Robert C. Ciampi, LCSW
From the book The Scarred Soul: Understanding and Ending Self-Inflicted Violence by Dr. Tracey Alderman
Self-inflicted violence or self-harm is most associated with individuals who engage in skin-cutting and are often diagnosed with Borderline Personality Disorder. However, other forms of self-inflicted violence can include burning, scratching, banging or hitting body parts, interfering with wound healing, hair pulling, and the ingestion of toxic substances or objects. And other diagnoses can be associated with depression, anxiety, substance abuse, eating disorders, PTSD, and schizophrenia.
For the purposes of this article, I will not focus on the types of self-inflicted violence or any particular diagnosis or disorder, but reasons why people may engage in self-harming behaviors including some statistics on this dangerous behavior:
- Each year, 1 in 5 females and 1 in 7 males engage in self injury
- 90 percent of people who engage in self harm begin during their teen or pre-adolescent years
- Nearly 50 percent of those who engage in self injury activities have been sexually abused
- Females comprise 60 percent of those who engage in self injurious behavior
- About 50 percent of those who engage in self mutilation begin around age 14 and carry on into their 20's
- Many of those who self injure report learning how to do so from friends or pro self-injurious websites
- Approximately two million cases are reported annually in the U.S.
Relief From Feelings
One of the most common reasons for self-injuring is to get relief from intense emotions. Many people who self-injure are not able to regulate or control their emotions well. They may find it difficult to identify, express, or release their emotions. They may never have developed the ability to feel and experience emotions as others do, such as crying, yelling, or screaming. People who engage in self-injury commonly report that before the incident they felt isolated, alienated, depressed, and frustrated. Thus, self-injury in this instance acts as a distraction from emotional feelings.
A Method of Coping
Many people use negative coping techniques to feel better. These include using alcohol or other drugs, violent behavior toward others, overeating, smoking, gambling, and self-inflicted violence. Although positive coping skills perhaps learned in counseling would be a much healthier way to deal with ones issues, many individuals look for a "guick fix" to assuage their problems.
Stopping, Inducing, or Preventing Dissociation
Dissociation is a psychological state in which a person experiences an alteration of consciousness, memory, and sometimes identity. Everyone dissociates to some extent, however, for most people it is fairly mild such as tuning out someone who is talking to you or daydreaming. Some people use dissociation as a defense mechanism to protect themselves from overwhelming emotion or physical pain. But these dissociative states themselves can be overwhelming in that it can block or separate someone from experiencing the here and now. Self-inflicted violence is one method to reduce, prevent, or end a disturbing dissociative state.
When a person experiences physical trauma, their body releases endorphins which have similar effects to morphine. During a self-injuring episode, endorphins are released so the self-injurer does not feel the pain associated with the self-injury. Like morphine, these endorphines can become addictive.
Physically Expressing Pain
Many people who self-injure have difficulty expressing emotional pain. At a time when people can't adequately express their emotions, they may turn to self-inflicted violence as a method of expression. The results of this violence (cuts, bruises, burns) serve as an expression of the internal conflict. Physically expressing emotional pain allows a person to have concrete evidence of intangible or indefinable emotions.
Sometimes self-inflicted violence is used as a form of communication. People who have difficulty expressing their feelings to others verbally, may use self-injury to let those around them know that they are hurting inside. Sometimes the violence may be used to carry a symbolic message. For instance, creating scars or woulds to mark a certain occasion.
Some people use self-inflicted violence as an attempt to make internal wounds external and to nurture and heal these wounds. Once the emotional pain or trauma is made external through self-injury, it is easier to nurture and heal than when it existed only on the emotional level. The gratifying part of self-injury then becomes the self-care which a person can provide afterwards.
Research shows that many of the people who self-injure were abused as children. As children, they may have been taught that certain behavior, thoughts, or feelings deserve punishment. This lesson follows them into adulthood and may influence the way they treat themselves. Additionally, self-injurers are often overly critical of themselves. This internal criticism facilitates their acts of self-injury.
Re-Enacting Previous Abuse
The reason a self-injurer may re-enact abuse are varied. Some may replicate the abuse so they can feel a sense of control. Some may re-enact the abuse as part of post-traumatic stress during a flashback. Some self- injurers may not know why they act out the abuse, but simply feel the need to do so.
Like everyone, when a self-injurer's feelings of control are lessened, their emotional and physical discomfort is increased. During these times, self-inflicted violence may be used to decrease the tension and ease psychological or physical discomfort by allowing the person a sense of control.