses of depression or bulimia
     * more acute and chronic suicidality
     * more lifetime suicide attempts
     * less sexual interest and activity
       
   In a study of bulimics who self-injure (Favaro and Santonastaso,
   1998), subjects whose SIB was partially or mostly impulsive had higher
   scores on measures of obsession-compulsion, somatization, depression,
   anxiety, and hostility.
   
   Simeon et al. (1992) found that the tendency to self-injure increased
   as levels of impulsivity, chronic anger, and somatic anxiety
   increased. The higher the level of chronic inappropriate anger, the
   more severe the degree of self-injury. They also found a combination
   of high aggression and poor impulse control. Haines and Williams
   (1995) found that people engaging in SIB tended to use problem
   avoidance as a coping mechanism and perceived themselves as having
   less control over their coping. In addition, they had low self-esteem
   and low optimism about life.
   
Demographics

   Conterio and Favazza estimate that 750 per 100,000 population exhibit
   self-injurious behavior (more recent estimates are that 1000 per
   100,000, or 1%, of Americans self-injure). In their 1986 survey, they
   found that 97% of respondents were female, and they compiled a
   "portrait" of the typical self-injurer. She is female, in her mid-20s
   to early 30s, and has been hurting herself since her teens. She tends
   to be middle- or upper-middle-class, intelligent, well-educated, and
   from a background of physical and/or sexual abuse or from a home with
   at least one alcoholic parent. Eating disorders were often reported.
   
   Types of self-injurious behavior reported were as follows:
   
   Cutting: 72 percent
          Burning: 35 percent
          Self-hitting: 30 percent
          Interference w/wound healing: 22 percent
          Hair pulling: 10 percent
          Bone breaking: 8 percent
          Multiple methods: 78 percent (included in above)
          
   On average, respondents admitted to 50 acts of self-mutilation;
   two-thirds admitted to having performed an act within the past month.
   It's worth noting that 57 percent had taken a drug overdose, half of
   those had overdosed at least four times, and a full third of the
   complete sample expected to be dead within five years.
   
   Half the sample had been hospitalized for the problem (the median
   number of days was 105 and the mean 240). Only 14% said the
   hospitalization had helped a lot (44 percent said it helped a little
   and 42 percent not at all). Outpatient therapy (75 sessions was the
   median, 60 the mean) had been tried by 64 percent of the sample, with
   29 percent of those saying it helped a lot, 47 percent a little, and
   24 percent not at all. Thirty-eight percent had been to a hospital
   emergency room for treatment of self-inflicted injuries (the median
   number of visits was 3, the mean 9.5).
   
  Why so many women?
  
   Although the results of an informal net survey and the composition of
   an e-mail support mailing list for self-injurers don't show quite as
   strong a female bias as Conterio's numbers do (the survey population
   turned out to be about 85/15 percent female, and the list is closer to
   67/34 percent), it is clear that women tend to resort to this behavior
   more often than men do. Miller (1994) is undoubtedly onto something
   with her theories about how women are socialized to internalize anger
   and men to externalize it. It is also possible that because men are
   socialized to repress emotion, they may have less trouble keeping
   things inside when overwhelmed by emotion or externalizing it in
   seemingly unrelated violence.
   
   As early as 1985, Barnes recognized that gender role expectations
   played a significant role in how self-injurious patients were treated.
   Her study showed only two statistically significant diagnoses among
   self-harmers who were seen at a general hospital in Toronto: women
   were much more likely to receive a diagnosis of "transient situational
   disturbance" and men were more likely to be diagnosed as substance
   abusers. Overall, about a quarter of both men and women in this study
   were diagnosed with personality disorder.
   
   Barnes suggests that men who self-injure get taken more "seriously" by
   physicians; only 3.4 percent of the men in the study were considered
   to have transient and situational problems, as compared to 11.8
   percent of the women.
   
   [INLINE]
   
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References

   1. file://localhost/usr/home/llama/Web/psych/cause.html
   2. file://localhost/usr/home/llama/Web/psych/injury.html
