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Abby Penson, Phd Self - Injury

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Self - Injury
Other Issues >> Self - Injury

SELF-INJURY
The number of young people who participate in acts of self-mutilation is growing. Although self-harm is rarely a suicidal act, it must be taken seriously because accidental deaths do occur. It’s difficult to see the light at the end of the tunnel but breaking the cycle of self-abuse is possible if you reach out to someone you trust. Finding new ways of coping with your feelings can help to tone down the intense urges you feel which results in you hurting yourself. Recovery is a continuous process and learning how to stop this addictive behavior is within your reach if you work at it. WHO ENGAGES IN SELF-INJURY?
The numbers are staggering…about two million people in the U.S. are self-injurers and approximately 1% of the population has inflicted physical injury upon themselves at some time in their life as a way to cope with an overwhelming situation or feeling. Those numbers are most likely an underestimation because the majority of acts of self-injury go unreported. In other parts of the world the numbers are considerably higher. Self-injury does not discriminate against race, culture, or socio-economic strata, but there is conflicting data regarding demographics. Some reference sites indicate that the majority of people who engage in this type of addictive behavior are predominately female teenagers and young adults, while other sites indicate that both genders, ranging in age from 14 to 60 self-injure. However, there is consistent agreement that self-harm has more to do with having poor coping mechanisms than anything else.

TYPES OF SELF-INJURY
Definition of self-injury

Self-injury, self-inflicted violence, self-injurious behavior or self-mutilation is defined as a deliberate, intentional injury to one’s own body that causes tissue damage or leaves marks for more than a few minutes which is done to cope with an overwhelming or distressing situation.

The most common self-injurious behaviors are:
  • Cutting - involves making cuts or scratches on your body with any sharp object, including knives, needles, razor blades or even fingernails. The arms, legs and front of the torso are most commonly cut because they are easily reached and easily hidden under clothing
  • Branding – burning self with a hot object, Friction burn – rubbing a pencil eraser on your skin
  • Picking at skin or re-opening wounds (dermatillomania) - is an impulse control disorder characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused which relieves stress or is gratifying
  • Hair-pulling (trichotillomania) – is an impulse control disorder which at times seems to resemble a habit, an addiction, or an obsessive-compulsive disorder. The person has an irresistible urge to pull out hair from any part of their body. Hair pulling from the scalp often leaves patchy bald spots on their head which they hide by wearing hats, scarves and wigs. Abnormal levels of serotonin or dopamine may play a role in this disorder. The combined treatment of using an anti-depressant such as Anafranil and cognitive behavioral therapy (CBT) has been effective in treating this disorder. CBT teaches you to become more aware of when you’re pulling, helps you identify your pulling habits, and teaches you about what emotions and triggers are involved in hair pulling. When you gain awareness of pulling, you can learn to substitute healthier behaviors instead.
  • Hitting (with hammer or other object), Bone breaking, Punching, Head-banging (more often seen with autism or severe mental retardation)
  • Multiple piercing or tattooing - may also be a type of self-injury, especially if pain or stress relief is a factor
  • Drinking harmful chemicals
REASONS FOR SELF-INJURY
Why do they do it?

Even though it is possible that a self-inflicted injury may result in death, self-injury is usually not suicidal behavior. The person who self-injures may not recognize the connection, but this act usually occurs after an overwhelming or distressing experience and is a result of not having learned how to identify or express difficult feelings in a healthy way. Sometimes the person who deliberately harms themselves thinks that if they feel the pain on the outside instead of feeling it on the inside, the injuries will be seen, which then perhaps gives them a fighting chance to heal. They may also believe that the wounds, which are now physical evidence, proves their emotional pain is real. Although the physical pain they experience may be the catalyst that releases the emotional pain, the relief they feel is temporary. These coping mechanisms in essence are faulty because the pain eventually returns without any permanent healing taking place.

Self-harm serves a function for the person who does it. If you can figure out what function the self-injury is serving then you can learn other ways to get those needs met which will reduce your desire to hurt yourself.

