Self-Injury Behavior by JayHew

With recent threads concerning cutting and perhaps other forms of self-injury and with increasing numbers of individuals, especially teens, being treated for the phenomenon, it is felt some explanation and discussion is warranted.

It is estimated that 4% of the general population and about 14% of college students engage in self-injury behavior. In spite of these numbers, this remains a taboo subject and stigmatized by counseling professionals as well as not being well understood.

Basically Self-injury Behavior is described as the deliberate alteration or destruction of body tissue without conscious suicidal intent; although 55-85% of self-injurers attempt at least one episode of suicide.

Although cutting is the most popular form of self-injury behavior, burning, self-hurting, interference with wound healing, hair pulling, and bone breaking are also types of self-injurious behavior. It appears that those who injure themselves are seeking to escape from intense feelings or to obtain some level of focus. After the act most feel better for a short time.

There are two classifications of individuals who have self-injury behavior. The technical terms are:

1. Dissociative - The individual performs the means of self-injury but is not aware they have done so until there is pain or blood is sensed or seen.
2. Nondissociative – The individual is aware of what they are doing in the process of self-injury and this group makes up the majority of people with self-injury behavior.

Some forms of self-injury are acceptable to our societies and cultures around the world. These primarily are associated with ear piercing, personal tattoos and eyebrow plucking to name a few. It is pointed out that excessive piercing and tattoos, etc. may be an expression of self-injury that satisfies something similar to others who cut themselves and do other injuries.

There are a number of reason a person self-injures and they are complex, but a few hallmarks have been identified, but the reasons may not be the same for each time an episode happens. It appears to affect males most.

So what are some of the characteristics of this disorder?

• Release anger, pain, or anxiety. The self-injury helps relieve the tensions.
• Gain a sense of control – helps them focus when they feel out of control.
• Physical pain to distract from emotional pain – better to feel something than nothing at all.
• Inflict pain on someone who is not available – transference or taking on the anger towards the other person when absent.
• Ground oneself – brings the individual back to reality.
• Communicates a need for support – gives an individual who has difficulty expressing their emotions a means of asking for help.
• Prevent suicide – used as a means of coping with thoughts of suicide.

What causes people to Self-injure?

It is felt there are a number of conditions that lead to the appearance of this disorder. Low self-esteem, feelings of neglect, being marginalized, not paid attention to, feelings of abandonment, physical as well as emotional abuse (conditions that can lead to PTSD – Post Traumatic Stress Disorder) dysfunctional family situations, alcoholic parent(s) are some of the better known situations that present multiple problems.

Self-injury is often carried out when individuals attempt to deal with difficult or overwhelming emotions and are not sure how to more effectively manage their emotions.

What can one do?

The following information comes from The University of Wisconsin, Eau Claire, Counseling Services and says it best:

What Can be Done if You Are Considering Injuring Yourself?

First, people generally do not wish to hurt themselves, but see no better way of managing their emotions. The suggestions below are for people who have made the decision to quit self-injuring, and are looking for alternative strategies to deal with their emotions. Author Deb Martinson suggests looking at the emotions behind the urge to help determine which strategies you might try. (Anger, frustration, restlessness, sadness, melancholic, craving sensation, wanting to see blood, wanting to focus):

Techniques to Try:

• Distract yourself. Get away from the situation you are in, and do something else.
• Talk with someone who is supportive, such as a family member, friend, RA, hall director, or counselor.
• Engage in another activity that requires stimulation. Give yourself a massage, take a hot or cold shower, squeeze ice, finger paint, or squish Play-doh.
• Exercise is a way of quickly managing emotions. Go for a brisk walk or run, punch a pillow, swim, lift weights, or engage in other aerobic activities that require physical exertion.
• Pamper yourself by doing something soothing. Read, listen to music, take a relaxing bath, look at the moon or clouds, open a window to get some fresh air.
• Make a list of activities to engage in that have been helpful in the past when you had the urge to self-injure. Keep this list handy to refer to if you do have the urge to self-injure.

Log the Following Information If You Have the Urge to Self-Injure:

• Rate the intensity of your urge to hurt yourself on a scale from 1-10.
• Identify which emotions you are feeling.
• Rate the intensity of each emotion on a scale from 1-10.
• Identify the situation you were in prior to your urge to hurt yourself.
• Identify the unhelpful/impulsive thoughts present when you had the urge to hurt yourself.
• Identify more helpful/more realistic thoughts to dispute the unhelpful ones.

Rate the intensity of your emotions a scale from 1-10 after completing this log.

You may notice that working through this activity helps you more closely identify what you are feeling and thinking, and how a situation that occurred before the desire to self injure may be connected to the urge. Some people find that the urge to self injure greatly decreases after going through this step by step process.

It may also be helpful to think about the first time self-injury occurred, the situations and emotional factors at that time, and how they were dealt with.

How Can I Break Free From Self-Injury?

Recognizing that there is hope beyond self-injury is the first step, and Counseling Services can be great support. People often fear that self-injury will be seen as shameful or secretive. It does not have to be. A counselor can be the empathic encourager coaching individuals to help meet their goals. A counselor can work with individuals to help increase coping mechanisms, and to provide support as people look more deeply at their emotions, thoughts, and behaviors. By looking at factors associated with self-injury, and underlying concerns, many can begin to break free from self-injury. Additionally, seeking assistance from Health Services or a health care professional may be beneficial, as there is research that suggests that medication in addition to therapy may help those who self-injure.

For Concerned Others:

It can be difficult to know that ones you care about deliberately injures themselves. It can be difficult to not want to rush in and “save” them from their pain. People engaging in self-injurious behaviors need to be the ones making the decision to change their behaviors. You can share your concern, and urge them to ask for help. You can also let them know that you are available to call if they have the urge to self-injure, feel emotionally overwhelmed, or want to be with someone. Unconditionally showing them that they do not need to self-injure to get love and attention from you can be helpful. Asking if you can take them out to a movie, or to get a snack is a way to provide a distraction, and gives them the chance to accept your offer.

If you are living in the residence halls, asking an RA or hall director to become a part of a support team can be an important step in empowering the person self-injuring, especially if the self-injury is distressing others, or endangering the safety of the one you care about.

Additional Resources:

Website by Deb Martinson:
This website offers a comprehensive look at self-injury, strategies for coping with the urge to self injure, and how to support someone who engages in self-injury. This website offers first-aid tips, but is not a substitute for professional medical care.

Website with information from Lisa Ferentz, LICSW:
This website offers an article reflecting the current research relating to self-injurious behavior.