Saturday, 15 September 2012

Self-Injury – The Spectrum of Function

The purposes of self-injury are manifold and therefore the function it serves falls somewhere on a spectrum. Many in the mental health community refer to self-injury as a “maladaptive coping strategy” – that is; It is a way to cope with disturbing emotions or dissociation. Yet even labeling it as “maladaptive” may be presumptuous given that a significant percentage use it to find relief from suicidal thoughts or urges. It may not be a healthy way to cope, but for those who self-injure it is effective and provides almost instant relief.

The motivation to self-injure typically falls into four categories, in each self-injury satisfies a need;

Overwhelming Emotions

There are many people who never learned to self-regulate their emotions, or have biochemical imbalances that cause them to be highly sensitive to distress. For them, self-injury may serve the following functions;
  • To escape from emptiness and depression 
  • To release unbearable tension 
  • To provide relief from inner turmoil; When intense emotions overwhelm them, people prone to self-injury find it more and more impossible to cope. Causing physical pain can reduce their emotional and physiological arousal to a bearable level 
  • To suppress anger: Some people who self-injure have enormous amounts of rage within them and are afraid to express it outwardly. Instead they often turn that anger inward and injure themselves as a way of venting or neutralizing these feelings 
  • To create wounds on the outside that they can care for [or have another care for] unlike the emotional wounds within 
  • To validate their emotional pain; As one young person put it; “To make my outsides look like my insides” 
  • To maintain a sense of security or feeling of uniqueness 
  • To prevent suicide 
  • To obtain a feeling of euphoria 
Dissociation or Depersonalization
Many individuals who experienced early childhood trauma entered a state of depersonalization or dissociation during their abuse – they, in effect, “went somewhere else”. Later in life when these episodes reoccur, they can become so emotionally and physically numb that they begin to doubt if they are still alive. For these individuals, self-injury can help;
  • To ground themselves in reality, as a way of dealing with feelings of depersonalization and dissociation 
  • To escape numbness: A number of those who self-injure say they do it in order to feel something, to know that they're still alive 
  • To escape feelings of unreality 
  • To reconnect with the body through the experience of bleeding & pain 
For some people self-injury serves the purpose of communication;
  • To express emotional pain they feel they cannot endure 
  • To communicate to others the extent of their inner turmoil 
  • To communicate a need for support 
  • To express or repress sexuality 
  • To express or cope with feelings of alienation 
  • To validate their emotional pain; The wounds can serve as evidence that those feelings are real
Self Control or Punishment
Feelings of worthlessness or low self-esteem can lead some to use self-injury as a form of punishment, while others have been known to use it to demonstrate that they can endure the pain – to be “tough enough to take it”. Therefore self-injury can be used;
  • To punish themself for being “bad” 
  • To exert a sense of control over their body 
  • To obtain biochemical relief: Many youth and adults who experienced trauma as children maintain a constant state of fear arousal or alertness and struggle to reach a state of calm. Others become addicted to living in a state of crisis. Self-injury can either help lower their arousal or perpetuate this type of crisis state 
  • To divert attention [inner or outer] from issues too painful to examine 
  • To produce physical injuries that they [or others] can care for to replace the emotional injuries that they feel cannot be treated 
  • To prevent something worse from happening 
Too often we hear the dismissive statement that a person self-injures “just to get attention”. This may indeed be true for a rare few, much in the same way a child who is in physical pain will cry to get the attention of a caring adult instead of calmly and rationally explaining that he has fallen and skinned his knee. In some cases, people feel self-injury is the only way they can convey their emotional distress and receive the attention they need from someone who cares about them.

Even armed with an understanding of why someone self-injures, many friends and family continue to struggle with the idea that someone they care about is doing physical harm to themselves in order to cope. To provide some perspective, there are other coping strategies which do equal or even greater harm to the human body, but are more socially accepted;
  • smoking/tobacco use 
  • drinking alcohol 
  • illicit drug use 
  • over-eating 
  • high-risk sports/activities 
  • excessive exercise/dieting 
  • tattoos, piercings, branding 
It’s all about perspective.

Next up: Self-Injury – Biochemistry

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

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