Self Harm / Self Injury

[Done-With-It!]

What is self-injury?

It's called many things -- self-inflicted violence, self-injury, self-harm, parasuicide, delicate cutting, self-abuse, self-mutilation (this last particularly seems to annoy people who self-injure).

Broadly speaking, self-injury is the act of attempting to alter a mood state by inflicting physical harm serious enough to cause tissue damage to one's body.

Approximately 1% of the United States population uses physical self-injury as a way of dealing with overwhelming feelings or situations, often using it to speak when no words will come.

What is self-injurious behavior?

The forms and severity of self-injury can vary, although the most commonly seen behavior is cutting, burning, and head-banging.

Other forms of self-injurious behavior include:

carving scratching branding markingburning/abrasions

biting bruising hittingpicking/pulling skin and hair

It's not self-injury if the primary purpose is:

• sexual gratification
• body decoration (e.g., body piercing, tattooing)
• spiritual enlightenment via ritual
• fitting in or being cool

Why does self-injury make some people feel better?

• It reduces physiological and psychological tension rapidly.
  Studies have suggested that when people who self-injure get emotionally overwhelmed, an act of self-harm brings their levels of psychological and physiological tension and arousal back to a bearable baseline level almost immediately. In other words, they feel a strong uncomfortable emotion, don't know how to handle it (indeed, often do not have a name for it), and know that hurting themselves will reduce the emotional discomfort extremely quickly. They may still feel bad (or not), but they don't have that panicky jittery trapped feeling; it's a calm bad feeling.

• Some people never get a chance to learn how to cope effectively.
  One factor common to most people who self-injure, whether they were abused or not, is invalidation. They were taught at any early age that their interpretations of and feelings about the things around them were bad and wrong. They learned that certain feelings weren't allowed. In abusive homes, they may have been severely punished for expressing certain thoughts and feelings. At the same time, they had no good role models for coping. You can't learn to cope effectively with distress unless you grow up around people who are coping effectively with distress. Although a history of abuse is common about self-injurers, not everyone who self-injures was abused. Sometimes invalidation and lack of role models for coping are enough, especially if the person's brain chemistry has already primed them for choosing this sort of coping.

• Problems with neurotransmitters may play a role.
  Just as it's suspected that the way the brain uses serotonin may play a role in depression, so scientists think that problems in the serotonin system may predispose some people to self-injury by making them tend to be more aggressive and impulsive than most people. This tendency toward impulsive aggression, combined with a belief that their feelings are bad or wrong, can lead to the aggression being turned on the self. Of course, once this happens, the person harming himself learns that self-injury reduces his level of distress, and the cycle begins. Some researchers theorize that a desire to release endorphins, the body's natural painkillers, is involved.

What kinds of people self-injure?


Self-injurers come from all walks of life and all economic brackets. People who harm themselves can be male or female; straight, gay, or bisexual; Ph.D.s or high-school dropouts or high-school students; rich or poor; from any country in the world. Some people who self-injure manage to function effectively in demanding jobs; they are teachers, therapists, medical professionals, lawyers, professors, engineers. Some are on disability. Their ages range from early teens to early 60s.
In fact, the incidence of self-injury is about the same as that of eating disorders, but because it's so highly stigmatized, most people hide their scars, burns, and bruises carefully. They also have excuses ready when someone asks about the scars.

Aren't people who would deliberately cut or burn themselves psychotic?


No more than people who drown their sorrows in a bottle of vodka are. It's a coping mechanism, just not one that's as understandable to most people or as accepted by society as alcoholism, drug abuse, overeating, anorexia and bulimia, workaholism, smoking cigarettes, and other forms of problem avoidance.
Okay, then isn't it just another way to describe a failed suicide attempt?

NO. Self-injury is a maladaptive coping mechanism, a way to stay alive.People who inflict physical harm on themselves are often doing it in an attempt to maintain psychological integrity -- it's a way to keep from killing themselves. They release unbearable feelings and pressures through self-harm, and that eases their urge toward suicide. And, although some people who self-injure do later attempt suicide, they almost always use a method different from their preferred method of self-harm.

Can anything be done for people who hurt themselves?

