
                 Why do people deliberately injure themselves?
                                       
     Drowning in the dark blood of would-be brothers who,
     beyond the pressing of fingers, those for whom
     the slice is only the beginning, and a different kind
     of light comes in, begs recognition and peace of mind.
     
                                -- Judybats
                                      
   This may be the aspect of self-harm that is most puzzling to those who
   do not do it. Why would anyone choose to inflict physical damage on
   him or herself? There is evidence that self-injurers, when faced with
   strong emotion or overwhelming situations, choose to harm themselves
   because it brings them a rapid release from tension and anxiety. These
   situations cause an increase in physiological arousal, and self-injury
   quickly drops that level of arousal close to baseline. The
   self-injurer may feel release,but even if s/he feels guilty or angry
   afterward, it won't be an oppressive, pushing, demanding
   tension-filled feeling like it was before.
   
   More insights into the reasons behind self-injury can be gained from
   two valuable sources: objective and subjective.
   
Subjective: What self-injurers say SI does for them

   Miller (1994) and Favazza (1986, 1996). among others, discuss several
   possible motivations:
     * Escape from emptiness, depression, and feelings of unreality.
     * In order to ease tension.
     * Relief: when intense feelings build, self-injurers are overwhelmed
       and unable to cope. By causing pain, they reduce the level of
       emotional and physiological arousal to a bearable one.
     * Expression of emotional pain
     * Escaping numbness: many of those who self-injure say they do it in
       order to feel something, to know that they're still alive.
     * Obtaining a feeling of euphoria
     * Continuing abusive patterns: self-injurers tend to have been
       abused as children. Sometimes self-mutilation is a way of
       punishing oneself for being "bad."
     * Relief of anger: many self-injurers have enormous amounts of rage
       within. Afraid to express it outwardly, they injure themselves as
       a way of venting these feelings.
     * Biochemical relief: there is some thought that adults who were
       repeatedly traumatized as children have a hard time returning to a
       "normal" baseline level of arousal and are, in some sense,
       addicted to crisis behavior.
     * Obtaining or maintaining influence over the behavior of others
     * Exerting a sense of control over one's body
     * Grounding in reality, as a way of dealing with feelings of
       depersonalization and dissociation
     * Maintaining a sense of security or feeling of uniqueness
     * Expressing or repressing sexuality
     * Expressing or coping with feeling of alienation
       
   Miller also notes one explanation for why such a large majority of
   these patients are female: women are not socialized to express
   violence externally. When confronted with the vast rage many
   self-injurers feel, women tend to vent on themselves. She quotes the
   feminist poet Adrienne Rich:
   "Most women have not even been able to touch
   this anger except to drive it inward like a
   rusted nail."
   As Miller says, "Men act out. Women act out by acting in." Another
   reason fewer men self-injure may be that men are socialized in a way
   that makes repressing feelings the norm. Linehan's (1993a) theory that
   self-harm results in part from chronic invalidation, from always being
   told that your feelings are bad or wrong or inappropriate, could
   explain the gender disparity in self-injury; men are generally brought
   up to hold emotion in.
   
Objective: What the researchers have found

   People who self-injure tend to be dysphoric -- experiencing a
   depressed mood with a high degree of irritability and sensitivity to
   rejection and some underlying tension -- even when not actively
   hurting themselves. The pattern found by Herpertz (1995) indicates
   that something, usually some sort of interpersonal stressor, increases
   the level of dysphoria and tension to an unbearable degree. The
   painful feelings become overwhelming: it's as if the usual underlying
   uncomfortable affect is escalated to a critical maximum point. "SIB
   has the function of bringing about a transient relief from these [high
   levels of irritability and sensitivity to rejection]," Herpertz said.
   This conclusion is supported by the work of Haines and her colleagues.
   
   In a fascinating study, Haines et al. (1995) led groups of
   self-injuring and non-self-injuring subjects through guided imagery
   sessions. Each subject experienced the same four scenarios in random
   order: a scene in which aggression was imagined, a neutral scene, a
   scene of accidental injury, and one in which self-injury was imagined.
   The scripts had four stages: scene-setting, approach, incident, and
   consequence. During the guided imagery sessions, physiological arousal
   and subjective arousal were measured.
   
   The results were striking. Subject reactions across groups didn't
   differ on the aggression, accident, and neutral scripts. In the
   self-injury script, though, the control groups went to a high level of
   arousal and stayed there throughout the script, in spite of relaxation
   instructions contained in the "consequences" stage. In contrast,
   self-injurers experienced increased arousal through the scene-setting
   and approach stages, until the the decision to self-injure was made.
   Their tension then dropped, dropping even more at the incident stage
   and remaining low.
   
   These results provide strong evidence that self-injury provides a
   quick, effective release of physiological tension, which would include
   the physiological arousal brought on by negative or overwhelming
   psychological states. As Haines et al. say
   
     Self-mutilators often are unable to provide explanations for their
     own self-mutilative behavior. . . . Participants reported continued
     negative feelings despite reduced psychophysiological arousal. This
     result suggests that it is the alteration of psychophysiological
     arousal that may operate to reinforce and maintain the behavior,
     not the psychological response. (1995, p. 481)
     
   In other words, self-injury may be a preferred coping mechanism
   because it quickly and dramatically calms the body, even though people
   who self-injure may have very negative feelings after an episode. They
   feel bad, but the overwhelming psychophysiological pressure and
   tension is gone. Herpertz et al. (1995) explain this:
   
     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).
     
   Herman (1992) says that most children who are abused discover that a
   serious jolt to the body, like that produced by self-injury, can make
   intolerable feelings go away temporarily.
   
   Brain chemistry may play a role in determining who self-injures and
   who doesn't. Simeon et al. (1992) found that people who self-injure
   tend to be extremely angry, impulsive, anxious, and aggressive, and
   presented evidence that some of these traits may be linked to deficits
   in the brain's serotonin system. Favazza (1993) refers to this study
   and to work by Coccaro on irritability to posit that perhaps irritable
   people with relatively normal serotonin function express their
   irritation outwardly, by screaming or throwing things; people with low
   serotonin function turn the irritability inward by self-damaging or
   suicidal acts. Zweig-Frank et al. (1994) also suggest that degree of
   self-injury is related to serotonin dysfunction. More information on
   the likely role of serotonin in self-injury can be found on the
   [1]psychopharmacology page.
   
   Those who self-injure may have personality characteristics that
   increase the likelihood of their self-injury. Haines and Williams
   (1997) found that self-mutilators reported more use of problem
   avoidance as a coping strategy and perceived themselves to have less
   control over problem-solving options. This feeling of disempowerment
   may in turn be related to the chronic invalidation many self-injurers
   have experienced.
   
   [INLINE]
   
  next section: [2]Who self-injures
  return to [3]SI main page

References

   1. file://localhost/usr/home/llama/Web/psych/pharm
   2. file://localhost/usr/home/llama/Web/psych/who.html
   3. file://localhost/usr/home/llama/Web/psych/injury.html
