Information AboutSelf-harm |
| CATEGORIES ABOUT SELF-INJURY | |
| abnormal psychology | |
Self-injury ('''SI''') or '''self-harm''' ('''SH''') is deliberate Injury inflicted by a person upon his or her own body without Suicidal Intent . Some scholars use more technical definitions related to specific aspects of this behaviour. These acts may be aimed at relieving otherwise unbearable Emotion s, sensations of unreality and numbness. It is listed in the DSM-IV-TR as a symptom of Borderline Personality Disorder and is sometimes associated with Mental Illness , a history of Trauma and Abuse , Eating Disorder s, or mental traits such as low Self-esteem or Perfectionism . There is a positive statistical correlation between self-injury and Emotional Abuse .Meltzer, Howard, et al., (2000), Non Fatal Suicidal Behaviour Among Adults aged 16 to 74 in Great Britain, The Stationary office ISBN 0-11-621548-8 Rea, K., Aiken, F., and Borastero, C., (1997) Building Therapeutic Staff: Client Relationships with Women who Self-Harm, Women's Health Issues, 7, 2, p121-125. DEFINITION Self-injury, sometimes referred to as ''self-harm'' (''SH''), ''self-inflicted violence'' (''SIV''), ''self-injurious behavior'' (''SIB'') refers to a spectrum of behaviors where demonstrable injury is self-inflicted. LifeSIGNS Self Injury Awareness Booklet, Version 3 Mar. 01, 2007 from Self Injury Awareness Booklet, LifeSIGNS ISBN 0955550602 The term ''self-mutilation'' is also sometimes used, although this phrase evokes connotations that some find worrisome, inaccurate, or offensive. A broader definition of self-injury might also include those who inflict harm on their bodies by means of disordered eating, as well as tattooing or body piercing that goes beyond the limits of culturally accepted body modification. Self-injury is not associated with Suicidal or Para-suicidal behavior. The person who self-injures is not usually seeking to end his or her own life, but is instead using self-injury as a coping mechanism to relieve emotional pain or discomfort.''"Sometimes it's nice to see that it is me hurting, instead of somebody else''". Fox, C & Hawton, K (2004) Deliberate Self-Harm in Adolescence, London: Jessica Kingsley ISBN 142370987X A common misconception regarding self-injury is that it is an attention seeking behavior. In point of fact, people who self-injure are very self-conscious of both their wounds and scars, and go to great lengths to conceal their behavior from others. They may offer alternative explanations for their injuries, or conceal their scars with clothing.Spandler, H (1996) Who's Hurting Who? Young people, self-harm and suicide, Manchester: 42nd Street ISBN 1-900782-00-6Pembroke, L R (ed.)(1994) Self-harm. Perspectives from personal experience, Survivors Speak Out ISBN 1-904697-04-6 Methods of injury A common form of self-injury involves making cuts in the skin of the arms, legs, abdomen, inner thighs, etc. This is colloquially referred to as "cutting"; a person who routinely does this may be colloquially called "a cutter". The number of self-injury methods are only limited to an individual's creativity. The bodily locations of self-injury often are areas that are easily hidden and concealed from the detection of others.Hodgson, Sarah. 2004. “Cutting Through the Silence: A Sociological Construction of Self-Injury.” Sociological Inquiry, Vol. 74, No. 2. pp. 162-179 Examples of self-injury other than cutting include:
Other definitions Strictly speaking, self-harm is a general term for self-damaging activities (which could include such activities as Alcohol Abuse or Bulimia ). Self-injury refers more specifically to the practice of cutting, bruising, poisoning, over-dosing (without suicidal intent), burning, or otherwise directly injuring the body. Harrsion, D (1994) Understanding self harm, Peterborogh, MIND (Cited in Greenwood, S & Bradley, P (1997) Managing deliberate self-harm: the A&E perspective Accident and Emergency Nursing 5: 134-136) Many people, including health-care workers, define self-harm based around the act of damaging one's own body. It may be more accurate to define self-harm based around the intent, and the emotional distress that the person wishes to deal with. An example of this form of definition is provided by the self-injury awareness charity, LifeSIGNS. What self-injury is Neither the DSM-IV-TR nor the ICD-10 provide diagnostic criteria for self-injury. It is often seen as only a symptom of an underlying disorder, though many people who self-injure would like this to be addressed. '' Reasons for Self inflicted wounds This differs from the common definition of self-injury as the damage is inflicted for a specific secondary purpose. DEMOGRAPHICS Accurate statistics on self-injury are hard to come by since most self-injurers conceal their injuries. Recorded figures tend to be based on hospital admissions, though more recently researchers have attempted to document the topography and correlates of the behavior in the general population. Studies based only on hospital admissions may hide the larger group of self-injurers who do not need or seek hospital treatment for their injuries. Many of these statistics show that more women seem to self-injure than men, and that it is more common among young people.
