Information about Self-InjuryWhat is self-injury?
There are a number of definitions, but I like Tracy Alderman's, which states that self-injury includes acts that are:
- Done to oneself and by oneself. If someone else does it to you, it's not self-injury.1
- Physically violent. Abusing oneself emotionally is not good, and it's something that many self-injurers do, but by itself, it's not self-injury.
- Intentional, or done on purpose. If it's an accident—whether clumsiness, a mistake, or just being in the wrong place at the wrong time—if you didn't mean to do it, it's not self-injury.
- Not suicidal. Although self-injurious acts may look like a suicide attempt, there is a clear-cut difference between the two. Suicide is done to die; self-injury is done to cope with life, to live.2
These acts can take many forms. Cutting, burning, and hitting are the most common, but self-injurers use all kinds of other methods as well.
Some definitions of self-injury are broader and take into account eating disorders, alcohol and drug abuse, and other harmful activities. While many would exclude eating disorders and substance abuse from a definition of self-injury, researchers such as Sutton would open the way for a more inclusive definition.3
How many people self-injure?
Favazza and Conterio, two leading researchers on self-injury, believe that self-injury affects 2 to 8 million Americans per year, or 0.7% to 2.8% of the population. Some of their later studies, however, have indicated that the number may be somewhat higher.4 At this point, we're really not sure.
Is self-injury the same as self-mutilation, self-harm, self-abuse, self-injurious behavior syndrome, self-inflicted violence, delicate self-cutting, or coarse self-cutting?
Yes. Self-injury isn't an official disorder yet, so it doesn't have an official name; as a result, everyone who writes a book on the subject makes up his or her own name for it. A few professionals have attempted to make distinctions between some of these terms—Levenkron, for instance, distinguishes between self-injury and self-mutilation5—but it's generally accepted that these terms all refer to the same thing.
Connotations, however, are a different matter. Self-mutilation seems to be the term most accepted among clinicians, but self-injurers often find it demeaning. I use the term self-injury, and occasionally self-harm, because these seem to be the terms that self-injurers prefer. They describe the behavior simply and do not carry demeaning or other unnecessary connotations.
One other term should be mentioned here. The term parasuicide is often used in journal articles and other literature about self-injury, occuring more frequently in U.K.-based literature than in articles from the U.S. Parasuicide, as summarized by Brown, Comtois, and Linehan, is injury to self "with or without the intent to die." It can be divided into three categories: "suicide attempts, ambivalent suicide attempts, and nonsuicidal self-injury."6 While parasuicide may be used to refer to self-injury, it incorrectly implies that self-injury is connected to suicide, which it isn't. When intent is known, more precise terms should be used.
My daughter has a lot of piercings. Is that self-injury?
Probably not. This is debated among professionals, but even those who allow that it might be self-injury emphasize that it depends on the motivation. Alderman says no, because piercings and tattoos are usually done by someone else and are done to improve your appearance and help you feel less alone: none of these motivations correlates with self-injury.7 On the other hand, V.J. Turner says that piercings or tattoos may cross over into the realm of self-injury when the person is obsessed with the behavior or craves the experience of pain; other self-inflicted wounds might serve to indicate that something is wrong.8 Most definitions of self-injury, though, don't include piercings, tattoos, or similar types of body modification at all.
Isn't self-injury just something people do for attention?
No. Self-injury is rarely attention-seeking or manipulative; in fact, most self-injurers do it in private and take care to hide the scars. Wearing long sleeves in summer is often one of the only visible signs of self-injury, since self-injurers take such great care to keep it a secret. Turner even classifies self-injury that is "manipulative and attention-getting" apart from typical self-injury, saying that the two have little in common.9 While others may not take such an extreme position, they tend to agree that manipulative self-injury is much less common that hidden self-injury. Jan Sutton sums it up well when she says, "Self-harm is rarely 'attention-seeking.' Perhaps a more apt description might be 'attention needing.'"10 No matter what the circumstances, self-injury of any sort signals emotional distress and, private or public, should be regarded as the cry for help that it is.
