Self-Injury
Self-injury is a topic that is being discussed more often in the news, on television shows, in school settings, and in the psychological and medical fields. In a survey conducted by McGill University, seventy-four percent of the teachers reported having a personal encounter with self-injury but only twenty percent felt knowledgeable about working with those students (see Heath, Toste, & Beettam, 2007, 73). If the results are similar for the larger population, then it would be beneficial to inform and educate people who may encounter the individuals who participate in self-injurious behavior. Because most people think of self-injury as a new topic of discussion, many people assume that it is not actually a problem but only a cry for attention. Consequently much more research has been conducted in the past decade to determine what self-injury actually is and how it can be recognized. The research has produced results that not only define self-injury but also identify the criteria for diagnosis, and patterns of behavior that assist in recognizing an individual who is engaging in the action. Further research is required due to the fact that most of the focus has been on Caucasian women and young adults; is it prevalent among other demographic populations? Are there disorders that are common among self-injurers? Because it is becoming a more common problem among young adults, educators would benefit from these findings. Individuals in a school setting have expressed an interest in receiving training about the self-injury disorder and would like to know how it is treated as well as the success rate of each treatment program.

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Literature Review Self injury is a topic that is discussed often, but people are generally uninformed or misinformed about what it is, its history, the types of people who practice it, and how to best treat it. Defining self injury was even difficult for clinicians, so the International Network for the Study of Self-injury (ISSS) was created to help solve the problem. ISSS defines self-injury as:
The deliberate, self-inflicted destruction of body tissue resulting in immediate damage, without suicidal intent and for purposes not socially sanctioned. As such, this behavior is distinguished from: suicidal behaviors involving an intent to die, drug overdoses, and other forms of self injurious behaviors, including culturally-sanctioned behaviors performed for display or aesthetic purposes; repetitive, stereotypical forms found among individuals with developmental disorders and cognitive disabilities, and severe forms ( e.g., self-immolation and auto-castration) found among individuals with psychosis. (Heath, Toste, Nedecheva, & Charlebois, 2008, p.138)
The DSM-IV-TR does not list self-injury as a disorder but as a symptom associated with many other disorders. Most of the disorders involve impulse control issues. The most common association is with borderline personality disorder, but it is also very common among individuals who have eating disorders and substance abuse problems. Research has also shown a strong correlation between people who have suffered childhood physical, emotional, or sexual abuse and those who self-injure. (Jeffreys, 2000) Most clinicians rely on self-reports to diagnose an individual as a self-injurer. This is a problem because people may not share information candidly on the topic for a variety of reasons. Some of the treatments in the past have been abusive to the patients. Out of the frustration of not understanding self-injury, some clinicians have punished patients by refusing to allow them to seek medical attention for their injuries. Even worse, other clinicians have actually caused more pain to the injury. There are instances of patients receiving stitches without anesthesia and instances of open wounds being scrubbed with surgical sponges as a deterrent. (Shaw, 2002) A less disturbing, but equally as influential, reason for remaining secretive about self-injurious behavior is the fact that the patients are often labeled
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as manipulative and attention-seeking. Some people do not seek counseling for their behavior because they do not believe they have a problem. They may believe that the behavior is a coping strategy that helps them remain functional, and the people who do not understand self-injury are the ones who have the problem. (Adler & Adler, 2007) There is a Self Harm Inventory, but it has not been used widely. There are twenty-two yes or no questions asking if the individual has ever intentionally performed certain types of self-harm behaviors. The score is found by adding up all the yes responses. This may be a more valid tool for diagnosing individuals with self-injury because they may be more open to sharing their behaviors honestly. (Samsone, Wiederman, & Jackson, 2008) Due to the fact that the media has focused on self-injury only recently, most people believe it is a new issue. Surprisingly the research showed that self-injury has been practiced since Greek and Biblical times when it was considered sinful behavior. It has been studied throughout the 1900’s, but the research is never completed. It was studied in the 1930’s, mid-60’s to 1970’s, and the mid-80’s to the present time. The research is usually abandoned just as the progress is being made, so new insight is rarely gained. This may be due to the fact that self-injury is a difficult idea for most clinicians to accept, so they pull away from understanding it. (Shaw, 2002)
There are many different forms of self-injury, but the most commonly reported type is cutting. This is usually done on parts of the body that can be covered with clothing, so the self-injury can remain hidden. Other types that are regularly reported are head banging, hair-pulling, hitting self, burning self, and preventing wounds from healing. (Matthews & Wallis, 2002) There are patients who will self-harm in more than one way. This seems to be more common with individuals who have been self-injuring for extended periods of time. (Turell & Armsworth, 2003)
Self-injury usually begins in early adolescence but has also been found to begin during late teen years and early twenties. The research shows that it is more prevalent among Caucasian, middle-class females. However, as the research continues, it is reported that males are equally afflicted with the
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behavior. It is a coping strategy used by people in rural, suburban, and urban communities of all ethnicities and socioeconomic backgrounds. However, the individuals’ reasons for self-harming differ. (Abrams & Gordon, 2003)
In one study, it was found that most of the suburban, middle-class, Caucasian patients said they self-harm to relieve stress and intense emotional pain. The urban minority patients from low socioeconomic backgrounds said they used self-harm strategies because they were angry and wanted to get their family or friend’s attention. (Abrams & Gordon, 2003) The study also found that the different groups had much different experiences with hospitals. The suburban group claimed to be able to manipulate psychiatric hospitals to their advantage. Many of them wanted to be admitted to the hospital, so they could escape the problems at their homes. They also stated that they felt better about their own problems when they were exposed to other patients in the hospital and their problems. The urban group said they felt misunderstood by people in the medical field, and they were often misdiagnosed as suicidal. One final difference is that all of the girls in the suburban group expressed emotional pain over sexual abuse while the girls in the urban group did not. This does not mean that the urban girls did not experience sexual abuse. It may just be that they are not as comfortable sharing private details with the investigators who were conducting the research.
