Deb Martinson, publisher of the website “Secret Shame” asserts; “Self-injury does not happen in a vacuum”. Within each person who self-injures there is an underlying cause and a need that self-injury fulfills.
There are a number of disorders that are sometimes associated with self-injury. The following list is not intended to suggest a diagnosis or even a pressing need for a diagnosis to be in place before offering help to someone who self-injures.
Borderline Personality Disorder – is typically characterized by a long-standing pattern of unstable and intense relationships, dramatic mood swings, unstable [or absent] self-image, feelings of emptiness, intense anger, suicidal ideation or threats, self-injury, paranoia or dissociation during times of stress, and a fear of abandonment or of being alone. Individuals struggle with emotion regulation and may lead lives in which they move from crisis to crisis.
Eating Disorders – such as anorexia and bulimia can be present with self-injurious behaviour, and are considered by some to be a form of self-harm. Anorexia nervosa is characterized as a person restricting their intake of nutritional foods and liquids in order to control their weight. This is usually combined with a distorted body image as many see themselves as overweight when in fact they are not. In some cases the sufferer feels that if they eat or even drink water, they will become larger and this goes against their need to feel smaller so as to not be noticed.
Bulimia nervosa is characterized by sufferers ingesting large amounts of food in a short period of time - “bingeing”, then ridding the body of that food by vomiting - “purging”.
Both of these conditions are often accompanied by self-hatred and shame and many self-injure to punish themselves for their behaviour.
Dissociative Disorders – fall on a continuum of disorders that cause the sufferer to experience periods of dissociation or dpersonalization from their environment or even their sense of self. These can range from states of “numbness” when a person feels nothing emotionally [and sometimes nothing physically], all the way to Dissociative Identity Disorder which was formally known as “multiple personality disorder”.
People who suffer from dissociative disorders have typically suffered some form of trauma or other developmental insult in early childhood. Self-injury can be a way for the individual to “bring himself back” to reality when they are in a dissociative state. Many describe the physical pain and/or the sight of blood as evidence that they are still alive and allow them to reconnect with their body.
Post Traumatic Stress – is an anxiety disorder that occurs as a result of exposure to a traumatic incident or ongoing circumstance that the person felt was life-threatening or that resulted in physical or emotional harm. This can range from physical or sexual abuse or assault to witnessing extreme violence such as war or family violence or strong emotional distress brought on by other violent actions. People suffering from post traumatic stress typically experience nightmares, flashbacks, difficulty with mood regulation, an exaggerated startle response, feeling detached from life, amnesia, sleep disturbances, emotional numbness, physical symptoms of anxiety, and a lack of interest in everyday life. Using the physical pain of self-injury as a coping strategy can distract them from flashbacks or alleviate the numbness they feel and pull them back into reality when they dissociate.
Bipolar Disorders – are mood disorders that sometimes sees the person alternate between manic or hypo-manic states and depressive moods. A manic episode is characterized by a person displaying a sudden change in their behaviour that typically manifest as grandiosity, decreased need for sleep, increased talking, and at-risk behaviour, [excessive spending, unsafe sex. etc]. A hypo-manic episode is similar but the symptoms are less severe.
A depressed episode is manifest as a period of extreme sadness, loss of interest or pleasure in activities they normally enjoy, suicidal thoughts, decreased ability to concentrate or reason, sleep and appetite disturbances and a change in activity level. Self-injury in bipolar patients is typically an attempt to regulate their mood, however; self-injury that occurs during a manic episode tends to be more dangerous and life threatening. Those who suffer from bipolar disorder also have a significantly higher rate of suicide attempts and completed suicides.
Major Depressive Disorder – or ‘clinical depression’, ‘major depression’, ‘unipolar depression’ etc, is characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities. Major depressive disorder is a disabling condition that adversely affects a person's family, work, or school life, sleep patterns, eating habits, and general health. People suffering from MDD have a high rate of suicide attempts and completed suicides. Treatment typically involves a combination of antidepressant medication and counseling. Because MDD presents differently in each person experiencing it, the reasons for self-injury varies from person to person and could be due to feelings of hopelessness, self-punishment, or relief from constant emotional pain.
Perfectionist Thinking – is a cognitive style in which the person seeks perfection in their performance or appearance to the extent that it interferes with normal functioning. Though many of us strive to do our best, those who engage in pathological perfectionism are relentless in pursuing goals that are unrealistic in one or more areas of their life. Once the person falls short of their unrealistic goals they feel a crushing disappointment in themselves, often having a "melt down" and feeling deep depression and/or strong self-loathing. In those who engage in pathological perfectionism, self-injury can be a method of self-punishment in response to perceived failure, or emotional regulation.
Many people in our society may display some of the symptoms of the above disorders or of perfectionist thinking without it impacting their lives to a great extent. As with any mood or anxiety disregulation to determine if there is an underlying problem, we use three measurements;
Frequency: How often does the mood or behaviour present?
Duration: How long does the mood or behaviour persist?
Intensity: How intense is the mood or behaviour?
If you find that someone is presenting moods or behaviours that are negatively impacting their life through frequency, duration, or intensity, they need to see a medical or mental health professional to explore the causes and possible treatment options.
To be an effective support person for someone who self-injures, we must believe there is a cause for their self-injury that is beyond their control, and beyond OUR control. Just like we would not grow angry or frustrated with someone who could not walk because their leg was broken, we must accept that self-injury is a coping strategy for an underlying disorder or chemical/hormonal imbalance. When supporting or working with a person who self-injures, we need to first change the way we think, beginning with believing that it is NOT their fault.
Next up: Self-Injury – Treatment Options
Previous articles in the Self-Injury series;
Aaron D. McClelland, RPCc – www.interiorcounselling.com/aaron/