self harming

"Self-harm is a way of dealing with very strong emotions. For some people it gives the relief that crying may provide for the rest of us - but maybe they've cried so much that it no longer gives them any relief. Some self-harming people feel so angry and aggressive that they can't control their emotions. They become afraid that they may hurt someone, so they turn their aggression inwards to get relief. People who self-harm are often labelled as 'attention seeking'. However, a person who self-harms may believe this is the only way to communicate their distress.

Self-harm can be a hidden problem that goes on for years. It may start as a spur-of-the-moment outlet for anger and frustration (such as punching a wall) and can develop into a major way of coping with stress that, because it remains hidden, generates more stress.

The severity of self-harm doesn't depend on how serious the underlying problems are. Usually, as time passes, the person becomes more tolerant of the pain they inflict and so has to do more severe harm to themselves to obtain the same sense of relief. This spiral can lead to permanent injury and serious infections.



How commen is it?
About ten per cent of admissions to medical wards in the UK are as a result of self-harm. Women are at the most risk of self-harming between the ages of 15 and 19; men, between 20 and 24. Women have higher rates of self-harm than men. Methods of infliction vary, but the majority of cases admitted to hospital are for drug overdoses - only five to 15 per cent are caused by cutting.

These figures probably hide another group that regularly self-harms to relieve stress. These people have usually found ways to keep their problem hidden and, when they do harm themselves badly enough to need treatment, they'll often have a story well prepared, or not seek help at all. The result can be permanent disfigurement or a serious infection.

About half the men admitted to hospital for self-harm and a quarter of women have drunk alcohol in the hours beforehand. This is a very worrying figure. A person taking the decision to overdose while under the influence of alcohol - and so possibly acting impulsively - runs the risk of having the drugs interact with the alcohol. Both the drugs and the alcohol could become more potent when mixed in the body - the person may end up taking a much stronger mixture than they anticipated, with tragic consequences.

It's important to make a distinction between self-harm and attempted suicide. About a quarter of the people treated in casualty for deliberate self-injury have tried to take their own lives, or - undecided about whether or not they want to live - have simply put the choice in the hands of fate.


Types of self-harm
The most common forms are cutting the arms, hands and legs, and less commonly the face, abdomen, breasts and even genitals. Some burn or scald themselves, others inflict blows on their bodies, or bang themselves against something. Other ways people injure themselves include scratching, picking, biting, scraping and occasionally inserting sharp objects under the skin or into body orifices and swallowing sharp objects or harmful substances.

Common forms of self-injury that rarely reach medical attention include sufferers pulling out their own hair and eyelashes, picking at spots or skin and scrubbing themselves so hard as to cause abrasion (sometimes using cleaners such as bleach).

It's hard to say how common self-mutilation is because it's such a secretive activity. Confidential helplines receive calls from those who've injured themselves for years without telling anyone, because of the shame and fear of condemnation. But some studies have found that 11 per cent of students questioned had slashed or cut themselves at some point.

Childhood sex abuse
A lot of people say they start self-harming behaviour in childhood disguising scratches and bumps as accidents and progressing to more systematic cutting and burning in adolescence.

A popular theory is that those who self-mutilate do so because they've been victims of sexual abuse during their childhood. The theory contends that because these victims were forbidden to reveal the truth about their abuse in oppressive or neglectful families, they use self-mutilation or self-cutting to express to the world the horrors of abuse.

Their self-harm is a form of communication to get others to notice that something is wrong without the victim actually saying what really happened because they're afraid of being punished by the perpetrators of the abuse.

Another theory is that sexual abuse in early childhood has led to extremely low self-esteem - either because you blame yourself for your abuse or the perpetrator ensures you feel low about yourself as part of their campaign to control you. If very low self-esteem develops, self-harm as an expression of self-hatred is understandable.

Certainly one research finding is that self-harmers tend to grow up in an 'invalidating environment' - one where the communication of private experiences is met with unreliable, inappropriate or extreme responses. The expression of private experiences as a result is not validated - instead, it's trivialised or punished.

The problem with these theories is that (for example, in the case of the sexual abuse theory), not everyone who's been sexually abused starts to self-harm, and also not everyone who self-harms has been sexually abused. For a small percentage of the group of patients that claim to be sexually abused, the evidence is non-existent and their own accounts are inconsistent.


Biological addiction
An increasingly popular biological theory for self-cutting is that it triggers the release of the body's natural opiate-like chemicals, which are released to reduce pain whenever we're injured. Perhaps self-cutters have become addicted to their body's heroin-like reaction to cutting, which is why they do it again and again. They may also suffer withdrawal if they haven't done it for a while. Drugs used to treat heroin addicts are helpful with self-cutters, but mostly for those who described a 'high' after they've cut themselves.

Another theory, which in-patient units often use, is based on the psychological principle that all behaviour has consequences that are somehow rewarding. Cutting usually leads to a sequence of behaviour, perhaps including provoking a reaction in others - increased attention, for example - which may become the rewarding reason to repeat the behaviour.

Removing rewards when self-harmers are moved from their home or local environment and admitted to a specialist unit, whatever reactions were provoked in others now can't occur. Staff in specialist units such as the Bethlem Royal are specially trained to ensure that no consequences might follow from an episode of cutting that could be rewarding, such as increased attention.

Instead, when the patient stops cutting themselves, they're rewarded with increased attention from staff. A framework is established in which patients learn to accept responsibility for self-harming.

Under inexperienced care, a complicated situation can evolve where staff come to be blamed for the 'patient not getting better' and so subtly take on responsibility for the self-cutting, therefore, releasing the patient from accepting their own role in the cause of their problems.

