The Truth About Self-Injury

This report on self-injury was carried out to discover what self-injury really is, because it seems to have become a big fad and subject of scorn. It discovered that although many people do self-injure, it is not done for popularity. Most self-injurers hide it well - they could be anyone. The three main topics of this report are how many self-injurers there are, what the problem is, and why people self-injure. The answers are that there are many self-injurers, but the total number is unknown because of the ease of hiding it; the problem is that most people have no idea how to view self-injury, including the medical and mental health professionals who would have to deal with it; and that people self-injure for a variety of reasons, usually powerful inner turmoil and that it is an effective coping mechanism for those people. The report concludes with the fact that much more work has to be done to get self-injury into the open.

Table of Contents
Introduction
Discussion
· How Many People Self-Injure?
· What are the Problems a Self-Injurer faces?
· Why Would Someone Self-Injure?
Conclusion
Recommendations
· If Someone Tells You They Self-Injure
· If the Self-Injurer Wants Treatment
· What Not To Do
· Self-Injury Awareness
Bibliography
Other Resources
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Introduction

This report will discuss three main questions: How many people self-injure, what are the problems a self-injurer faces, and why would someone self-injure. It will focus on self-injury in North America, as most of the statistics are American or Canadian. Self-injury is commonly split into three categories: psychotic, organic, and typical. The majority of self-injurers are in the typical category, so the report will focus on it. The following list gives a brief description for each category.

· Psychotic: Self-injury that usually occurs during an extreme psychosis
  caused by heavy drug use or schizophrenia. Psychotic self-injurers amputate their
  body parts.
· Organic: Self-injury that is influenced by physical or chemical problems in
  the body, such as autism. Organic self-injurers do repetitive actions like head
  banging and lip biting.
· Typical: Self-injury that does not fall into the other categories. It is typically
  superficial with minor scarring, but an accidental slip may cause serious damage.

The short definition of self-injury is the deliberate harm of one’s own body, to cause injury, without suicidal intent. It is not yet an official disorder and therefore does not have an official name. Although self-mutilation is usually the term clinicians use, self-injurers often find it demeaning. They prefer the terms self-injury (SI) and self-harm.

Cutting is the most common form of self-injury (See Figure 1:http://www.deviantart.com/deviation/32734038/), because self-injurers usually start with it, and then gradually use other forms until they find their preferred method. Some self-injurers carve words into their bodies. Self-injurers are resourceful and if they can not find a knife or razor, they will use pen caps, bottle caps, credit cards, etc. The arms and legs are most common areas for self-injury (See Figure 2:http://www.deviantart.com/deviation/32734038/), but other common places are the breasts, stomach, and thighs. Many self-injurers only hurt themselves in certain places; usually they do it at home for privacy and seclusion. As well, some self-injurers use only one particular object or type of instrument to self-injure and will not use any other type even if it will hurt them in a similar manner.

Self-injury is not something, such as tattooing, piercing, and scarring, done to decorate the body or something done for sexual pleasure or spiritual enlightenment. It does not necessarily imply a mental disorder such as schizophrenia or borderline personality. It is not a suicide attempt. Most importantly, self-injury is not done to be cool or fit in with the crowd. Self-injury is a faulty, but effective, coping mechanism.
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Discussion
How Many People Self-Injure?

According to a 1998 estimate, one in a hundred Americans self-injure (Turner, V. J.), but because self-injury is severely underreported and misdiagnosed, it is expected that the number is significantly higher. One in eight university students self-injure (Strong, Marilee) and a study done in California in the 1990’s discovered that school psychologists were aware of two to three self-injuring students per high school (Turner, V. J.). According to the Journal of Abnormal Psychology, 14-39% of American teens self-injure and in 2003, nearly 70% of American counselling centre directors reported increases in cases of self-injury (Milne, Celia). Self-injury has been called “the new anorexia.” Most of the time shame, social stigma, and guilt cause the self-injurer to do their best to hide their problem, which means that “getting a true estimate of how often self-injury actually occurs in the general population is not possible (Secret Scars 120).” Although there are self-injurers of both sexes, it is more likely in females (See Figure 3:http://www.deviantart.com/deviation/32734038/).

