Self-destructive behavior

Self-harm (SH) is injury inflicted by a person upon his or her own body, whether conscious or unconscious. Some scholars use more technical definitions related to specific aspects of behavior. This injury may be aimed at relieving otherwise unbearable emotions, sensations of unreality and numbness, or for other reasons. Self-harm is generally a social taboo. It is sometimes associated with mental illnesses such as Borderline Personality Disorder, with a history of trauma and abuse, with eating disorders, or with mental traits such as perfectionism. Note that this article focus on repetitive self-harm, not severe self-harm inflicted during psychosis, such as eye enucleation and amputation.

Definition
Self-harm is also known as self-injury (SI), self-inflicted violence (SIV), self-injurious behavior (SIB), and self-mutilation1, although this last term has connotations that some people find worrisome. When discussing self-harm with someone who engages in it, it is suggested to use the same terms and words which that person uses, e.g. "cutting", rather than insisting on labeling it "self-harm".

A common form of self-injury is shallow cuts to the skin of the arms or legs, or less frequently to other parts of the body, including the breasts and sexual organs. Since this is the most well-known, it is casually referred to as "cutting", though it may also involve punching, slapping, or burning oneself as   well. The usual thought process behind self-injury is not to attempt suicide, but to relieve unbearable emotional pressure, or some kind of discomfort. Self-injury is seen by some as attention seeking behavior, though many people who self injure are very self-conscious of their wounds and scars and go to great lengths to conceal their behavior from others. They may offer alternate explanations for their injuries or conceal their scars with clothing.

Strictly, self-harm is a general term for self-damaging activities (which could include alcohol abuse, bulimia, etc). Self-injury refers more specifically to the practice of cutting, bruising, self poisoning, over-dosing (without suicidal intent, at first), burning or otherwise directly injuring the body. Self-harm is also a way for people to relieve the emotional pain of everyday life, especially in the case of teenagers, but not exclusively. People who self harm may hurt themselves with a favourite 'tool' or by whatever means available to "wipe out" the emotional distress that they feel inside. There may also be a specific ritual associated with the activity, such as being in a certain location, listening to certain types of music, or following the activity with specific behaviors not directly related to the harming itself.

Many people, including Health Care Workers, define self-harm based around the act of damaging one's own body. It may be more accurate to define self-harm based around the intent, and the emotional distress that the person wishes to deal with.

Demographics

 * The average European rate of self-harm for persons over 15 years is estimated to be 0.14% for males and 0.193% for females. For each age group the female rate exceeds that of the males, with the highest rate among females in the 15-24 age group and the highest rate among males in the 12-34 age group. Recently, however, it has been found that the female to male ratio, previously thought to be around 2:1, is diminishing &#8211; in Ireland it has been close to parity for a number of years.2 It has also been speculated that there is a significant amount of unrecorded cases among men, which never surface because males tend to feel more guilty and ashamed of showing signs of "weakness", or else feel they should cope alone.


 * The Mental Health Foundation meanwhile estimates the rate in the UK to be 0.77%.


 * Conterio and Favazza estimate that 0.75% exhibit self-injurious behavior.


 * According to the NMHA, experts estimate that nearly 1% of the United States population engages in habitual self-injurious behavior.


 * In the Netherlands, recent studies showed that 5% of the females in the 15-24 group actively conduct self-harm, against 2% of the males in the same category.

Accurate statistics on self-harm are hard to come by. Recorded figures tend to be based on hospital admissions. These hide the larger group of self-harmers who do not need hospital treatment for their injuries.


 * In New Zealand, more females are hospitalised for intentional self-harm than males. Females more commonly choose methods such as self-poisoning that generally are not fatal, but still serious enough to require hospitalization.3


 * About 10% of admissions to medical wards in the UK are as a result of self-harm.

Psychology
One theory states that self-injury is a way to "go away" or dissociate, separating the mind from the feelings that are causing the anguish. This is done by tricking the mind into believing the pain felt at the time is caused by self-injury instead of the issues they were facing before. The physical pain may also act as a distraction from emotional pain, similar to the way a hot water bottle reduces the pain of a stomach ache. The sexual organs may be deliberately hurt as a way to deal with unwanted feelings of sexuality.

To complement this theory, one can consider the need to 'stop' feeling emotional pain and mental agitation. "A person may be hyper-sensitive and overwhelmed; a great many thoughts may be revolving within their mind, and they may either become triggered or could make a decision to stop the overwhelming feelings." 4

Alternatively self-injury may be a means of feeling something, even if the sensation is unpleasant and painful. Those who self-injure sometimes describe feelings of emptiness or numbness, and physical pain may be a relief from these feelings. "A person may be detached from himself or herself, detached from life, numb and unfeeling. They may then recognise the need to function more, or have a desire to feel real again, and a decision is made to create sensation and ‘wake up’." 5

A flow diagram of these two theories is here''.