Whitlock, J.L., Eckenrode, J.E. & Silverman, D. (2006). The epidemiology of self-injurious behavior in a college population. Pediatrics, 117(6).
Retrieved Jul. 20, 2004 from Hospitalisation for intentional self-harm, New Zealand Health Information Service
RISK FACTORS A number of social or psychological factors can be seen to have a positive statistical correlation with self-injury or its repetition. People experiencing various forms of mental ill-health can be considered to be at higher risk of self-injuring. Key issues are depression, Hawton, K., Kingsbury, S., Steinhardt, K., James, A., and Fagg, J., (1999) Repetition of deliberate self-harm by adolescents: the role of psychological factors, Journal of Adolescence, 22, 369-378. Phobias , Conduct Disorders Wessely et al. (1996) Deliberate self-harm and the probation service: An overlooked public health problem?, Journal of Public Health Medicine, 18, 129-32 Substance abuse is also considered a risk factor as are some personal characteristics such as poor problem resolution skills, impulsivity, hopelessness and aggression. Emotionally invalidating environments where parents punish children for expressing sadness or hurt can attribute to a lack of trust in oneself and difficulty experiencing intense emotions http://www.palace.net/~llama/psych/cause.html. Abuse during childhood is accepted as a primary social factor,Strong, M., (1998, 2000) A Bright Red Scream: Self-mutilation and the Language of Pain, London: Virago. also losing a parent or loved one, along with troubled parental or partner relationships.. Factors such as war, poverty, and unemployment may also contribute. Third World faces self-harm epidemic The deportation machine: unmonitored and unimpeded However, some people who self-injure have no experience of these factors. PSYCHOLOGY Attempts to understand self-injury fall broadly into either attempts to interpret motives, or application of psychological models. Motives for self-injury are often personal, often do not fit into medicalised models of behaviour and may seem incomprehensible to others, as demonstrated by this quote: Assessment of motives in a medical setting is usually based on precursors to the incident, circumstances and information from the patient however the limited studies comparing professional and personal assessments show that these differ with professionals suggesting more manipulative or punitive motives.Hawton, K., Cole, D., O'Grady, J., Osborn, M. (1982) Motivational Aspects of Deliberate Self Poisoning in Adolescents, British Journal of Psychiatry, 141, 286-291 The UK ONS study reported only two motives: “to draw attention” and “because of anger”. Many people who self-injure state that it allows them to "go away" or Dissociate , separating the mind from feelings that are causing anguish. This may be achieved by tricking the mind into believing the pain felt at the time is caused by self-injury instead of the issues they were facing before: the physical pain therefore acts as a distraction from emotional pain. The sexual organs may be deliberately hurt as a way to deal with unwanted feelings of sexuality, or as a means of punishing sexual organs that may be perceived as having responded in contravention to the persons well being. (e.g., responses to child sexual abuse) To complement this theory, one can consider the need to 'stop' feeling emotional pain and mental agitation. "A person may be hyper-sensitive and overwhelmed; a great many thoughts may be revolving within their mind, and they may either become triggered or could make a decision to stop the overwhelming feelings."Retrieved Jul. 28, 2005 from LifeSIGNS: Precursors to Self Injury Alternatively self-injury may be a means of feeling ''something'', even if the sensation is unpleasant and painful. Those who self-injure sometimes describe feelings of Emptiness or numbness ( Anhedonia ), and physical pain may be a relief from these feelings. "A person may be detached from himself or herself, detached from life, numb and unfeeling. They may then recognise the need to function more, or have a desire to feel real again, and a decision is made to create sensation