Yes. Several websites offer self-help ideas. Many new therapeutic approaches have been and are being developed to help self-harmers learn new coping mechanisms and teach them how to start using those techniques instead of self-injury. These approaches reflect a growing belief among mental-health workers that once a client's patterns of self-inflicted violence stabilize, real work can be done on the problems and issues underlying the self-injury. Also, research into medications that stabilize mood, ease depression, and calm anxiety is being done; some of these drugs may help reduce the urge to self-harm.

This does not mean that individuals should be coerced into stopping self-injury. Any attempts to reduce or control the amount of self-harm a person does should be based on the person's willingness to undertake the difficult work of controlling and/or stopping self-injury. Treatment should not be based on a practitioner's personal feelings about the practice of self-harm.

What problems may be encountered when getting professional help?

Self-injury brings out many uncomfortable feelings in people who don't do it: revulsion, anger, fear, and distaste, to name a few. If a medical professional is unable to cope with her own feelings about self-harm, then she has an obligation to herself and to her client to find a practitioner willing to do this work. In addition, she has the responsibility to be certain the client understands that the referral is due to her own inability to deal with self-injury and not to any inadequacies in the client.

People who self-injure do generally do so because of an internal dynamic, and not in order to annoy, anger or irritate others. Their self-injury is a behavioral response to an emotional state, and is usually not done in order to frustrate caretakers.

What problems may be encountered in the emergency room?

In emergency rooms, people with self-inflicted wounds are often told directly and indirectly, that they are not as deserving of care as someone who has an accidental injury. They are treated badly by the same doctors who would not hesitate to do everything possible to preserve the life of an overweight, sedentary heart-attack patient.

Doctors in emergency rooms and urgent-care clinics should be sensitive to the needs of patients who come in to have self-inflicted wounds treated. If the patient is calm, denies suicidal intent, and has a history of self-inflicted violence, the doctor should treat the wounds as they would treat non-self-inflicted injuries. Refusing to give anesthesia for stitches, making disparaging remarks, and treating the patient as an inconvenient nuisance simply further the feelings of invalidation and unworthiness the self-injurer already feels.

Although offering mental-health follow-up services is appropriate, psychological evaluations with an eye toward hospitalization should be avoided in the emergency room unless the person is clearly a danger to his/her own life or to others. In places where people know that self-inflicted injuries are liable to lead to mistreatment and lengthy psychological evaluations, they are much less likely to seek medical attention for their wounds and thus are at a higher risk for wound infections and other complications.

http://www.focusas.com/SelfInjury.html

[Done-With-It!]