It is difficult to understand the motivations behind self-injurious behavior, but a clearer picture develops when you hear the common explanations self-injurers give for doing it:
  • “It expresses emotional pain or feelings that I’m unable to put into words. It puts a punctuation mark on what I’m feeling on the inside!”
  • “It’s a way to have control over my body because I can’t control anything else in my life”
  • “I usually feel like I have a black hole in the pit of my stomach, at least if I feel pain it’s better than feeling nothing”
  • I feel relieved and less anxious after I cut. The emotional pain slowly slips away into the physical pain”
Self-injury can regulate strong emotions. It can put a person who is at a high level of physiological arousal back to a baseline state.

Deliberate self-harm can distract from emotional pain and stop feelings of numbness.

Self-inflicted violence is a way to express things that cannot be put into words such as displaying anger, shocking others or seeking support and help.

Self-injurious behavior can exert a sense of control over your body if you feel powerless in other areas of your life. Sometimes magical thinking is involved and you may imagine that hurting yourself will prevent something worse from happening. Also, when you hurt yourself it influences the behavior of others and can manipulate people into feeling guilty, make them care, or make them go away.

Self punishment or self-hate may be involved. Some people who self-injure have a childhood history of physical, sexual and emotional abuse. They may erroneously blame themselves for having been abused, they may feel that they deserved it and are now punishing themselves because of self-hatred and low self-esteem.

Self-abuse can also be a self-soothing behavior for someone who does not have other means to calm intense emotions. Self-injury followed by tending to one’s own wounds is a way to express self-care and be self-nurturing for someone who never learned how to do that in a more direct way.

People who self-injure have some common traits:
o Expressions of anger were discouraged while growing up
o They have co-existing problems with obsessive-compulsive disorder, substance abuse or eating disorders
o They lack the necessary skills to express strong emotions in a healthy way
o Often times there is a limited social support network

SELF-INJURY AS AN ADDICTION
BECOMING A HABITUAL SELF-INJURER IS A PROGRESSIVE PROCESS
The first incident of self-injury may occur by accident, or after finding out about others who engage in this behavior The next time a similar strong feeling arises, the person has been “conditioned” to seek relief in the same way
  • The person has strong feelings such as anger, fear or anxiety before an injuring event
  • These feelings build, and the person has no way to express or address them directly
  • The person feels compelled to repeat self-harm, which is likely to increase in frequency and degree
  • The person hides the tools used to injure, and covers up the evidence, often by wearing long sleeves
Cutting or other self-injury provides a sense of relief; a release of the mounting tension
Endorphins, specifically enkephalins, contribute to the 'addictive’ nature of self-injury
  • A feeling of guilt and shame usually follows the event
  • The feelings of shame paradoxically lead to continued self-injurious behavior
  • When a person injures themselves endorphins are released in the body and function as natural pain killers
  • The behavior may become addictive because the person learns to associate the act of self-injury with the positive feelings they get when endorphins are released in their system
  • The use of SSRI medications (selective serotonin reuptake inhibitors) such as Prozac and Zoloft, may be helpful in increasing brain serotonin levels and reducing self-injury in cases of moderate to severe depression

FDA Suicide Warning
In May 2007, the U.S. Food and Drug Administration (FDA) recommended a new warning label for all antidepressant medications. The current “black box” label includes a warning about the increased risk of suicidal thinking and behavior in children and adolescents. The FDA wants to expand this warning to include young adults from ages 18 to 24. Children and young adults should also be monitored for the emergence of agitation, irritability, and unusual changes in behavior, as these symptoms can indicate that the depression is getting worse. The risk of suicide is particularly great during the first one to two months of treatment.

SELF-INJURY AND SUICIDE
Self-injury is usually not suicidal behavior but rather a way to reduce tensions. Inflicting physical harm on oneself is a poorly learned coping mechanism which is used to communicate feelings and self-soothe. Self-injury is strongly linked to a poor sense of self-worth, and over time, that depressed feeling can spiral into a suicidal attempt. Sometimes self-harm may accidentally go farther than intended, and a life-threatening injury may result which is why intervention and profession help is required sooner rather than later.

HELPING A FRIEND OR FAMILY MEMBER WHO IS A SELF-INJURER
No matter how you look at it, self-harm scares people. It is very hard coming to terms with the fact that someone you care about is physically harming themselves. From the depths of your own fear and helplessness you may feel frustrated if you are unable to get the person to stop hurting themselves which can further drive the person away.