Self-harm may also give a feeling of being in control of one's own body, which could be especially important for survivors of sexual abuse.

Self-injury may also be a means of communicating distress. This motivation is sometimes dismissed as "attention seeking" and has often been seen as the primary motivation. However, for many, the act of self-harm fulfils a purpose in itself and is not a means of communicating with or influencing others. Many who self-injure keep their injuries secret, while those who do disclose their injuries may be embarrassed and ashamed of their actions.

Those who engage in self-harm face the contradictory reality of harming themselves whilst at the same time obtaining relief from this act. For some self-injurers this relief is primarily psychological whilst for others this feeling of relief comes from the beta endorphins released in the brain (the same chemicals responsible for the "runner's high"). These act to reduce tension and emotional distress and may lead to a feeling of calm. A similar rush of endorphins is triggered when someone receives a tattoo. In this way, one can become addicted to getting tattoos. Similarly, those who self injure may also become addicted to the endorphin rush.

As a coping mechanism, self-injury can become psychologically addictive because, to the self-injurer, it works; it enables him/her to deal with intense stress in the current moment. The patterns sometimes created by it, such as specific time intervals between acts of self-injury, can also create a behavioral pattern that can result in a wanting or craving to fulfill thoughts of self-injury.

A lesser form of this extreme act is, for example, hitting one's head on the table or pulling one's hair out. Although this is often used euphemistically, for those who do it serves the same purpose of deferring the stress experienced by the major cause by the pain from this secondary option.

Culture / Community
It has been said, usually in a derogatory fashion by the Media, that there is a 'culture of self injury' within schools and on the Internet. There are certainly communities that are based around the subject of self harm, and they tend to focus around a message board with or without a main website. But there is not 'a community'; there is not one Umbrella organisation that represents or speaks for people who self harm. There are many community sites of varying sizes that offer peer-support, emotional discussion, philosophical and psychological discussion, and general chit-chat. As the acts of self-harm can be widely misconstrued amongst the general populance, finding support from another person who has or does engage in self-harm can be preferable to discussion with someone not familiar with the underlying roots and thought structure behind it. Anecdotally, there are self harmers who state that it is easier for them to identify other self harmers than the average person would be able to, much as one who has been through other types of emotional distress can recognize the subtle cues given off by others who suffer the same affliction.

There is some disagreement as to whether such communities encourage and support self harm, however, such communities are known as Pro-SI and are separate from general self-injury Awareness communities.

There is anecdotal evidence6 that by being free to express feelings and self-harm related thoughts, that a person can understand their emotional world and reasons for self harming; people who no longer hurt themselves often continue to be members of self-injury Awareness Message Boards for some time after 'quitting' and offer support to those people who wish to move away from self harm. Maintaining involvement in such support groups can also foster a continued remission of self-harm, though there is a far less organized support structure involving 'sponsors' as there is in alcoholism support groups, for example.

Self-harm awareness
There are many movements among the general self harm community to make self harm and treatment better known to mental health professionals as well as the general public. SIAD (Self Injury Awareness Day) which is set for March 1st of every year, is the widest known movement. On this day some people choose to be more open about their own self harm, and awareness organisations make special efforts to raise awareness about self harm. Orange has been chosen as the colour used to represent SIAD, and many people wear orange clothes or ribbons on March 1st of every year.

SIAD was initiated by selfinjury.org (Now known as the American Self-Harm Information Clearinghouse). It is not universally recognised, but it is a well known date within the grass-roots movement of self-injury awareness.

Treatment
Self-harm may be an indicator of depression and / or other psychological problems. It is worth noting that whilst self-injury is emphatically not a failed or half-hearted suicide attempt, there is a non-causal correlation between self-injury and suicide. Many make the mistake of believing that self-harm and suicide are directly connected in the sense that the former leads to the latter 100% of the time. This is not so. While self harming behaviour may seem alarming and appear dangerous, for most of the people engaged in self injurious behaviour, self-injury serves a purpose, allowing them some degree of control over their feelings. Identification of the cause of emotional distress and subsequent therapy (e.g. behavior modification through Cognitive Behavioral Therapy [i.e. the learning of new coping mechanisms]), a person who is injuring themselves may be advised to do something else when they have the urge to harm themselves. They might be told to write in a journal or address their feelings in another safe manner. They may also be told to avoid having the objects they use to harm themselves within easy reach. Diagnosis and treatment of the causes is thought by many to be the best approach to self-harm; some clinicians, however, take a behavioral approach in order to reduce the behavior itself. People who rely on habitual self-harm are sometimes psychiatrically hospitalised.

Self-harm is more common than many people realise, especially in adolescents under stress. People who self-harm often feel a great amount of guilt as it is, so when encountering or discovering self-harm it is vital that support and understanding be shown, for the good of all involved.