Deliberate self harm

What is deliberate self harm? Deliberate self harm (also known as self injury) is when you deliberately inflict physical harm on yourself, usually in secret and often without anyone else knowing. Some examples are cutting, burning, biting or hitting your body, pulling out hair or scratching and picking at sores on your skin. Deliberate self harm is not necessarily a suicide attempt and engaging in self harm may not mean that someone wants to die. Most commonly deliberate self harm is a behaviour that is used to cope with difficult or painful feelings. Why do people deliberately harm themselves? People who deliberately harm themselves have often had tough experiences or relationships in their lives. You may have: Been bullied or discriminated against Lost someone close to you, such as a parent, brother, sister or friend Broken up with a boyfriend or girlfriend Been physically or sexually abused Experienced a serious illness or disability that affects the way you feel about yourself Experienced problems with family, school or peer groups Deliberate self harm may be used as a way to cope with experiences and the strong feelings associated with it. Self harm may: Provide a way to express difficult or hidden feelings. It is not uncommon to feel numb or empty as a result of overwhelming feelings you may be experiencing and engaging in deliberate self harm may provide you with a temporary sense of feeling again. It may also provide a way to express anger, sadness, grief or hurt. Be a way of communicating to people that you need some support when you feel unable to use words or any other way to do so. Be a way of proving to yourself that you are not invisable Provide you with a feeling of control: you might feel that self harm is one way you can have a sense of control over your life, feelings or body, especially if you feel as if other things in your life are out of control. Deliberate self harm can bring an immediate sense of relief but it is only a temporary solution. It can also cause permanent damage to your body if you damage nerves. Psychologically, it may be associated with a sense of guilt, depression, low self-esteem or self-hatred and tendency to isolate yourself from others. Finding help Although it may seem hard, it's important that you reach out to someone who can help you work through some of the reasons for harming yourself and find healthier, more positive alternative strategies for alleviating the pain you feel inside. It may take time, but it's important to remember that you can move to a happier, better place. Speaking to someone about your self harm may be hard and it is particularly important to trust the person you are speaking with. If you are having difficulty speaking about what you're going through, you might start with sentences such as 'right now, I'm feeling...', 'I think it started when...', 'I've been feeling this for...', 'My sleep has been...', 'Lately school/work/uni has been...'. It may be necessary to talk to someone like a counsellor, psychologist or psychiatrist to help you to work through some of the reasons why you are harming yourself and to find alternative strategies for alleviating the pain you feel inside. Like any relationship, building up trust with your counsellor, psychologist or psychiatrist may take time and it is important you find someone you feel comfortable with. This may mean seeing several people before finding one that you "click" with. If there is a family member you feel comfortable telling, it may be helpful for you to have their support in finding a counsellor that is right for you. It's likely that the person you feel comfortable telling will already be worried about you and will be relieved at having the opportunity to listen and help. If you don't get a positive response, try to remember that it is not because you have done something wrong, but because the person you have told may not know how to respond to what you have told them or may not understand much about deliberate self harm. Don't give up - either try again or maybe speak to someone else who you think you might receive a more supportive response from. If talking about it with someone is too overwhelming, an alternative is to email or write down what you want to say. Otherwise, a first step might be to talk to Lifeline (131 114) or Kidshelpline (1800 55 1800)- both of which are free anonymous 24 hour telephone counselling that won't appear on your phone bill. If you or a friend are harming yourselves it is also important that you take care of the injuries caused and if necessary, seek medical help through your GP or, if it's serious, a hospital's emergency department. In most situations, doctors and other health professionals must keep information given to them by patients or clients confidential. However, they are required to report information they receive if they have serious concerns about your (or someone else's) safety. See the confidentiality fact sheet listed on the right hand side for more info. Coping without harming yourself As well as support from a friend, family member and/or health professional, it may also be necessary to create a list of alternative strategies to self harm for managing your emotions. If you are feeling like you want to harm yourself there are a number of things that you might try to distract yourself until the feelings become more manageable. If you can, make sure that you are around people and remove any sharp objects. Some ideas for releasing energy or feelings include: Scream it Dream it - An interactive program on the Reach Out! site where you can release some of the emotions by writing things down and shooting them away in a rocket. Choose to put off harming yourself until you've spoken to someone or for 15 minutes (and see if you can extend it for another 15 minutes on so on, until the feeling passes) Write in a journal - you might like to use an online journal, such as the one on Reach Out! that is password protected Exercise - Go for a run or walk in the park to use up excess energy. Play video games - This may be a good way to distract you and help until the anxiety passes. Yell or sing at the top of your voice on your own or to music. You might do this into a pillow if you don't want other people in the house to hear. Draw or write in red texta over your body (instead of cutting) Relaxation techniques - Activities like yoga or meditation are often helpful in reducing anxiety Cry - crying is a healthy and normal way (ie not weak or dumb) to express your sadness or frustrations. Talk to someone - talk with a trusted friends or call a helpline like Lifeline (13 11 14) or Kids help line (1800 55 1800). Both are free and anonymous and the call does not show up on your phone bill. Alternatives to deliberate self-harm If none of the above suggestions help and you still feel the need to self harm, there may be a number of things that you can do which won't cause injury like: Punching a pillow or punching bag Squeeze ice cubes till your fingers go numb Eat a chilli, or something really hot Have a cold shower Put vapour rub or deep heat under your nose (it stings and makes you cry) waxing your legs (or getting them waxed) Take care of yourself It's important to eat well, exercise and be kind to yourself. While not a solution in itself, doing all these things contribute to a higher self worth, increased stability of moods, and a general better sense of wellbeing - making you feel more happy, on the outside and the inside. More information Other things on Reach Out! to check out are Reach Out! Central (ROC), a new interactive space, and the community forum, where you can talk about stuff and find support on dealing with a range of issues.