Self-injury seems a lot like a suicide attempt. What's the difference?
Motivation and scale are the two major differences. Self-injury is a coping behavior, so it's done in order to deal with life. The goal may be to release feelings, become calm, punish oneself, or visually express one's pain, but in any case, the person still plans to be alive when it's over. Therefore, the self-harming behaviors are usually not serious enough to cause death (although in cases of extreme anger or intoxication, the person may not realize or care how serious the wounds actually are11). Suicide attempts, on the other hand, are done with the apparent intent to die. The person may get her affairs in order beforehand—giving away possessions, writing a note—and will usually try to harm herself seriously enough to cause death.
Do more men or women self-injure?
That's a question that, as yet, remains unanswered. Women show up more for treatment, so it appears to be more prevalent in women. On the other hand, in institutional settings such as prisons or psychiatric hospitals, it is found more often in men. Alderman, writing in 1997, speculates that rates of self-injury among men and women overall are about equal,12 but she is in the minority. Conterio and Lader,13 Strong,14 Turner,15 and Levenkron16 are among those who believe that self-injury is much more common in women than in men. Because this does seem to be the case, I generally use female pronouns (she, her) to refer to self-injurers. Still, it's important to keep in mind that many males struggle as well.
Why do people self-injure?
For many, many different reasons. In her book Women Living With Self-Injury, Jane Hyman lists twenty-five different reasons for self-injuring! The following, in my opinion, are seven of the most common and most representative:
Essentially, self-injury is a way to cope with life: current problems or past problems, strong feelings or lack of feeling, desire for calm or desire for pain.
- To release emotions
- To show hatred for oneself
- To discipline or punish oneself
- To feel pain or see blood
- To calm racing thoughts
- To stop flashbacks or intrusive, vivid memories
- To avoid suicide17
Doesn't it hurt?
Surprisingly enough, it often doesn't. Many who self-injure feel a certain sort of numbness during the actual act of self-injury, sometimes to the point where they feel little or no pain at all. On the other hand, some who self-injure do feel pain, but it usually isn't enough to dissuade them from self-harming. Those who self-injure to punish themselves may primarily be seeking pain, but sometimes it may be difficult for them to obtain.18
Why is this? Well, when the body is injured, neurotransmitters called endorphins are released. Endorphins—which are also released when you exercise—dull the pain and give the person a general "feel-good" sensation. Some theorists, notably Turner, believe that people can get addicted to these endorphin releases.19
Interestingly enough, while self-injurers can endure quite a bit of self-inflicted pain, many have a low tolerance for other types of pain—headaches, pain from illness, or pain inflicted by others.20 Others try to regard all pain—accidental or otherwise—as self-inflicted, or at least as something they deserved.21 Some former self-injurers can proudly relate the day when they accidentally cut themselves and thought, Ouch. This hurts! Feeling pain from accidental self-inflicted injury is, paradoxically, often a step towards healing for those who used to be able to see pain, but not feel it.
I took Abnormal Psychology and I didn't hear a thing about self-injury. How come?
Many abnormal psychology classes follow the structure of the DSM-IV, the manual that mental health professionals use to diagnose mental illness. As of this writing (2005), self-injury is not classified as a disorder in the DSM-IV; it is listed as a symptom of certain disorders, but not as a disorder of its own. This doesn't mean that it doesn't exist, but it does mean that the psychological community has been slow to recognize and deal with it. In his book Bodies Under Siege, Armando Favazza suggested DSM-IV-style diagnostic criteria for Repetitive Self-mutilation Syndrome,22 but nothing of the sort has been included yet in the official DSM-IV.
I had a friend who was badly treated because she self-injured, so I want to help raise awareness about self-injury. How can I do that?
Go to http://www.selfinjury.org and read about NSIAD (National Self-Injury Awareness Day), which is held on March 1st each year. It's important for people, especially those in authority, to know about self-injury so that they can respond compassionately. Deb Martinson, author of the secret shame site, encourages distribution of materials among emergency room personnel; I believe it's also important that schools, especially school counselors, be informed about self-injury.
