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Issues >> Self - Injury
SELF-INJURY
The number of young people who participate in acts
of self-mutilation is growing. Although self-harm
is rarely a suicidal act, it must be taken seriously
because accidental deaths do occur. It’s difficult
to see the light at the end of the tunnel but breaking
the cycle of self-abuse is possible if you reach out
to someone you trust. Finding new ways of coping with
your feelings can help to tone down the intense urges
you feel which results in you hurting yourself. Recovery
is a continuous process and learning how to stop this
addictive behavior is within your reach if you work
at it.
WHO ENGAGES IN SELF-INJURY?
The numbers are staggering…about two million
people in the U.S. are self-injurers and approximately
1% of the population has inflicted physical injury
upon themselves at some time in their life as a way
to cope with an overwhelming situation or feeling.
Those numbers are most likely an underestimation because
the majority of acts of self-injury go unreported.
In other parts of the world the numbers are considerably
higher. Self-injury does not discriminate against
race, culture, or socio-economic strata, but there
is conflicting data regarding demographics. Some reference
sites indicate that the majority of people who engage
in this type of addictive behavior are predominately
female teenagers and young adults, while other sites
indicate that both genders, ranging in age from 14
to 60 self-injure. However, there is consistent agreement
that self-harm has more to do with having poor coping
mechanisms than anything else.
TYPES OF SELF-INJURY
Definition of self-injury
Self-injury, self-inflicted violence, self-injurious
behavior or self-mutilation is defined as a deliberate,
intentional injury to one’s own body that causes
tissue damage or leaves marks for more than a few
minutes which is done to cope with an overwhelming
or distressing situation.
The most common self-injurious behaviors are:
- Cutting - involves making
cuts or scratches on your body with any
sharp object, including knives, needles,
razor blades or even fingernails. The arms,
legs and front of the torso are most commonly
cut because they are easily reached and
easily hidden under clothing
- Branding – burning
self with a hot object, Friction burn –
rubbing a pencil eraser on your skin
- Picking at skin or re-opening
wounds (dermatillomania) - is an impulse
control disorder characterized by the repeated
urge to pick at one's own skin, often to
the extent that damage is caused which relieves
stress or is gratifying
- Hair-pulling (trichotillomania)
– is an impulse control disorder which
at times seems to resemble a habit, an addiction,
or an obsessive-compulsive disorder. The
person has an irresistible urge to pull
out hair from any part of their body. Hair
pulling from the scalp often leaves patchy
bald spots on their head which they hide
by wearing hats, scarves and wigs. Abnormal
levels of serotonin or dopamine may play
a role in this disorder. The combined treatment
of using an anti-depressant such as Anafranil
and cognitive behavioral therapy (CBT) has
been effective in treating this disorder.
CBT teaches you to become more aware of
when you’re pulling, helps you identify
your pulling habits, and teaches you about
what emotions and triggers are involved
in hair pulling. When you gain awareness
of pulling, you can learn to substitute
healthier behaviors instead.
- Hitting (with hammer
or other object), Bone breaking,
Punching, Head-banging (more often
seen with autism or severe mental retardation)
- Multiple piercing or tattooing
- may also be a type of self-injury, especially
if pain or stress relief is a factor
- Drinking harmful chemicals
|
REASONS FOR SELF-INJURY
Why do they do it?
Even though it is possible that a self-inflicted injury
may result in death, self-injury is usually not suicidal
behavior. The person who self-injures may not recognize
the connection, but this act usually occurs after
an overwhelming or distressing experience and is
a
result of not having learned how to identify or express
difficult feelings in a healthy way.
Sometimes the person who deliberately harms themselves
thinks that if they feel the pain on the outside instead
of feeling it on the inside, the injuries will be
seen, which then perhaps gives them a fighting chance
to heal. They may also believe that the wounds, which
are now physical evidence, proves their emotional
pain is real. Although the physical pain they experience
may be the catalyst that releases the emotional pain,
the relief they feel is temporary. These coping mechanisms
in essence are faulty because the pain eventually
returns without any permanent healing taking place.
Self-harm serves a function for the person who does
it. If you can figure out what function the self-injury
is serving then you can learn other ways to get those
needs met which will reduce your desire to hurt yourself.
It is difficult to understand the motivations behind
self-injurious behavior, but a clearer picture develops
when you hear the common explanations self-injurers
give for doing it:
- “It expresses emotional pain or
feelings that I’m unable to put into
words. It puts a punctuation mark on what
I’m feeling on the inside!”