Regardless of ethnicity or socioeconomic background, most self-injurers have a history of childhood abuse or exposure to family problems which leads to emotional regulation problems. The longer the person experienced the abuse and the higher the frequency of the abuse, the more likely they are to be a self-injurious person. This population often becomes depressed, and they may experience memory loss of the stressful time in their lives. The majority has trouble dealing with their intense emotions during stressful periods and cannot control their impulses, so they release their emotional pain through physical harm. This also makes their pain visible to others. In addition to childhood abuse or neglect, being overprotected in early years may also lead to self-harm. Due to the lack of independence, individuals may not feel accepted enough to express themselves freely therefore it becomes natural to
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stifle emotions. When the emotions become too intense, self-harm releases the pain. (Wagner & Rehfuss, 2008)
A correlation was found between a Christian upbringing and self-injury among some women. Feelings of unworthiness as a child, combined with a negative view of sexuality in the home leads some young women to engage in self-harm. This is especially common among college age women who are beginning to experiment with sexuality. The same is true for men of this age, and it seems to increase when either gender is experiencing same sex attractions. Fear-based parenting styles aggravate these situations further. Children who experience this style tend to feel anxious and unaccepted by their families and religion which leads to feelings of guilt. The unexpressed feelings cause problems with defining a self-identity and some people express the invalidated feelings by self-injuring. (Wagner & Rehfuss, 2008)
Self-injury is a growing problem among homeless street youths, prisoners (especially juveniles), and people in the foster care system. This may be due to the fact that they have been exposed to more psychologically damaging situations or that they do not know any other coping strategies. (Adler & Adler, 2007)
It is also an increasing problem in adolescents in general, and they begin self-injuring in many different ways. Some adolescents have said they have just accidentally cut themselves and they felt a rush of adrenaline. They liked the release of emotion it gave them, so they continued. Other adolescents claimed to begin self-harming after reading about it in magazines or hearing about it in the media or in health classes. Those individuals said they could identify with the people they were exposed to who self-injured, so they thought they should try self-injury too. It made them feel better, so they continued to use it as a coping strategy. (Matthews & Wallis, 2002)
In several studies, there were many adolescents who admitted to participating in self-harm because they wanted to fit in. Some said they were regarded as “cool” and were accepted into a group once they began cutting themselves. There are many websites available for adolescents to share their
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self-harm stories and receive recognition, praise, and acceptance for their participation. One website sells self-harm bracelets that are used to cover scars. The more bracelets an individual has, the more advanced the person is in the self-injury world. Those individuals who self-harm for acceptance typically do not have problems with impulsivity. Although they are praised for the self-harm behavior within the group of people they are trying to gain acceptance from, there are still many people in their lives who would not condone the acts. At this point, they will either self-harm routinely or plan when they can do so.
Sometimes they harm themselves simply because it is the scheduled time. They may not get as much satisfaction from the act, but they will still self-harm because they feel they must follow through, so they can trust their own commitments to themselves. (Adler & Adler, 2007)
Self-injury could be increasing so rapidly in adolescents because this generation has so many more problems than past generations have had. There are many more children of divorced parents and unstable families. They are also exposed to eating disorders, substance abuse problems, sexual encounters, and depression frequently. (Adler & Adler, 2007)
It is usually easy to conceal self-harm behavior when it first begins because the injuries are usually mild. However, as an individual uses self-harm to cope more regularly, the feeling of relief does not last as long, and the person may find the need to self-harm more often or more severely. This is why self-harm can become an addiction. Some people plan a schedule of when they should visit hospitals and clinics for medical attention, so the nurses and doctors will not begin to question their frequent visits. The self-injurers will rotate around to the available medical personnel and may even seek out veterinarians and non-licensed individuals (including themselves) to suture incisions. Even more disturbing are the people who refuse to seek medical attention unless they have fatal injuries, or they are requiring at least forty to fifty stitches. (Adler & Adler, 2007)