Monday, 24 September 2012

Self-Injury – Addiction: Process or Biochemical?


Psychiatrist Armando Favazza was the first to suggest that self-injury can become addictive in his book Bodies Under Seige in 1987.  Favazza stated that somewhere between the twentieth and thirtieth cut self-injury takes on an addictive quality.

Many practitioners still hold to the old belief that this represents a process addiction – That is; If the act of self-injury is repeated often enough it becomes ritualized and the ritual itself becomes a comfort to the self-injuring person whether it is triggered by other stimulus or not.  There is anecdotal evidence supporting this idea from comments from some who self-injure that stopping the practice brought up feelings of grief and loss, and that self-injury was thought of as “an old friend” who was always there when needed.

However, more recent research is indicating that there is an evident biochemical relationship between self-injury and the feelings of relief it provides many people.

Robert Grossman and Larry Siever postulated an “addiction theory” in their 2001 research that suggests “self-injurious acts may solicit involvement of the endogenous opioid system” [EOS].  The EOS regulates both pain perception and the release of endogenous endorphins - the body’s natural “heroin”.

Many people who self-injure describe that after self-injuring they feel “at peace”, “calm”, “happy”, “like I’m floating on a cloud”.  In my own interaction with a number of people who self-injure, certain similarities of experience arise; Leading up to self-injury they often feel a building tension or anxiety, troublesome thoughts or urges or feelings, all of which can reach almost overwhelming levels.  As they begin to self-injure, they feel the tension rise to a peak and suddenly release, “like a balloon popping” as Favazza stated in a National Public Radio radio interview.  Often they will describe their tensions or anxiety flowing out of their body along with the blood they shed.

One statement I have heard variations of from a number of those who self-injure is; “You will never know how good it feels.”  This in itself speaks to the blissful physical feelings brought on after self-injury.

On the YouTube channel “SelfHarmSupport where panel members comprised of those who are in recovery [or have recovered] from self-injury answer questions posed by viewers, one past panel member stated; “It became an addiction and I had to do it more and more often to get the same results.”  He is not alone in this, as evidenced by the increased frequency, severity, and number of injuries many who self-injure complete to maintain the levels of relief they seek.

But it is an example put forth by Dr. Bruce Perry of the Child Trauma Academy in Houston, Texas in his 2006 book; The Boy Who Was Raised As a Dog: And Other Stories from a Child Psychiatrist's Notebook, that illustrates a strong argument in favour of the endorphin addiction theory;

While working in a Houston hospital as a resident psychiatrist, Perry was called to the Emergency Room to help calm the mother of a teenaged girl who had been admitted while the attending physicians attempted to diagnose and treat her daughter.

As Perry spoke to the mother, asking her questions about her daughter, he noticed that there were gaps in the life history she was providing.  When Perry questioned her about those gaps, the mother revealed that one of her ex-boyfriends who had lived with them, had sexually abused the girl for an extended period of time.  The man would force himself on the daughter only when he had been drinking while the mother was at work.  In order to exert some control over the situation, the daughter began making him drinks so that he would “get it over with”, allowing her to get on with her daily activities.  Once mom discovered what was going on, the boyfriend was sent packing but the girl had never received counselling for the sexual abuse

When Perry asked if anything had happened in the previous 48 hours that might have triggered memories of that time, the mother admitted that the ex-boyfriend had called their home the previous night and the daughter had answered the phone.  The man told the girl that he was “coming to see her.”

At this point, Perry’s focus shifted from the mother to the daughter and he read her chart; The girl was 15 years old and had been found unconscious on the floor of a school bathroom.  Her heart rate was dangerously low, hovering under 50 beats per minute and had stopped three times while the Emergency Room Doctors struggled to stabilize her.  Her tox-screen showed no narcotics in her system and Doctors were mystified as to the cause of her unresponsiveness and alarmingly low heart and respiration rates.

Perry went on to examine the girl and found fresh cuts on her arms, indicating she had recently self-injured.  He suspected that this is what she’d been doing in the school bathroom in response to the distress she was feeling after hearing her mom’s ex-boyfriend’s threat to visit her the night before.

A theory began to emerge for Perry that the girl had overdosed on the rush of her own endorphins brought on by the act of self-injury.  But when he suggested as much to the attending physicians, they replied that it was impossible and refused to consider it.  Perry persevered and suggested giving the unconscious girl an injection of naltrexone which is used to block opioids during a heroin overdose, stating that it would do no harm even if he was wrong because naltrexone is a relatively harmless agent.

Humouring Perry, the attending physicians did so, and within 90 seconds after the injection of naltrexone, the girl’s stats returned to normal and she regained consciousness.  She had indeed suffered an overdose of her own endorphins.

The good news is that the girl became a patient of Perry’s and went on to recover both from the lingering affects of the sexual abuse she’d experienced, and from self-injury.  And her experience is a strong argument supporting the biochemical nature of self-injury.

In the next article, we will be looking at other contributing factors to self-injury such as anxiety, mood, and personality disorders.


Previous articles in the Self-Injury series;



Aaron D. McClelland, RPCc – www.interiorcounselling.com/aaron/

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