Background Info & Answers to Common Questions:
This thread will not contain any graphic descriptions of self injury or any images pertaining to it. These are not necessary to discuss the issue, and they may be harmful to those reading it. We would ask that, when replying to this thread, you follow this guideline as well.
However, the subject matter is still very serious and may be upsetting. Please stop reading anytime you feel you are becoming very upset or are considering any kind of self injury, and instead either engage in a distracting chore (walking, watching TV, calling a friend) or post about it and share your feelings with others in the thread.
Terminology:
At the time this thread was written, there was a thread in the forum discussing burning as an "alternative" to cutting. Cutting is a generic term for a variety of self injurious behaviors done repetitively. However, as cutting can be a misleading term, in this thread we primarily use 'self injury' as it is a more accurate and descriptive term.
What Kinds of Self Injury Are There?
dizzyjess
Favazza (1986) separated self-injury into two major groups:
Culturally sanctioned self injury: this is subdivided into rituals and practices. However, this is not the variety of self-mutilation I wish to concentrate on.
Deviant self injury: this can be subdivided again into major self injury, stereotypic self injury and superficial or moderate self injury.
He then divided this into three further subcategories.
Major self injury: this involves acts such as self-castration and amputation. This is mostly commonly associated with psychotic states. Such acts tend to occur suddenly and are associated with major tissue damage and profuse bleeding, as well as commonly being in response to audible and visual hallucinations.
Stereotypic self injury: this tends to be rhythmic self injury, typically headbanging which is associated with the autistic, mentally handicapped and psychotic. This type of self injury is always influenced by physical or chemical problems within the body.
Superficial self injury: this is the most common form of self injury and tends to involve cutting, burning, skin picking, hair pulling (trichotillomania), bone breaking, hitting and wound interference. This type of self-injury is usually a response to overwhelming emotions or situations.
Favazza (1996) then subdivided superficial self-injury into three subcategories:
Compulsive: this is repetitive, ritualistic and involves several episodes within a day. This is most commonly characterised by trichotillomania, skin picking or excoriation when it is done to remove perceived faults or blemishes in the skin. It may be a symptom of a condition such as OCD and generally has a different nature and roots from the other two forms described below.
Episodic: this occurs every so often and generally without the participant identifying themselves as a cutter, burner or similar. This may be a symptom or associated feature of conditions such as anxiety, dissociative disorders, personality disorders or depression. This can develop into repetitive self-injury when a person becomes overly preoccupied with such activities and begins to identify themselves as a cutter, burner or similar.
Repetitive: somebody who participates in repetitive acts of self injury may describe themselves as addicted. It is not the number of injuries that occur that influence whether somebody is an episodic or repetitive self-injurer but rather whether or not they identify with such behaviour. It is also characterised by the self-injurer thinking about such acts, even when not participating in them.
It often becomes a response to stress (both positive and negative), anxiety, depression, numbness, in fact just about any emotion you can think of. Just as a smoker may reach for a cigarette when stressed, a repetitive self-injurer will reach for a blade or lighter. Repetitive self-injury is considered an Axis I impulse control disorder, not otherwise diagnosed by the DSM.
Both episodic and repetitive self-injury can be considered to be impulsive self-injury.
The most commonly discussed form of Self Injury on this message board is the third, superficial self injury. The most common subtype of this kind is called "repetitive self injury".
So what is repetitive self injury and how is it different from other forms of "typical" self injury?
Repetitive Self Injury is
not masochism. Masochism is inflicting pain for sexual gratification. So there are people who engage in play piercing, blood play, and cutting as part of sexual play. These people are
not self injurers. Neither are people who say things such as "Oh, well I tried to cut but I didn't want to hurt myself and I couldn't stand the pain or the blood, so I stopped".
Repetitive self injury is a pattern of behavior, occuring multiple times over an extended period of time, typically in response to a 'triggering' event; a fight with a friend, a bad grade, or even an internal, upsetting thought without any external component.
Self injury is a behavioral symptom of mental illness or distress. Self injurers, in response to unbearable emotional and mental distress have turned their anger, their pain, and their troubles upon themselves. It is a coping mechanism, albiet a terribly unhealthy one, as self injury is disfiguring and can lead to permanent injury and death when the injury rages out of control.
Self injury can be psychologically addictive, and some believe it can be physically addicted as well. Cigarettes are addictive because of what they contain, however people also become addicted to the feeling of smoking, to the act itself. It may be the same with self injury. Pain releases endorphins that give a pleasurable feeling, or at the very least reduce the pain we feel, both mental and physical. Thus there is some thought that self injury can cause a physical addiction to the chemicals released by the process.
And at the same time, self injury is often a highly ritualized behavior. People will, before injurying, systematically lay out materials they will use to cut, in a precise, ordered fashion, guaze, razors, bandages. It becomes compulsive, the act itself is what is essential, not the after effects, the cuts that remain after it is complete, but the actual act of cutting and bleeding and release. That is why self injurers will hide away their cuts and wounds under clothing or by selecting areas that are not commonly visible.