- “It’s a way to have control
over my body because I can’t control
anything else in my life”
- “I usually feel like I have a black
hole in the pit of my stomach, at least
if I feel pain it’s better than feeling
nothing”
- I feel relieved and less anxious after
I cut. The emotional pain slowly slips away
into the physical pain”
|
Self-injury can
regulate strong emotions.
It can put a person who is at a high level of physiological
arousal back to a baseline state.
Deliberate self-harm can
distract from
emotional pain and stop feelings of
numbness.
Self-inflicted violence is a way to
express
things that cannot be put into words
such as displaying anger, shocking others or seeking
support and help.
Self-injurious behavior can
exert a sense
of control over your body if you feel
powerless in other areas of your life. Sometimes magical
thinking is involved and you may imagine that hurting
yourself will prevent something worse from happening.
Also, when you hurt yourself it influences the behavior
of others and can manipulate people into feeling guilty,
make them care, or make them go away.
Self punishment or self-hate may be involved. Some
people who self-injure have a childhood
history
of physical, sexual and emotional abuse.
They may erroneously blame themselves for having been
abused, they may feel that they deserved it and are
now punishing themselves because of self-hatred and
low self-esteem.
Self-abuse can also be a
self-soothing
behavior for someone who does not have
other means to calm intense emotions. Self-injury
followed by tending to one’s own wounds is a
way to express self-care and be self-nurturing for
someone who never learned how to do that in a more
direct way.
People who self-injure have some common traits:
o Expressions of anger were discouraged while growing
up
o They have co-existing problems with obsessive-compulsive
disorder, substance abuse or eating disorders
o They lack the necessary skills to express strong
emotions in a healthy way
o Often times there is a limited social support network
SELF-INJURY AS AN ADDICTION
| BECOMING A HABITUAL SELF-INJURER
IS A PROGRESSIVE PROCESS |
| The first incident of
self-injury may occur by accident, or after
finding out about others who engage in this
behavior |
The next time a similar strong feeling
arises, the person has been “conditioned”
to seek relief in the same way |
- The person has strong feelings such as anger, fear or anxiety before an injuring event
- These feelings build, and the person has no way to express or address them directly
|
- The person feels compelled to repeat self-harm, which is likely to increase in frequency and degree
- The person hides the tools used to injure, and covers up the evidence, often by wearing long sleeves
|
Cutting or other self-injury provides
a sense of relief; a release of the mounting
tension
|
Endorphins, specifically enkephalins,
contribute to the 'addictive’ nature of
self-injury |
- A feeling of guilt and shame usually follows the event
- The feelings of shame paradoxically lead to continued self-injurious behavior
|
- When a person injures themselves endorphins are released in the body and function as natural pain killers
- The behavior may become addictive because the person learns to associate the act of self-injury with the positive feelings they get when endorphins are released in their system
- The use of SSRI medications (selective serotonin
reuptake inhibitors) such as Prozac and
Zoloft, may be helpful in increasing brain
serotonin levels and reducing self-injury
in cases of moderate to severe depression
|
FDA
Suicide Warning
In May 2007, the U.S. Food and Drug Administration
(FDA) recommended a new warning label for all
antidepressant medications. The current “black
box” label includes a warning about the
increased risk of suicidal thinking and behavior
in children and adolescents. The FDA wants to
expand this warning to include young adults
from ages 18 to 24. Children and young adults
should also be monitored for the emergence of
agitation, irritability, and unusual changes
in behavior, as these symptoms can indicate
that the depression is getting worse. The risk
of suicide is particularly great during the
first one to two months of treatment. |
SELF-INJURY AND SUICIDE
Self-injury is usually not suicidal behavior but rather
a way to reduce tensions. Inflicting physical harm
on oneself is a poorly learned coping mechanism which
is used to communicate feelings and self-soothe. Self-injury
is strongly linked to a poor sense of self-worth,
and over time, that depressed feeling can spiral into
a suicidal attempt. Sometimes self-harm may accidentally
go farther than intended, and a life-threatening injury
may result which is why intervention and profession
help is required sooner rather than later.
HELPING A FRIEND OR FAMILY
MEMBER WHO IS A SELF-INJURER
No matter how you look at it, self-harm scares people.
It is very hard coming to terms with the fact that
someone you care about is physically harming themselves.
From the depths of your own fear and helplessness
you may feel frustrated if you are unable to get the
person to stop hurting themselves which can further
drive the person away.