Some helpful tips in dealing with someone who self-injures
  • Understand that self-harming behavior is an attempt to maintain a certain amount of control which in and of itself is a way of self-soothing
  • Let the person know that you care about them and are available to listen
  • Encourage expressions of emotions including anger
  • Spend time doing enjoyable activities together
  • Offer to help them find a therapist or support group
  • Don’t make judgmental comments or tell the person to stop the self-harming behavior – people who feel worthless and powerless are even more likely to self-injure
  • If your child is self-injuring, prepare yourself to address the difficulties in your family. Start with expressing feelings which is a common factor in self-injury – this is not about blame, but rather about learning new ways of dealing with family interactions and communications which can help the entire family
HOW CAN A SELF-INJURING PERSON STOP THIS BEHAVIOR?
Self-injury is a behavior that over time becomes compulsive and addictive. Like any other addiction, even though other people think the person should stop, most addicts have a hard time just saying no to their behavior – even when they realize it is unhealthy.

What You Can Do to Help Yourself
Acknowledge this is a problem You are probably hurting on the inside and need professional help to stop this addictive behavior
Realize this is not about being a bad person This is about recognizing that a behavior that helped you handle your feelings has become a big problem
Find one person you trust and get professional help Maybe a friend, teacher, rabbi, minister, counselor, or relative. Tell them you need to talk about something serious that is bothering you
Get help in identifying what “triggers” your self-harming behaviors Ask for help in developing ways to either avoid or address those triggers
Recognize that self-injury is an attempt to self-soothe Learn how to develop better ways to calm and soothe yourself
Figure out what function the self-injury is serving Replace the act of self-harm with learning how to express anger, sadness, and fear in healthy ways

TREATMENTS FOR SELF-INJURY
One danger connected with self-injury is that it tends to become an addictive behavior, a habit that is difficult to break even when the individual wants to stop. As with other addictions, qualified professional help is almost always necessary. It is important to find a therapist who understands this behavior and is not upset or repulsed by it. Call your doctor or insurance company for a referral to a mental health professional who specializes in self-injury.
  • Cognitive-behavioral therapy may be used to help the person learn to recognize and address triggering feelings in healthier ways
  • Because a history of abuse or incest may be at the core of an individual’s self-injuring behavior, therapies that address post-traumatic stress disorder such as EMDR may be helpful (see Helpguide’s article on Eye Movement Desensitization and Reprocessing
  • Hypnosis or other self-relaxation techniques are helpful in reducing the stress and tension that often precede injuring incidents (see Helpguide’s article on Yoga, meditation and other relaxation techniques
  • Group therapy may be helpful in decreasing the shame associated with self-harm, and help to support healthy expressions of emotions
  • Family therapy may be useful, both in addressing any history of family stress related to the behavior, and also in helping other family members learn how to communicate more directly and non-judgmentally with each other
  • In cases of moderate to severe depression or anxiety an antidepressant or anti-anxiety medication may be used to reduce the impulsive urges to self-harm in response to stress, while other coping strategies are developed.
  • In severe cases an in-patient hospitalization program with a multi-disciplinary team approach may be required
Alternatives to avoid self-harm
If you self-injure to…Deal with anger that you cannot express openly, try working through those feelings by doing something different – running, dancing fast, screaming, punching a pillow, throwing something, ripping something apart

If you hurt yourself in order to…Feel something when you feel numb inside, hold ice cubes in one hand and try to crush them, hold a package of frozen food, take a very cold shower, chew something with a very strong taste (like chili peppers, raw ginger root, or a grapefruit peel), wear an elastic rubber band around your wrist and snap it (in moderation to avoid bruising) when you feel like hurting yourself

If you inflict physical pain to…Calm yourself, try taking a bubble bath, doing deep breathing, writing in a journal, drawing, or doing some yoga

If you self-mutilate to…See blood, try drawing a red ink line where you would usually cut yourself, in combination with the other suggestions above


Deborah Cutter, Psy.D., Jaelline Jaffe, Ph.D., and Jeanne Segal, Ph.D., contributed to this article. Last modified on: 2/26/08.

Reprinted with permission from http://www.helpguide.org/. C 2008 Helpguide.org. All rights reserved.

You can find the original article at
http://www.helpguide.org/mental/self_injury.htm

SOURCE: www.helpguide.org

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