The Uncomfortable Reality of Self-Injury

October 19th, 2008

By Rachel Keranen

Angelina Jolie did it—so did Johnny Depp and Princess Diana. According to recent research studies, between 10-20 percent of college students do it too. Self-injury is an increasing phenomenon in today’s young adult culture, but it’s often misunderstood.

According to the Mayo Clinic, the majority of those who self-injure are adolescents. Risk factors include depression, anxiety disorders, substance abuse disorders, eating disorders, and other mental health conditions. Victims of childhood trauma are especially likely to self-injure—those haunted by neglect or abuse often have an impaired ability to control their emotions and behavior.

A common misperception of self-injury is that those who commit it are suicidal. In reality, those who harm themselves are usually not trying to kill themselves, but instead trying to hold their lives together. Everyone has coping mechanisms to let out feelings of hurt, anger, and frustration: some go for a run, some write in their journal, and some throw a temper tantrum. Others, in silent secrecy, choose to take a blade to their skin. The sight of blood swirling down the drain can be as therapeutic to a cutter as a deep tissue massage; and the phrase, “it hurts so good” takes on a new, much more disturbing meaning.

There are many reasons that those who self-injure choose to hurt themselves. In her book A Bright Red Scream, Marilyn Strong writes that self-injury often occurs when the perpetrator feels abandoned or alone. The feelings build until they are unmanageable, and then the act is committed and dissociation is attained. Dissociation is commonly described as a feeling of numbness, a sensation of separation from one’s body. Unable to cope with the chaotic emotions they are experiencing, self-injurers use dissociation to distance themselves from the pain of reality.

A completely opposite motive for self-injury is the feeling of life it brings. Some who cut themselves report that the sight and sensation of bleeding is the only way to prove that they are still alive. For those who are depressed, the pulsating red release can be the sole sign of life in an otherwise gray existence. Some cutters feel that the blood is a symbol of the negative feelings or impurities inside their bodies. By cutting, they are letting the bad blood escape. This idea echoes the historical method of using leeches and bloodletting to cure ailments: once the evil has been evicted, the body can be pure and healthy.

Self-injury can also grant a feeling of power or control. People who have had many of their freedoms and choices taken away turn to the one thing they can control—their bodies. It is interesting, though not surprising, that many women who suffer from eating disorders also self-injure. Both disorders can stem from the need to maintain whatever control they can in a world of perceived powerlessness. In a study published in the American Journal of Psychiatry by Drs. Winchel and Stanley, 35 percent of anorexics and 39 percent of bulimics reported self-injuring.

In the end, self-injury can be a cry for help. While most self-injurer hide their wounds, some are also hoping that someone notices their silent suffrage. Scars, usually on the arms, legs, and torso, may casually flicker in and out of sight. Unable to express emotion in conventional ways, some resort to their bodies as their medium of communication.

The scars left from self-injury can be viewed as burdens or battle wounds. Some self-injurers try to erase their scars with creams or surgical procedures so they can forget their bloody past. Others view their scars as life markers too important to disregard.

While cutting is one of the most well known modes of self-injury, numerous others exist. Other methods include carving, burning, hitting, pulling out hair, biting, and many more. According to the Mayo Clinic, scars, injuries, bruises, frequent “accidents”, the constant carrying of sharp objects (knives and razors, but also paper clips, pins, or pieces of jagged metal), and wearing long sleeves and pants even in hot weather are signs of self-injury.

If someone reveals that they self-injure, or have done so in the past, it’s important to remain supportive. If they are willing to talk, be willing to listen without judgment. Self-injury is unsettlingly common –it occurs in somewhere between 1 in 10 and 1 in 5 college students, and some studies suggest it’s even more frequent than that. By increasing awareness and understanding of the phenomenon, society can give a voice to those who carry silvery secrets and facilitate outward expression rather than inward aggression.

