7 - Self-injurious Behaviour

Self-injurious behaviour is included in the lesson on psychosis because it is an extreme way to cope with psychological/emotional problems. Self-injurious behaviour refers to any deliberate behaviour that can cause tissue damage such as open wounds, bruises, and redness without the conscious intent to commit suicide. Other names may also be used such as self-mutilation or slashing. Three times more women than men engage in selfinjury. Often this behaviour begins during late childhood and early adolescence. Certain personality factors may be involved: inability to express emotional needs, rapid mood swings, inability to tolerate intense feelings, and having a perfectionist approach to required tasks.

There are three major types of self-injury:

• Major self-mutilation — the most extreme and uncommon kind; a great deal of tissue is destroyed
• Stereotypic self-mutilation — fixed or rhythmic pattern such as repeated headbanging
• Superficial or moderate self-mutilation — relatively little tissue is damaged. Injury may occur by cutting the skin with razors, skin carving, burning, interference with wound healing, needle sticking, self-punching, or scratching. Self-injury can become addictive; some people have difficulty giving up the practice.

Causes

People who self-mutilate often have a history of violence and/or sexual abuse in their past that they have not told anyone about. They may be drug or alcohol abusers or have parents who were heavily involved in alcoholism. They may be devastated by the loss of a parent through death or divorce.

Self-injury is anger turned inward. The common element that triggers self-injury is anxiety from overwhelming psychological distress—intense anger, guilt, frustration, or self-hatred. To direct anger at themselves rather than at their abusers feels safer and more controlled. Besides release of tension, self-injury converts unbearable emotional pain into manageable physical pain. One psychologist proposed the theory that children who are not nurtured and protected fail to learn to protect themselves.

self_mutilationSymptoms

Slashing involves using something sharp like a razor, knife, or broken glass to cut the skin, usually the arms. It is fairly common in prisons. Women and girls are most likely to slash, especially if they are survivors of sexual abuse. The physical pain seems to reduce the emotional pain the women are feeling.

Moderate self-injury can be a symptom of many disorders including post-traumatic stress disorder, multiple personality disorder, eating disorders, substance abuse, and clinical depression. The person has a repeated impulse to destroy or alter body tissue. Tension increases immediately before, and a sense of relief follows the act of self-harm. No association occurs between the self-harm act and actual suicide.

Treatment

If you are prone to self-injury, stay away from the materials that are usually used for self-injury. Remind yourself about long-term consequences such as scars. Stay away from drugs and alcohol. Stay in the company of others. Find new ways to cope with your feelings—such as mediation, exercise, and healthy hobbies. Learn to nurture yourself. When you are very angry, engage in vigorous physical activity. Visit a therapist to help express your anger and make changes in your life. Most people who self-harm have problems with low self-esteem and are disgusted by their own selfinjury behaviour. There are more socially acceptable forms of self-mutilation such as piercing the ears, nose, naval skin, and other body parts.

If you are a friend of someone who self-injures, do not shame the person. Understand that he or she is under a lot of stress and give your support. Stay with the person until the impulse to self-injure passes. Encourage him or her not be alone.