Self-injury also comes in “waves”, which means that if one person is known to self-injure, they will likely be associated with three or four others who also self-injure. This may be due to “observed learning”; people can pickup on self-injury by observing a self-injurer, seeing that their habit helps them in some form, and self-injuring themselves. Fortunately, the chances of seeing another person self-injure are very slim.

What are the Problems a Self-injurer Faces?

The bulk of the “silent epidemic” of self-injury receives no attention from the medical or mental health community. One of the main reasons for this is that “there is no diagnostic criteria for self-injury or established guidelines that are used by mental health professionals or medical doctors (Secret Scars 87)” In the DSM-IV, the manual that mental health professionals use to diagnose mental illness, self-injury is listed only as a symptom of certain disorders. In spite of this, self-injury can be classified as an Impulse-Control Disorder (Not Otherwise Specified) and V. J. Turner in her book, Secret Scars, has described self-injury as a disorder in DSM terms, for inclusion in a DSM-V (See Figure 4).

Figure 4

    Research Criteria for (#XXX.X) Self-Injurious Behaviour Syndrome

    A pervasive pattern of deliberate mutilation of one’s own body with intent to
    cause injury or damage, but without suicidal intent, in order to provide relief from
    an intolerable emotional state, usually beginning in adolescence and marked by
    the following:

    (1) recurrent impulse to physically harm oneself
    (2) intrusive, obsessional thoughts about self-injuring
    (3) intolerable, increasing states of emotional anxiety and agitation and/or
        emotional numbing and dissociation
    (4) feelings of both physical and psychological relief after the act of self-injury
    (5) multiple episodes of self-injury
    (6) low lethality
    (7) impulsivity in other areas that are potentially self-destructive (e.g., alcohol or
        substance abuse; eating disorders; high-risk or dangerous behaviours such
        as reckless driving or becoming involved in abusive interpersonal relationships)
    (8) a general pervasive mood of depression or anxiety


Because their injuries are seldom lethal, self-injurers usually keep up appearances and work and live normally. However, when they do seek psychological treatment, it typically does not work out.  Psychologists sometimes ignore self-injury out of inexperience, ignorance, or feelings of disgust. In addition, mental health professionals rarely ask about self-injuring behaviour and make it the self-injurers job to mention their behaviour. Self-injurers can lose their jobs or be suspended from school if other people find out they self-injure. The reactions and strategies for self-injury by psychologists are often distasteful to the self-injurer. They may demand that the self-injurer stop hurting themselves or risk being sent to a psychiatric ward or hospital. Many self-injurers who have ended up in the hospital have been treated badly. They are sometimes stitched up without anaesthetic or made to feel like a waste of time because of their self-inflicted wounds. For many doctors, self-injurers are among the most challenging patients to manage.

Why Would Someone Self-injure?

Modern society can be a big cause of self-injuring behaviour. Problems such as sexual perversions, kleptomania, incest, compulsive shopping, gambling, and self-injury have been statistically on the rise in the last two decades for the following reasons:

· An extended community is seldom available, because relatives are farther away,
  and people move a lot.
· More parents work and leave their children to be raised by strangers or
  themselves.
· Increased isolation leads to fewer confidants, a “doing instead of saying”
  mentality, and increased reliance on technology.
· The media promotes the idea of a “quick fix” or immediate gratification.
· Modern culture has become more body focused: more people are dieting, getting
  cosmetic surgery, tanning, dyeing, piercing, and tattooing.

The majority of self-injurers were abused or neglected by their parents. 41% of sexually or physically abused children will self-injure (Turner, V. J.) and 70% of self-injurers have been sexually abused (Zila, Laurie MacAniff). This is because recurrent sexual trauma, especially at the hands of a parent or other trusted loved one, is emotional terrorism. It causes serious and lasting damage to a child’s emotional, neurological, and physiological development. It is the ultimate boundary violation, which can shatter a child’s capacity for trust and intimacy. An abused self-injurer’s scars are a symbolic cry for help; they say, "I’ve been torn open, intruded upon, broken into," in a very literal way.

The typical self-injurer is a white, middle-class female, who started cutting around puberty. She is usually intelligent, but with a low self-esteem or depression. She also has a hard time expressing her thoughts and feelings coupled with an insatiable need for love and acceptance.