But if more people know about it, won't more people do it?
Maybe. On the other hand, the general public is just beginning to learn about self-injury, but there are at least 2 million self-injurers in the U.S. alone, many of whom have been self-injuring for years.23 Many have been badly treated because others didn't understand what was really going on.24 Self-injurers often say they don't know where the idea of self-injury came from—it just came.25 They often try to hide their self-injury from everyone, because they believe other people will think they are freaks.26 Sometimes people do respond unkindly.
Think, instead, about how eating disorders are handled. Eating Disorders Awareness Week is held the last week of February, and many people learn about eating disorders in general and what to do if a friend has an eating disorder. A person with anorexia or bulimia knows that there is treatment available for these problems, and if she chooses to reveal her struggle to someone else, she doesn't have to explain it from scratch. If someone finds out about her disorder, they have a general idea of what it is. Self-injurers, on the other hand, do not have any of these advantages. Maybe it's time to change that.
- V. J. Turner disputes this point in her book Secret Scars; this question explains her objection more fully. Turner still agrees, however, that self-injury is primarily (if not always) done to oneself and by oneself.
- Tracy Alderman, The Scarred Soul: Understanding & Ending Self-Inflicted Violence (Oakland, CA: New Harbinger, 1997), 8-9. For a detailed explanation of the various classifications of self-injury, see Deb Martinson's excellent explanation at http://crystal.palace.net/~llama/selfinjury/fwhat.html
- Jan Sutton, Healing the Hurt Within: Understand and Relieve the Suffering Behind Self-Destructive Behavior (Oxford: Pathways, 1999).
- Marilee Strong, A Bright Red Scream: Self-Mutilation and the Language of Pain (New York: Penguin, 1998), 25.
- Steven Levenkron, Cutting: Understanding and Overcoming Self-Mutilation (New York: W. W. Norton, 1998), 22-30, 73-74.
- Milton Z. Brown, Katherine A. Comtois, and Marsha M. Linehan, "Reasons for Suicide Attempts and Nonsuicidal Self-Injury in Women With Borderline Personality Disorder," Journal of Abnormal Psychology 111, no. 1 (February 2002): 198-202, http://search.epnet.com/login.aspx?direct=true&db=psyh&an=2002-00421-019 (December 31, 2004).
- Alderman, The Scarred Soul, 11.
- V.J. Turner, Secret Scars: Uncovering and Understanding the Addiction of Self-Injury (Center City, MN: Hazelden, 2002), 18.
- Turner, Secret Scars, 19.
- Sutton, Healing the Hurt Within, 20.
- This comment is partially based on Vicki Duffy's experiences in Vicki F. Duffy, No More Pain!: Breaking the Silence of Self-Injury (Longwood, FL: Xulon, 2004), 104-108 and 133-136.
- Alderman, The Scarred Soul, 19.
- Karen Conterio, Wendy Lader, and Jennifer K. Bloom, Bodily Harm: The Breakthrough Healing Program for Self-Injurers (New York: Hyperion, 1998), 23-24.
- Strong, A Bright Red Scream, 19.
- Turner, Secret Scars, 124.
- Levenkron, Cutting, 20.
- Jane Wegscheider Hyman, Women Living With Self-Injury (Philadelphia: Temple University Press, 1999), 45-46.
- Conterio, Lader, & Bloom, Bodily Harm, 55.
- Turner, Secret Scars, 22-24.
- Conterio, Lader, & Bloom, Bodily Harm, 57.
- This observation comes from anecdotal evidence.
- Armando R. Favazza, Bodies Under Siege: Self-mutilation and Body Modification in Culture and Psychiatry, 2nd ed. (Baltimore, MD: Johns Hopkins University Press, 1996), 253. Favazza notes that these criteria were developed with the help of Dr. Richard Rosenthal.
- Strong, A Bright Red Scream, 25.
- See, for instance, Deb Martinson's collection of quotes from self-injurers at http://www.palace.net/~llama/psych/quot.html.
- Alderman, The Scarred Soul, 13.
- Alderman, The Scarred Soul, 13.
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