Some helpful tips in dealing with someone
who self-injures
- Understand that self-harming behavior
is an attempt to maintain a certain amount
of control which in and of itself is a way
of self-soothing
- Let the person know that you care about
them and are available to listen
- Encourage expressions of emotions including
anger
- Spend time doing enjoyable activities
together
- Offer to help them find a therapist or
support group
- Don’t make judgmental comments
or tell the person to stop the self-harming
behavior – people who feel worthless
and powerless are even more likely to self-injure
- If your child is self-injuring, prepare
yourself to address the difficulties in
your family. Start with expressing feelings
which is a common factor in self-injury
– this is not about blame, but rather
about learning new ways of dealing with
family interactions and communications which
can help the entire family
|
HOW
CAN A SELF-INJURING PERSON STOP THIS BEHAVIOR?
Self-injury is a behavior that over time becomes compulsive
and addictive. Like any other addiction, even though
other people think the person should stop, most addicts
have a hard time just saying no to their behavior
– even when they realize it is unhealthy.
| What You Can Do to Help
Yourself |
| Acknowledge this is a
problem |
You are probably hurting on the inside and
need professional help to stop this addictive
behavior |
| Realize this is not about being a
bad person |
This is about recognizing that a behavior
that helped you handle your feelings has become
a big problem |
| Find one person you trust and get
professional help |
Maybe a friend, teacher, rabbi, minister,
counselor, or relative. Tell them you need to
talk about something serious that is bothering
you |
| Get help in identifying what “triggers”
your self-harming behaviors |
Ask for help in developing ways to either
avoid or address those triggers |
| Recognize that self-injury is an attempt
to self-soothe |
Learn how to develop better ways to calm and
soothe yourself |
| Figure out what function the self-injury
is serving |
Replace the act of self-harm with learning
how to express anger, sadness, and fear in healthy
ways |
TREATMENTS FOR SELF-INJURY
One danger connected with self-injury is that it tends
to become an addictive behavior, a habit that is difficult
to break even when the individual wants to stop. As
with other addictions, qualified professional help
is almost always necessary. It is important to find
a therapist who understands this behavior and is not
upset or repulsed by it. Call your doctor or insurance
company for a referral to a mental health professional
who specializes in self-injury.
- Cognitive-behavioral therapy
may be used to help the person learn to recognize
and address triggering feelings in healthier ways
- Because a history of abuse or incest may be
at the core of an individual’s self-injuring
behavior, therapies that address post-traumatic
stress disorder such as EMDR may be helpful (see
Helpguide’s article on Eye
Movement Desensitization and Reprocessing
- Hypnosis or other self-relaxation techniques
are helpful in reducing the stress and tension
that often precede injuring incidents (see Helpguide’s
article on Yoga,
meditation and other relaxation techniques
- Group therapy may be helpful
in decreasing the shame associated with self-harm,
and help to support healthy expressions of emotions
- Family therapy may be useful,
both in addressing any history of family stress
related to the behavior, and also in helping other
family members learn how to communicate more directly
and non-judgmentally with each other
- In cases of moderate to severe depression
or anxiety an antidepressant or anti-anxiety medication
may be used to reduce the impulsive urges to self-harm
in response to stress, while other coping strategies
are developed.
- In severe cases an in-patient hospitalization
program with a multi-disciplinary team approach may
be required
Alternatives to avoid self-harm
If you self-injure to…
Deal with anger
that you cannot express openly, try working through
those feelings by doing something different –
running, dancing fast, screaming, punching a pillow,
throwing something, ripping something apart
If you hurt yourself in order to…
Feel
something when you feel numb inside, hold
ice cubes in one hand and try to crush them, hold
a package of frozen food, take a very cold shower,
chew something with a very strong taste (like chili
peppers, raw ginger root, or a grapefruit peel), wear
an elastic rubber band around your wrist and snap
it (in moderation to avoid bruising) when you feel
like hurting yourself
If you inflict physical pain to…
Calm
yourself, try taking a bubble bath, doing
deep breathing, writing in a journal, drawing, or
doing some yoga
If you self-mutilate to…
See blood,
try drawing a red ink line where you would usually
cut yourself, in combination with the other suggestions
above
Deborah Cutter, Psy.D., Jaelline Jaffe, Ph.D., and
Jeanne Segal, Ph.D., contributed to this article.
Last modified on: 2/26/08.
Reprinted with permission from http://www.helpguide.org/.
C 2008 Helpguide.org. All rights reserved.
You can find the original article at
http://www.helpguide.org/mental/self_injury.htm
SOURCE:
www.helpguide.org
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