Self-injury is an emotionally triggered behaviour whether it is used to release unbearable tension, distract from overwhelming emotional distress, or to help a person return to reality from dissociation or depersonalization. However, most people will experience intense emotions or tension at some point in their life and do not resort to self-injury to regulate those emotions. Why?
There are a number of theories based on brain chemistry and hormonal imbalances that may shed some light on what makes some more prone to self-injury as a means to regulate emotional states.
Serotonin is a neurotransmitter and is a well-known contributor to feelings of well-being; therefore it is sometimes known as a ‘happiness hormone’. It is biochemically derived from tryptophan, and is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of humans and animals. Serotonin regulates our appetite, sleep, sex drive, and plays a major role in regulating mood. If serotonin levels are low or there are too few receptors in our brains to keep it moving at an effective speed, we can become depressed. In addition, because it also regulates our anxiety levels, we can experience anxiety, panic attacks, and obsessive thinking if there isn’t enough available serotonin in our system. Some studies have shown that reduced levels of serotonin also contribute to irritability, anger, and aggression/self-aggression (Herpertz, Sass, and Favazza 1997).
It makes sense that people who self-injure also report greater depression and anxiety due to lower levels of available serotonin which may also be triggering anger, irritability, and impulsivity. Some research also links self-injury to obsessive-compulsive symptoms with serotonin deficiencies as a common link (McKay, Kulchycky, and Danyko 2000). This obsessive-compulsive trait may explain why self-injury often becomes ritualistic if repeated often.
Psychiatrists can prescribe medications called SSRIs (selective serotonin reuptake inhibitors) to increase levels of available serotonin in the brain. These medications are often referred to as antidepressants but can address many other symptoms related to mood, anxiety, and obsessive-compulsiveness.
Cortisol and Norepinephrine
Cortisol and Norepinephrine are classified as stress hormones and are released by our adrenal glands when we are under stress. Some research (New et al. 1997; Sachsse, Von Der Heyde, and Huether 2002) suggests that those who self-injure have lower levels of cortisol that makes them more sensitive to small increases of the hormone. Lower levels of norepinephrine are associated with increased inhibition and lower levels of aggression, while increased levels are associated with the impulsivity and the intense emotional reactivity of those who self-injure. This may explain why those who self-injure are more reactive to smaller environmental or emotional triggers – more sensitive to and unable to cope with stress in a healthy way.
According to Ulrich Sachsse and his colleagues, not only are those who self-injure more vulnerable to negative emotional states and stressful environmental events, they are also more biologically reactive to cortisol and norepinephrine as well. Self-injury becomes the preferred method for them to self-regulate not only their emotions, but also the hormonal changes in their bodies.
Often referred to as the body’s natural ‘heroin’ or ‘opiate’, endorphins are one of the brain’s pleasure chemicals that produce feelings of well-being. ‘Runner’s high’ is linked to the release of endorphins during physical stress and endorphins are also released when the body is injured to protect us from feeling too much pain. Some research indicates that those who self-injure have lower levels of endorphins and their acts of self-injury is an attempt to restore those levels to normal (Oquendo and Mann 2000; Russ 1992; Winchel and Stanley 1991). For some it may take an act of self-injury to release the endorphins that can help end an emotional state that is negatively impacting their life.
It is the creation of a cycle of self-injury for affect regulation that some are predisposed to; Low circulation of endorphins create negative moods which require self-injury to obtain the rush of endorphins that provide immediate feelings of relief, increased relaxation, and improved mood. Repeated often enough and the act of self-injury becomes ritualistic and even addictive. Like addiction to some narcotics ‘tolerance’ of the opiate response to the release of endorphins causes an increased need in the frequency, duration, and intensity of self-injury. Armando Favazza (1998) asserts that somewhere between the twentieth and thirtieth ‘cut’, self-injury may take on an addictive quality.
Some psychiatrists will prescribe medications that increase the endorphin levels in the brain of self-injurers, but because there has been much less research on the endorphin theory, most will rely on SSRIs instead.
The next article in the series will explore the addictive qualities of self-injury, based on the biochemical changes it triggers, and some of the facts may surprise you.
Next Up: Self-Injury – Addiction: Process or Biochemical?
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Previous articles in the Self-Injury series;