[taken from The Wake]

University of Minnesota Student Magazine

Im A Cutter

ImACutter.com is a brand new non-profit movement dedicated to presenting hope and finding help for those struggling with self-injury, cutting, addition, and suicide.


“See they label me a cutter,
but it stables me enough that,
I can make it through the cludder,
but it aint about the cuttin,
its just something about the rush and all the rage involved,
until all the hate is gone the pains resolved,
to waken all the neighbors cuz im bangin on the walls,
all the hatred and entertainment for this nation at war,
i see this world its so much wrong,
ask me why and ill show you why theres no such god, My arm!”
- Mint from Steppin Stone

The poem is from the new website. I've only had a little look around but they seem to have some good information. The only issue I had was that I couldnt access the Forum, but as they are new it may be just a glitch.

National Institute For Health & Clinical Excellence

Self-harm

Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care
Guidance type: Clinical guideline
Date issued: July 2004
Expected review date: July 2008
Reference: CG16
Summary Documents Implementation Development history
Summary
The NICE clinical guideline on self-harm covers:
the care people who harm themselves can expect to receive from healthcare professionals in hospital and out of hospital
the information they can expect to receive
what they can expect from treatment
what kinds of services best help people who harm themselves
The guideline does not attempt to explain self-harm or describe the treatment in detail.
Top

Documents
For healthcare professionals
CG16 Self-harm: Full guideline
CG16 Self-harm: Algorithms
CG16 Self-harm: Quick reference guide
CG16 Self-harm: NICE guideline
For patients, carers and the public
CG16 Self-harm: Information for the public
Background information
2004/031 New guideline to standardise care for people who self-harm
CG16 Self-harm: Distribution list
Scope: Self-harm

Nice Home Page

What Self-injury Is & Isn't

Self-injury is behavior in which people deliberately harm their own bodies in some way to cope with overwhelming emotions. Self-injury frequently is an impulsive act. You may become upset and spontaneously seek a way to hurt yourself, recklessly doing damage to your body. Other times, self-injury may be inflicted in a controlled, methodical manner. You may even plan it in advance, taking steps to avoid detection and to prevent infections.

Self-injury isn't the same as injury that arises from culturally sanctioned practices in some parts of the world, including scarring, piercing and tattooing, which historically have been considered forms of self-mutilation. Self-injury is distinguished from such practices by the emotional intent behind it — it's an unhealthy coping method for overwhelming feelings.

Self-injury also isn't the same as a suicide attempt. For instance, someone may try to harm himself or herself by taking an overdose of medication, but stop short of taking a lethal dose. In self-injury, the intent isn't to die, but to inflict bodily harm. However, self-injury can accidentally result in suicide.

Types of self-injurySelf-injury is most commonly associated with cutting, which involves making cuts or scratches on your body. Cutting can be done with any sharp object, including knives, needles, razor blades or even fingernails.

Most frequently, the arms, legs and front of the torso are the targets of self-injury because these areas can be easily reached and easily hidden under clothing. But any area of the body may be subjected to self-injury.

Some people don't feel pain while they're hurting themselves, even when creating deep cuts. Others do find self-injury painful but welcome the pain as a punishment or as a distraction from emotional turmoil.

There are many types of self-injury besides cutting, and someone may engage in one or more of them. Other types of self-injury include:

Burning
Poisoning or overdosing
Scratching
Carving words or symbols on the skin
Breaking bones
Hitting or punching
Piercing the skin with sharp objects
Head banging
Pulling out hair
Interfering with wound healing
Pinching
Biting

Some experts consider overexercising a form of self-injury, as well as stopping medication in an attempt to cause harm to yourself.

[Link: Mayo Clinic]

Bill Of Rights For People Who Self Harm

Preamble
An estimated one percent of Americans use physical self-harm as a way of coping with stress; the rate of self-injury in other industrial nations is probably similar. Still, self-injury remains a taboo subject, a behavior that is considered freakish or outlandish and is highly stigmatized by medical professionals and the lay public alike.

