Sunday, 2 September 2012

Self-Injury - Mythbusting

The orange Self-Injury Awareness ribbon

As I stated in my previous article, Non-Suicidal Self-Injury is one of the most mythologized, misunderstood, and ignored mental health issues we face.  This second article in the series will hopefully dispel some of those myths.

Most of the statistics quoted in this article were gathered through a longitudinal study performed in British Columbia from 2003 to 2005 by Mary K. Nixon, MD, FRCPC, Department of Psychiatry, University of British Columbia, Division of Medical Sciences, University of Victoria, Mikael Jansson Ph.D. Department of Sociology, University of Victoria, Paula Cloutier MA, Mental Health Research Unit, Children’s Hospital of Ontario

“Self-injury is a failed suicide attempt”
Though people who self-injure should be screened for suicidal ideation, the act of self-injury in itself is typically not intended as a means of suicide.  For most, it is a coping method used to survive, not to end life.  For many – (50% according to Nixon, et al, 2005) - self-injury drives away sometimes overwhelming emotions and urges to complete suicide to end unbearable emotional distress.  So for them, self-injury may be the only thing keeping them alive.

It is true that there are higher completed suicides amongst those with a prolonged history of self-injury, but to understand the relationship between self-injury and suicide, one must look at the related emotions behind motive; Many people who attempt or complete suicide do not want to die, they want the emotional torment to end and killing themselves seems like the only way to do it.  The shame and guilt some feel after an episode of self-injury can also result in a person wondering if they should live or die.  Plus self-injury can lead to accidental death

“People self-harm to fit in or be cool”
The most recent statistics indicate that about 17% of adolescents between the ages of 12 and 18, will self-injure for a period of 21 months.  What is very revealing about the longitudinal study in BC was that many of the young people surveyed lived in isolated communities and 72% said they came up with the idea to self-injure on their own.  Therefore, self-injury amongst the adolescent population is not a trend or fad.

“It’s only a teenage thing - they will grow out of it”
In the same BC study cited above, 42% did not “grow out of it”, and continued to self-injure into adulthood.

“People who self-harm could stop if they wanted to”
Some can and do stop (58%), but self-injury can become addictive.  There are many who argue that self-injury is a process addiction, that the ritualistic elements of the behaviour become habitual.  There are others [this writer included] that have seen enough evidence to believe that self-injury can become a biochemical addiction.  The act of self-injury – of causing a wound to one’s body – triggers the same response as though the person had been injured accidentally.  When injured, endorphins are released by our pituitary gland and hypothalamus.  Endorphins are endogenous opioid peptides that function as neurotransmitters and are often referred to as the body’s "natural heroin".  Just like heroin, one can become addicted to endorphins. [Note: a future article in this series will examine self-injury addiction in more detail]

“People who self-injure have been abused”
Not necessarily; Though the BC survey indicated that 85% of those who self-injured reported some form of past trauma – abuse, neglect, unresolved grief & loss, bullying at school or in the community - there are diverse triggers that can lead to self-injury and many people who do it cannot always say what brings it on.  For many, the act of self-injury is a way to cope, to release tension, to relieve stress or pressure.

“Self-injury is when you cut yourself”
Cutting is only one of many forms of self-injury and, although it is most common, there are many others, including; scratching, burning, imbedding, hair pulling, hitting, biting, head-banging, ingesting drugs or a non-ingestible substance or item, ingesting alcohol  or illicit narcotics to excess, or interfering with wound healing.

“People self-injure to get attention”
Young people self-injure in response to emotional distress, and most hide it from friends and family and go to great lengths to cover their injuries and scars.  But if someone was going to the extreme of taking a razor blade and cutting their flesh to get our attention, don’t you think we should give it to them?

“If you self-injure you have Borderline Personality Disorder (BPD)”
Self-injury can be a symptom of BPD but only as part of a complex set of other criteria.  This false assumption arose due to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for a BPD diagnosis including self-injury as part of repeated suicidal behaviour.

“They will stop if their tools are taken away”
By taking away the familiar tools from someone who self-injures, we are - in most cases - forcing them to use unfamiliar tools when they need to find relief and they then risk greater injury or possible death.  Many in the world-wide self-injury peer support community have even found makeshift tools in psychiatric hospitals that pride themselves on being “safe” facilities; staples, paperclips, the threads on a faucet, broken glass, broken plastic, even the foil lid from a yoghurt container have all been used to fashion tools to self-injure right under the noses of hospital staff.  Taking away a person's tools will not "cure" them; Treating the underlying cause of self-injury is best accomplished under the care of a qualified and experienced therapist who understands self-injury.

“Self-mutilation …”
The term “self-mutilation” is not synonymous with self-injury.  Many who self-injure take great offence and are hurt by the term because it speaks to motive.  Most people who self-injure don’t do so to create scars or disfigure their body, they do so to find relief from overwhelming emotions or tension.  The term “self-mutilation” was coined as an observation made by clinical practitioners without investigating motive.  There are people who do mutilate their body, but that behaviour lies in the realm of psychosis, not for most of those who self-injure.

Next Up: Self-Injury – In History & Nature

Previous articles in the Self-Injury series;
Aaron D. McClelland, RPCc –

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