They cut their bodies using razors and other sharp-edged instruments. They also burn their flesh with cigarettes and soldering irons. The wounds are normally not meant for public display. In most cases the “secret” is carefully concealed beneath the clothing. A person who happens to catch a glimpse of a fresh scar is likely to hear that “I got a burn while ironing my clothes” or “it was an accident involving a kitchen knife.” Accidents like that happen now and then, don’t they?
In actuality, everyday mishaps have nothing to do with a phenomenon referred to as self-injury or self-harm. Self-injury is deliberate injury inflicted by a person upon his or her own body without intent of taking his or her own life. One in every one hundred persons is thought to exhibit self-injurious behavior. As regards teenagers, especially female subjects, statistics on self-injury are even higher.
Self-injury usually evolves into an irresistible urge, a kind of addiction. Despite being perfectly aware of a negative impact this kind of behavior would have on their reputation, people who engage in self-injury simply cannot help it. The acts of self-harm may be aimed at relieving otherwise unbearable emotions, sensations of unreality and numbness.
They do not have masochistic or suicidal tendencies
There is no direct correlation between self-injurious behavior and suicidal intent though on an average the self-injurer contemplates suicide more frequently and even makes attempts at suicide at times. The person who self-injures is not usually seeking to end his or her life. On the contrary, sometimes those inflict harm on their bodies explain their behavior citing a desire to avoid suicide through self-injury.
As paradoxical as it may seem, they hope to cope with or relieve unbearable emotional pain or discomfort by damaging their own bodies. Persons with self-injurious tendencies often cite a decision to deal with the overwhelming feelings (anger, fear, self-loathing, despair) and stress as the cornerstone of their reasons for harming their bodies. They also see self-injury as a means of feeling something when they feel emotionally numb, even if the sensation is unpleasant and painful.
Statistics indicate that 67% of self-injurers report feeling little or no pain while self-harming. Self-injurers seem to be perfectly aware of their goals: obtain relief and a feeling of calm after having their “share of suffering.”
In 1991, Van der Kolk and Herman carried out a research into the causes of self-injury among “cutters,” the persons who make shallow cuts to the skin of their arms and legs. The majority of patients were found to have experienced physical or sexual abuse during childhood. Some of them were raised in dysfunctional families, with parents who shirked their responsibilities. Others admitted to being victims of systematic abuse in school.
Besides, the study lists other risk factors associated with self-injury:
- A person subjected to abuse in his or her early childhood is believed to run a higher risk of developing self-injurious tendencies in adulthood.
- Compared to physical or psychological abuse, sexual abuse is more closely correlated with self harm.
Later studies confirmed the conclusions Van der Kolk and Herman arrived at: most self-injurers have experienced physical and/or sexual abuse in the past. However, it is important to note that a “majority” does not equal “all.” Some people who self-injure have no experience of these factors. Other scientists maintained that some people are “predisposed” to engaging in self-damaging activities, while a distressing experience canstimulate predisposition for self-injury.
A study published in 1993 by the psychologist Leanehan contains the following explanation of self-injury: “Persons who practice self-injury were raised in an atmosphere that devalued their feelings. Such an atmosphere is, without doubts, common in families with troubled parental relationships displayed through acts of violence yet relatively ‘normal’ families may create it too. The feelings become devalued because the child hasn’t been given an opportunity to discuss his or her personal experience and emotions, which were either ignored or met with ridicule.”
Some persons with certain biological characteristics are thought to be predisposed to self-injury. According to one of the theory, self-damaging activities result in a dramatic change in the level of some substances e.g. serotonins released in the brain. These act to reduce tension and emotional distress and may give the person an opportunity to “manage anger,” which cannot be immediately expressed under the circumstances.
Despite a popular viewpoint on self-injury as a condition that is more common among young people, it can occur to persons of any age, sex, nationality and social status. However, statistics show that more women seem to self-injure than men. According to a variety of estimates, from 67% to 85% of persons with self-injurious behavior are women.
There are several explanations of the female to male ratio. A popular theory put forth by the psychologist Miller stresses the point that girls aretaught to repress their feelings of anger and aggression during childhood for an overt display of them would be interpreted as a “lack of femininity.” Boys are told to keep their emotions in check too yet the restrictions are less severe when it comes to aggression and anger. Men are allowed to “let it show,” whereas women tend to direct their emotions inward.
On the other hand, we need to bear in mind a correlation between sexual abuse and self-injury. By and large, more girls and women are subject to sexual abuse than boys and men.
Healing the wounds
“Classic” treatment of a patient suffering from self-injury implies compulsory hospitalization, behavioral monitoring and the use of drugs e.g. antidepressants. However, most Western clinicians recently agreed that standard methods based on severe restrain could backfire.
Likewise, methods similar to those used for treating “bad habits” e.g. overeating or smoking would be a waste of time and money when applied for the treatment of self-injurers. It is believed that effective methods of anger management can help patients cope with the urge to harm themselves. Self-injury is more complex a condition than a “bad habit” or “addiction.”
Today psychiatrists recommend that patients start their treatment by taking antidepressants and a variety of mood stabilizers in order to alleviate emotional distress and thus reduce a craving to fulfill the thoughts of self-injury. Patients are also advised to learn the anger management skills while taking medication.
Physical injury inflicted by patients on their own bodies is just the “tip of the iceberg,” and therefore psychotherapy aimed at dealing with problems that lie “beneath the water” should be the next step of the treatment. DBT, or dialectical behavioral therapy, and family counseling can be very successful for those with self-injurious behavior. The therapy module used should vary depending on the person’s diagnosis and individual needs.
Translated by Guerman Grachev