However, in extreme cases, when people who self injure cannot get access to these things they will do whatever they can to injure, including punch walls, kick things, slam their heads into things.
These are extremes, but they reinforce that self injury is not something that should be ignored or viewed as a "phase' that will be grown out of. Some people do grow out of it as they mature and learn other ways to deal, or some never had the tendency towards addiction and stopped doing it when they found it was not satisfactory. But others become trapped in a cycle, causing increasingly more harm. And most importantly, self injury is a behavioral symptom of underlying issues which may need to be addressed.
What factors contribute to self-injury, and who self-injures?
There is no one theory of what causes people to engage in repetative self-injury. It is unlikely that, even with much research, one theory would be agreed upon, as there are many different factors that appear to contribute to the behavior, and these factors are not present in all individuals who self-injure. A great deal more study needs to be done to understand self injury.
Both men and women self injure. While the behavior appears most prominent in adolescents and young adults, people of all ages may self injure. It is important to not dismiss someone because they do not fit a sterotype of what you may think someone who self injures is like.
The most common type
appear to be young women who were abused or abandoned when they were children or preadolescents, causing self esteem and trust issues. They may fear offending and hurting those around them because they are terrified they may lose someone again or be abused again, and so they take out any anger or difficulties they may have with others on themselves.
I say "appear" because it is difficult to throughly study self injurers. Many hide what they do. Many never come to the attention of health professionals or even friends and family. Those that do come forward may not accurately represent the whole population of people who are self injuring.
Secondly, it is very difficult to properly asses the impact of abuse or abandonment on an individual. Many people who experience such traumas grow to be healthy individuals free of mental disease or disorder, and many people who self injure did not have traumatic experiences in their childhood. An individuals total experiences, not just their negative ones, as well as their genetic and environmental factors, all will play a role.
How and Why?
Self injury is typically not something that people simply up and choose to pick up one day. People don't logically sit back and think "I had a shitty day, I'm going to go hurt myself now" when they start self injuring, although later, as it becomes 'normal', they may have such a thought process.
Typically, self-injury will start in an accidental way or stem from an moment of extreme emotional distress, where normal, rational thinking patterns are disturbed. Someone may be upset and angry and frustrated and punch something, cutting themself in the process. They see that this immediate, physical sensation momentarily distracted them from the mental, it numbed it. The relief experienced may be so great that they then seek out the experience again. Overtime, this harmful coping mechanism replaces or prevents learning of heathier ones, such as confronting someone who is upsetting you, going for a run, talking to a therapist, watching a movie, the normal, everday things people do to cope with difficulties in life.
For a self injurer, however, these normal behaviors are replaced by self injury, and it becomes habitual unless other mechanisms are learned, either through simple aging and maturity or through therapy or some other form of treatment.
Suicide Prevention
Self Injury is often confused with suicide attempts. However, self injury is a distinct behavior that, while related to sucidal thoughts or urges, can often be the exact opposite of a suicide attempt.
This may seem contradictory, but it actually makes a great deal of sense. When a person is suicidal, they will often try anything they can to elevate themselves from that state. They do not want to die on one level, but yet on another they are crushed and feel the overwhelming need to die. So they die little deaths. They cut and they see the blood and feel the pain and the endorphin rush and they are, for a time, lifted out of that haze of depression and death. It is not a permanant solution to depression and to being suicidal. People who were never in this state look at it and say "Well, it's just temporary, that doesn't make any sense." But when you are that far down that every single minute is a struggle to survive you will take whatever you can get that makes you live on from second to second and from minute to minute and from day to day, until hopefully you get help so that you no longer need rely on it to stay sane and alive.
When someone self injures unnoticed for a long time, the pattern of behavior can become increasingly more difficult to break. It becomes not only an addiction but a part of one's life, one begins to identify themself as "a self injurer" or 'cutter'. It becomes a part of one's identity, and by then it has become such a habit and a part of life that giving it up is unimaginable. What would you do then? It is everything. It brings you up when you are down, it calms you when you are out of control, it brings you back to earth when you dissociate, it lets you punish yourself when you hate yourself and feel worthless or when you fear you have hurt someone you love.
This is why some people injure for years, long past their teen years. They are trapped in a cycle and they have become complacent with it, it is now a part of their identity and they see nothing wrong with it. These are the people that are the most difficult to help, for they have moved beyond the point where the SI was initial and so could be rapidly headed off and replaced with therapy to deal with the underlying issues and with healthier coping mechanisms.
People who self injure in this manner often hide it well due to confusion and shame, and so unless those around them are perceptive or notice other problems in their life, their self injury may go unnoticed and untreated.
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Our follow up posts will contain resources to go if you self injure and resources for learning more about self injury.
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