Self-injurers generally have no language of feeling and cannot communicate their inner turmoil. They also have a hard time controlling their emotions. Some may find it dangerous to communicate their emotions at home, because their thoughts and feelings are usually ignored, questioned or rejected. Commonly their thoughts are turned towards themselves in a negative light. Self-injurers are least dangerous to others, because aggression is one of the most difficult emotions for them to face.

Many self-injurers feel sad, lonely, depressed, angry, frightened or isolated. Some feel they have an “inner badness” or worthlessness. Some believe that they are fragile or poorly understood. Most are regressed and childlike. They are frequently unsure of their sexuality or sexual orientation and have a lot of identity or gender confusion. Self-injurers tend to be neutral or asexual. Almost none get pleasure from sex. They find it disgusting and prefer hugging, snuggling, and kissing, yet a lot of them also go through a period of promiscuity. 58-65% of female self-injurers hate their period  (Zila, Laurie MacAniff).

One of the most common factors connected to self-injury is shame. The feeling of shame can result from many different aspects of self-injury, but the three main sources are:

· Wounds, Bruises, and Scars
  - Wounds from self-injury can be a life-long reminder of what a self-injurer has
    suffered. By exposing their scars, a self-injurer risks people seeing, questioning,
    and reacting to their self-injury. When other people question the scars, the self
    injurer anticipates their disgust, and may feel compelled to lie. However, some
    self-injurers are not ashamed of their scars and see them as battle scars.
· Isolation or Alienation
  - Self-injurers often feel shame because of the very nature of their behaviour.
    Usually they feel alone, because they do not realize that other people also self
    injure.
· Loss of Control
  - Self-injurers can feel that hurting themselves makes them weak. They may even
    have tried to stop self-injuring, but found themselves unable to. If they talk to
    anyone about it, they do not want to admit to new injuries.

Self-injurers may also have problems with alcoholism, eating disorders, drug addiction, compulsive exercise, sexual addiction, compulsive spending, workaholism, or co-dependency. 71% of self-injurers believe they are addicted to self-injury  (Turner, V. J.).

Some other characteristics of a self-injurer include:
· A childhood disability or illness in themselves or close family
· Poor social skills
· A fear of change
· An inability or unwillingness to care for themselves
· Rigid thinking or perfectionism
· A feeling that nobody understands and nothing will change

Few self-injurers exhibit all these characteristics, some exhibit only one or two, some exhibit none.

Some reasons people self-injure are to:
· Control themselves
· Be cleansed
· Calm themselves
· Punish themselves
· Get vengeance on loved ones
· Re-enact abuse
· Release tension and anger
· Stop violent, sexual, or “bad” urges
· Stop numbness or become real.

The pain of self-injury replaces internal pain and people self-injure to put an end to emotional suffering. It does physically reduce tension by increasing enkephalin levels in the brain (Strong, Marilee). Self-injury can be a release of painful bottled up emotions. It can happen when a person has low coping skills or difficulty maintaining emotional stability. It takes the place of a hug, a compliment, or a mother’s kiss.
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Conclusion

More people self-injure than is realised by the general population, and it is on the rise. Self-injury needs to be dealt with, people need to realise that it happens. The same help that has been made available for people with addictions or eating disorders should be made available to self-injurers. Doctors and mental health professionals need to be aware of this so it can be treated. The public needs to be aware of it so they are not disgusted about it. Self-injurers need to know that they are not alone. They need to know they are not freaks, nor will most people treat them that way. They need to know it is okay to feel and that it is safe to talk about it. Stopping self-injury from being a source of shame could go a long way towards stopping it altogether. Self-injurers need to be aware that they do have a problem and that the help they need is available; they will not lose their friends or their jobs for this. They do not need to be ashamed. Self-injurers are still people and self-injury is not a fad or a phase, but a legitimate problem.
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Recommendations
If Someone Tells You They Self-injure

The first thing to realize about self-injury is that there is no quick fix. In most cases, a self-injurer has found in self-injury a coping mechanism that helps get them through life. That cannot just be taken away from them without first helping them replace it with something else that is not harmful, because “breaking a deeply ingrained and highly comforting pattern of behaviour can be one of life’s greatest challenges (Bodily Harm cover).” It takes time and trust needs to be earned. The most important thing for a self-injurer is someone who is patient and who will listen to them without judgment, threats, or prejudice.