Self-harm, also called self-injury, self-inflicted violence, or self-mutilation, can be defined as self-inflicted physical harm severe enough to cause tissue damage or leave visible marks that do not fade within a few hours. Acts done for purposes of suicide or for ritual, sexual, or ornamentation purposes are not considered self-injury. This document refers to what is commonly known as moderate or superficial self-injury, particularly repetitive SI; these guidelines do not hold for cases of major self-mutilation (i.e., castration, eye enucleation, or amputation).

Because of the stigma and lack of readily available information about self-harm, people who resort to this method of coping often receive treatment from physicians (particularly in emergency rooms) and mental-health professionals that can actually make their lives worse instead of better. Based on hundreds of negative experiences reported by people who self-harm, the following Bill of Rights is an attempt to provide information to medical and mental-health personnel. The goal of this project is to enable them to more clearly understand the emotions that underlie self-injury and to respond to self-injurious behavior in a way that protects the patient as well as the practitioner.

The Bill of Rights for Those who Self-Harm

• The right to caring, humane medical treatment.
• The right to participate fully in decisions about emergency psychiatric treatment (so long as no one's life is in immediate danger).
• The right to body privacy.
• The right to have the feelings behind the SI validated.
• The right to disclose to whom they choose only what they choose.
• The right to choose what coping mechanisms they will use.
• The right to have care providers who do not allow their feelings about SI to distort the therapy.
• The right to have the role SI has played as a coping mechanism validated.
• The right not to be automatically considered a dangerous person simply because of self-inflicted injury.
• The right to have self-injury regarded as an attempt to communicate, not manipulate.

Bill Of Rights For People Who Self Harm

[Full Document]

© 1998-2001 Deb Martinson. Reprint permission granted with proper credit to author.

Image: Octupus Dancing by *Widyantara

Getting The Most Out Of Appointments

The hardest step, often is asking for help. Perhaps you've told a friend or a school counsellor. Though often willing they may not know how to help you. Talking to your GP is often a good starting point or phoning the mental health unit at your local hospital, many now have specific adolescent workers. Often we are afraid of being judged or decisions made that we don't wish.

Appointments with doctors, mental health workers, or other professionals may make you feel nervous. It’s easy to forget what you want to ask or to come away feeling confused about what was said. Appointments with professionals can be very short, and sometimes you have to wait a long time to get one, so it’s important to get the most out of every meeting.

You may find the following tips useful:

* If you make an appointment to see someone and you feel uncomfortable going on your own, take a friend or family member with you. They can provide support and help you remember what was said
* Before your appointment, write down all the questions you want to ask and make sure they've all been answered before you leave
* Write down the answers you're given. If you’re given the names of other people or organisations, make sure you write down the correct contact information
* There may be a number of support or treatment options available. Explain that you would like to know about all possible alternatives
* If something is said during the meeting that you don’t understand, don't be afraid to ask the person to explain what they mean
* Ask if there are any leaflets or other types of information you can take away with you
* If the appointment is with a mental health professional or counsellor you might want to see on a regular basis, use your first meeting to decide whether you feel comfortable with them and whether they are someone you think you could trust
* If you don’t feel that you are going to get on with a particular person or professional, go elsewhere. You have the right to choose. What matters is that you get the help you need
* Don't forget, you don't have to take any help or advice if it doesn't feel right.

The last 2 points are important to me. You are the consumer, Dr's are not Gods, and not all Counsellors suit all clients. If in anyway you are not happy, satisfied or confident in the person, then shop around but be clear with your motivations. I once didn't see a counsellor as all had told me 'This guy is tough but good, he can really help', I think I was totally scared it may work (if that makes sense) and I chose a woman who was nice but not really effective.

You need to keep thinking 'I am the most important here' but its hard at a time when you are emotionally exhausted and not feeling empowered. Being informed is one of the most important steps you can take both with SH and life in general. Take a friend who knows your needs, can help 'translate' or just repeat back what was said later, if this helps you.

[taken in part from: Self Harm.Org.UK