and ‘wake up’." A Flow Diagram of these two theories accompanies this section. It is also important to note that many self-injurers report feeling very little to no pain while self-harming.Strong, M. (1999). A Bright Red Scream: Self-Mutilation and the Language of Pain. Those who engage in self-injury face the contradictory reality of harming themselves whilst at the same time obtaining relief from this act. It may even be hard for some to actually initiate cutting, but they often do because they know the relief that will follow. For some self-injurers this relief is primarily psychological whilst for others this feeling of relief comes from the Beta Endorphins released in the brain (the same chemicals that are thought to be responsible for the " Runner's High "). These act to reduce tension and emotional distress and may lead to a feeling of calm. As a coping mechanism, self-injury can become psychologically addictive because, to the self-injurer, it works; it enables him/her to deal with intense stress in the current moment. The patterns sometimes created by it, such as specific time intervals between acts of self-injury, can also create a behavioral pattern that can result in a wanting or craving to fulfill thoughts of self-injury. Another possible source of self-injury can be Self-loathing , often as a means of punishment for having strong feelings that they were expected to suppress when they were children, or because they feel bad and undeserving, having previously been physically or emotionally abused and feeling that they were deserving of the abuse. Self-injury - types, causes and treatment SELF-INJURY AWARENESS There are many movements among the general self-injury community to make self-injury itself and treatment better known to mental health professionals as well as the general public. SIAD (Self Injury Awareness Day) which is set for March 1 of every year, is one such movement. On this day some people choose to be more open about their own self-injury, and awareness organizations make special efforts to raise awareness about self-injury. Some people wear Ribbons to show awareness; commonly Orange Ribbon s are used for this. Sometimes a red and black ribbon is also used, generally signifying a person who self-injures. American Self-harm Information Clearing-House Sometimes orange is used to represent those who self-injure, white for those who don't injure but show support and white and orange together show someone who is trying to stop or has stopped self-injury. Bracelet colours A single white bead on an orange bracelet may sometimes be used for those who want to stop and several mixed white and orange beads is for those who have stopped. Bracelet colours 2 TREATMENT Self-injury may be an indicator of Depression and/or other psychological problems. Therapy and skills training can be very useful for those who self-injure. The therapy module used will vary depending on the person's diagnosis and their individual needs. DBT, or Dialectical Behavioral Therapy can be very successful for those with a Personality Disorder , and could potentially be used for those with other mental illnesses who exhibit self-injurious behavior. Cognitive Behavioral Therapy is generally used to assist those with Axis 1 diagnoses, such as depression, schizophrenia, and bipolar disorder. Diagnosis and treatment of the causes is thought by many to be the best approach to self-injury; but in some cases, particularly in clients with a personality disorder, this is not very effective, which is why more clinicians are starting to take a DBT approach in order to reduce the behavior itself. A person who is injuring themselves may be advised to use coping skills, such as journaling or taking a walk, when they have the urge to harm themselves. They may also be told to avoid having the objects they use to harm themselves within easy reach. People who rely on habitual self-injury are sometimes psychiatrically hospitalised, based on their stability, and their ability and especially their willingness to get help. Self-help - how do I stop right now? SEE ALSO FURTHER READING
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