Self-harm culture
It's essential that self-harm is destigmatised. A good start would be to acknowledge the extent to which self-injury is part of contemporary culture. For example, we modify our bodies by cutting, piercing, cosmetic surgery (breast enhancement and nose jobs), hair removal, skin bleaching, hair straightening and tattooing.

Research has found that criminals who have tattoos are more likely to self-harm than those who don't. All this activity bears a resemblance to clinical self-injury in an important respect - it always contains an underlying assumption that an individual is not good enough without changing their body."(in the words of some1 from the BBC- click on the title for the linkor just click on this link
"

"Self-harm, also known as self-injury, self-inflicted violence, self-injurious behavior, or self-mutilation, can be defined as the deliberate, direct injury of one's own body that causes tissue damage or leave marks for more than a few minutes and that is done in order to deal with an overwhelming or distressing situation.

It's important to remember that, even though it may not be apparent to an outside observer, self-injury is serving a function for the person who does it. Figuring out what functions it serves and helping someone learn other ways to get those needs met is essential to helping people who self-harm. Some of the reasons self-injurers have given for their acts include:

*Affect modulation (distraction from emotional pain, ending feelings of numbness, lessening a desire to suicide, calming overwhelming/intense feelings)
*Maintaining control and distracting the self from painful thoughts or memories
*Self-punishment (either because they believe they deserve punishment for either having good feelings or being an "evil" person or because they hope that self-punishment will avert worse punishment from some outside source
*Expression of things that can't be put into words (displaying anger, showing the depth of emotional pain, shocking others, seeking support and help)
*Expression of feelings for which they have no label -- this phenomenon, called alexithymia (literally no words feeling), is common in people who self-harm
See Osuch, Noll, & Putnam, Psychiatry 62 (Winter 99), pp: 334-345
Zlotnick et al, Comprehensive Psychiatry 37(1) pp:12-16.

People who self-injure often never developed healthy ways to feel and express emotion or to tolerate distress. Studies have shown that self-harm can put a person at a high level of physiological arousal back to a baseline state.

It's natural to want to help people who self-injure develop healthier ways of coping when they feel overwhelmed, but it's important not to let your discomfort with the concept of self-harm cause you to issue ultimatums, punish self-harming behavior, or threaten to leave if the person self-harms again. Ideally, you should set boundaries to keep yourself feeling safe while respecting the person's right to make his or her own decisions about how to deal with stress.


Common Myths about Self-Injury

Self-harm is usually a failed suicide attempt.
This myth persists despite a wealth of studies showing that, although people who self-injure may be at a higher risk of suicide than others, they distinguish betwen acts of self-harm and attempted suicide. Many, if not most, self-injuring people who make a suicide attempt use means that are completely different to their preferred methods of self-inflicted violence.

People who self-injure are crazy and should be locked up.
Tracy Alderman, Ph.D., author of The Scarred Soul, addressed this:

"Fear can lead to dangerous overreactions. In dealing with clients who hurt themselves, you will probably feel fear. . . . Hospitalizing clients for self-inflicted violence is one such form of overreaction. Many therapists, because they do not possess an adequate understanding of SIV, will use extreme measures to assure (they think) their clients' best interests. However, few people who self-injure need to be hospitalized or institutionalized. The vast majority of self-inflicted wounds are neither life threatening nor require medical treatment. Hospitalizing a client involuntarily for these issues can be damaging in several ways. Because SIV is closely related to feelings of lack of control and overwhelming emotional states, placing someone in a setting that by its nature evokes these feelings is very likely to make matters worse, and may lead to an incident of SIV. In addition, involuntary hospitalization often affects the therapeutic relationship in negative ways, eroding trust, communication, rapport, and honesty. Caution should be used when assessing a client's level of threat to self or others. In most cases, SIV is not life threatening. . . . Because SIV is so misunderstood, clinicians often overreact and provide treatment that is contraindicated.
People who self-harm are just trying to get attention.
A wise friend once emailed me a list of attention-seeking behaviors: wearing nice clothing, smiling at people, saying "hi", going to the check-out counter at a store, and so on. We all seek attention all the time; wanting attention is not bad or sick. If someone is in so much distress and feels so ignored that the only way he can think of to express his pain is by hurting his body, something is definitely wrong in his life and this isn't the time to be making moral judgments about his behavior.
That said, most poeple who self-injure go to great lengths to hide their wounds and scars. Many consider their self-harm to be a deeply shameful secret and dread the consequences of discovery.

Self-inflicted violence is just an attempt to manipulate others.
Some people use self-inflicted injuries as an attempt to cause others to behave in certain ways, it's true. Most don't, though. If you feel as though someone is trying to manipulate you with SI, it may be more important to focus on what it is they want and how you can communicate about it while maintaining appropriate boundaries. Look for the deeper issues and work on those.

Only people with Borderline Personality Disorder self-harm.
Self-harm is a criterion for diagnosing BPD, but there are 8 other equally important criteria. Not everyone with BPD self-harms, and not all people who self-harm have BPD (regardless of practitioners who automatically diagnose anyone who self-injures with BPD).

If the wounds aren't "bad enough," self-harm isn't serious.
The severity of the self-inflicted wounds has very little to do with the level of emotional distress present. Different people have different methods of SI and different pain tolerances. The only way to figure out how much distress someone is in is to ask. Never assume; check it out with the person.

Only teen-aged girls self-injure.
In five years of existence, the bodies-under-siege email list has had members of both genders, from six continents, and ranging in age from 14-60+. It's a person-who-has-no-other-way-to-cope thing, not a teenage (or female or American or whatever) thing."(in the word of sum1 from the self injery website thats the link)