Talk to the self-injurer about what they think would be the most helpful thing that could happen to get them through their problem. Let them know you care, even if you do not understand. Try not to react too strongly to the behaviour itself, even though it may upset or frighten you. Let that person know that they can phone you any time to talk to you instead of cutting. If you cannot do it, set the self-injurer up with someone who can.

If they feel ready, you can explore why they are self-injuring and how they can change their immediate environment so that self-injury triggers can be changed or stopped. Following is a list of questions that might be helpful.

· Are there any things you should not do that would break their trust?
· Do they believe they may try to commit suicide?
· How deep are the cuts and how much blood do they lose?
· How deep are the bruises and is there any danger of fracturing bones?
· Do they want to stop?
· Are they ready to stop?
· Can they envision any help they might need that you can provide?

Remind the self-injurer to disinfect their weapons and self-injury areas before and after they cut, so they heal up. If they are setting themselves on fire, swallowing batteries, or doing anything else life-threatening, a safe haven, such as a friend’s house, a centre or support group for self-injurers, or a hospital, should be found immediately.

Try helping the self-injurer find some alternatives. Some useful suggestions are:

· Breathing
· Praying or meditating
· Finding a safe place
· Listening to music
· Singing or dancing
· Reading, writing, or drawing
· Doing puzzles
· Walking
· Playing with pets
· Helping people
· Napping
· Taking a bath
· Cleaning

It is a good idea to make sure your emotions are also dealt with. When talking to people for advice or help, do not reveal the self-injurer’s identity unless it is okay with them. You may also want to get help for your friend, but you should ask them first. Sometimes family and friends will institutionalize a self-injurer without making sure the institution has a program for self-injurers and will not impact them negatively and if a family member has abused the self-injurer, the family finding out could make things worse.

Another important reason for the self-injurer to be allowed control over the situation is that once they are inside a psych ward, they lose a lot of personal freedoms and individual rights. Doctors often proceed to prescribe medication, which while they may help some people, usually do more harm than good, because there is no evidence of any bio-chemical cause for self-injury. In addition, even if the self-injurer signs in voluntarily, it is very difficult to get back out. The hospital can put them on 72-hour hold if they request to leave the ward, at the end of which they are put on trial to determine their condition.

The more you know about self-injury, the more you can help a self-injurer. It is helpful to print out information from web sites or books for the self-injurer to show if she seeks treatment. It is normally up to the self-injurer to educate the professionals on this issue. Most of all let them know that many other people do what they are doing, they are not the only ones, and their self-injury does not have to last forever.

If the Self-Injurer Wants Treatment

Be aware that no single therapeutic approach works with all self-injurers, but long-term treatment is required. Unfortunately, there are not enough resources for self-injurers and the cost of therapy is very high. If a self-injurer’s underlying trauma is not resolved, there will be a relapse. Professionals also say that self-injury is harder to give up than eating disorders or alcohol.

Help the self-injurer find an institution that has discussion groups about self-injury, so they get a broader picture and are not isolated. Make sure the doctors do not jump to conclusions and start medication. Find a professional who has experience with self-injurers and can help them work through their pain and find new ways of coping.

What Not To Do

· Do not ignore the self-injury.
· Do not believe it is just a phase or that they will grow out of it
· Do not say a self-injurer is only trying to be popular or copying someone else.
· Do not be disgusted and say they are freaks.
· Do not tell them not to be stupid
· Do not accuse them of keeping secrets
· Do not keep guard over them. They are unlikely to appreciate losing their freedom
  and privacy, however well intentioned you may be.
· Do not march them off to the doctor to be fixed. Suggest they go to the doctor,
  but leave the choice with them.
· Do not start gossiping. No one wants to be known as some sort of freak.

Self-Injury Awareness

March 1 is self-injury awareness day, but because it is a grassroots effort, it is not an officially recognized day. Some of the things you can do to raise awareness are:

· Wear an orange ribbon or buy self-injury awareness wristbands here:
  http://www.selfharm.org/services/wristbands.html. The money goes to LifeSIGNS
  (Self-Injury Guidance and Network Support)
· Write letters to your local newspapers. A sample letter is available here:
  http://www.selfharm.org/files/self-injury-awareness-newspaper-letter-version1.do...
· Email your Premier/local Member of Parliament/other
· Distribute this booklet: http://www.selfharm.org/publications/sia/index.html
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