Self-mutilation
From Drug Rehab Wiki
Self-harming behaviors—also called self-injury or self-mutilation—are behaviors intended to harm the body without suicidal intent. Such behaviors include self-inflicted cuts, burns, wounds and other injuries done by any means intended to damage bodily tissue. The ingestion of substances intended to do harm to bodily tissue such as self-poisoning or overdosing on usually nonharmful substances, is also considered self-harm.
While self-harming behavior can be complicated by suicidal thoughts and intentions, suicidal behavior has the intent of ending one’s life. A distinction is made clinically between behaviors intended to end one’s life and the broader category of self-harming, self-mutilating or self-injurious behaviors. The key determining factor that distinguishes these categories (self-harm and suicidal behavior) is whether or not the self-inflicted injury intends to cause death. Some self-harm becomes life-endangering if severe enough even when one’s original intent was not to end one’s life.
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Why Self-Injure?
While self-harm occurs in individuals without chronic mental health conditions and in the course of several psychiatric illnesses such as severe depression and schizophrenia, self-harming behavior is generally considered to be a symptom of Borderline Personality Disorder. In this disorder, self-inflicted injury is seen as behavior that is not suicidal although suicidality is often a complication of Borderline Personality Disorder. In Borderline Personality Disorder, self-harm appears related to an intense emotional experience that is distressful and unrelenting. Many individuals with this disorder report using self-harm to relieve themselves of emotional pain. It is thought that self-injury may actually activate innate brain responses to physical pain that help to override the experience of emotional pain.
Self-injury causes an abrupt change in brain chemistry—as does any traumatic injury to bodily tissue—releasing natural ‘brain opiates’ which help us cope with pain. For individuals with severe emotional distress, this change in brain chemistry may play a large role in reinforcing the self-harming behavior as a coping strategy for emotional distress. Some believe that self-injury ‘resets’ the brain in much the same way that ‘rebooting’ a frozen computer screen allows the computer to return to normal functioning.
For some, self-injury may also relieve the feeling of emptiness or numbness many with Borderline Personality Disorder report. In these instances, self-injury is often said to ‘enliven’ the individual, returning a sense of being real, being grounded or being alive when the physical pain of self-injury is felt.
Overall, the tendency to self-injure repeatedly is generally viewed as a maladaptive coping strategy used to regulate unwanted emotional states. Some of the feelings those who self-injure report having prior to episodes of self-injury are:
• Frustration
• Rage
• Sadness
• Grief
• Fear
• Anxiety
• Self-loathing
• Shame
• Guilt
• Helplessness
• Hopelessness
• Emptiness
• Feelings of rejection, abandonment, humiliation, loneliness
Self-Injury and Co-occurring Conditions
Several mental health conditions, if severe enough, can include self-injury in their symptomology. These include psychosis, schizophrenia, depression, anxiety, Personality Disorders and Post-traumatic Stress Disorder ([PTSD]), to name a few of the more common conditions. Additionally, some who have traumatic brain injuries or those who are developmentally delayed may also self-harm. Individuals with Autistic Disorders, for example, may be particularly prone to self-inflicted injuries.
There is generally a distinction made between a pattern of intentional self-injury used as a coping strategy over long periods and self-injury resulting from an acute episode of an illness such as psychosis or schizophrenia. In psychotic or acute schizophrienic episodes, self-injury is typically the result of confusion due to hallucinations or delusions. In this instance, self-injury is not part of the individual’s usual methods of coping.
During bouts of severe depression or intense anxiety that may occur after a traumatic event, self-injury may be used in an attempt to cope with an unusually debilitating and emotionally overwhelming experience. In this case, an individual who self-harms during the course of severe clinical depression or PTSD, for example, may not use self-harm after the emergency stage of these conditions has passed. This is distinguished from the use of self-harm as a regular coping strategy in everyday life as is often seen in individuals who have Personality Disorders.
Other disorders such as substance use disorders and eating disorders can cause self-inflicted harm. some individuals with these disorders also use self-harm as a coping strategy as described above and usually have a co-occurring condition in which intentional self-harm is a symptom. Much of the self-harm that occurs with Substance Disorders and Eating Disorders is not intentional, but an effect and consequence of the disorder’s behaviors. Causing harm to one’s self such as tissue damage resulting from substance use or eating disorders is usually a result of the disorder and not the primary intent of using substances or engaging in eating disordered behaviors. There are also obsessive-compulsive disorder that can take the form of trichotillomania, which is when a person pulls their own hair out.
Self-harm and Related Issues
There is a significant correlation between self-harming behaviors and a history of abuse, particularly emotional abuse and sexual abuse. Also, people who use self-harm as a coping mechanism also tend to have a higher incidence of co-occurring Substance Disorders and Eating Disorders, depression and anxiety.
Treatment
Self-harming behaviors can be treated successfully with a variety of therapies and typically include a combined effort of individual and group counseling, education and medication.
For those with depression and anxiety, anti-depressants can be effective in reducing self-harm as negative feelings about the self are improved and the distress of dysphoria and self-loathing are alleviated. Mood stabilizers are also effective in reducing the mood instability, mood intensity and impulsivity that is often involved in self-harming behavior.
Counseling that focuses upon the building of other coping skills such as stress management and mood management is also beneficial. Resolving longstanding issues of trauma such as childhood abuse in a supportive counseling relationship is also effective in reducing the felt need to self-harm. Some very specific therapies designed to reduce trauma-related issues such as EMDR have successfully reduced self-harming behavior. Education about the behavior and more adaptive coping skills usually supplements other parts of a comprehensive treatment plan to reduce and eliminate self-harm. Community support groups are available for affected individuals and therapy groups provide support and opportunities to address underlying issues and to identify new coping strategies.
