Self-Injury – Biochemistry

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

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.

Endorphins

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?

Previous articles in the Self-Injury series;

• Introduction
• Mythbusting
• In History & Nature
• Spectrum of Function

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

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 

Communication

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;

• Introduction
• Mythbusting
• In History & Nature

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

Self-Injury – In History & Nature

Like most modern mythology, society’s labeling of adolescents and young adults as “Emos” or “Cutters” is an easy way to place blame and dismiss people who struggle with self-injury. Contrary to popular opinion, self-injury is not a modern fad nor a rite of passage for young people wishing to fit into a fringe cohort.

Self-injury has been around since the dawn of mankind and has been documented throughout the ages ...

490 BC

The Greek historian Herodotus, wrote of a Cleomenes, a Spartan King who was thrown into the stocks after exhibiting strange behavior;

“And as he was lying there, fast bound, Cleomenes noticed that all the guards had left him, except one, and he asked the man, who was his serf, to lend him his knife. As soon as the knife was in his hands, he began to mutilate himself, beginning on his shins.”

Cleomenes went on to complete suicide rather than endure his imprisonment.

Unto the Other Side of the Sea

In the Bible’s book of Mark, Jesus is said to have crossed the sea to the land of the Gadarenes with the express purpose of visiting a troubled man who lived there.  From Mark 5:5;

“And always, night and day, he was in the mountains, and in the tombs, crying, and cutting himself with stones.”

This is the man who, when Jesus asked his name, said; “My name is legion, for we are many.”

I have written of this encounter in a past article that can be found here. But in a nutshell, I believe that this passage in the Bible is the first documented case of Dissociative Identity Disorder [once known as Multiple Personality Disorder] where a person who has endured early childhood trauma develops alternate “personalities” – or sometimes strong ego states – in order to disassociate from the abuse they suffered.

The Victorian Era

The 1800s saw the beginnings of social awareness and curiosity about mental health issues during the long period of peace that came to be called Pax Britannica in Great Britain and the Gilded Age in the United States.  Physicians began documenting the behaviours of prisoners and mental asylum patients in order to attempt to understand puzzling symptoms.

In 1872 the Chief Medical Officer of Chatham Convicts Prison documented 163 incidences of self-injury amongst the prison population that year alone.

Also documented in 1872, a female mental-asylum patient in Utica, New York, stuck 300 needles into her body. This act, however, was not rare to the times …

The Needle Girls

During the morally strict and sexually repressive Victorian Era, a phenomenon spread across Western Europe amongst young women – the practice of inserting needles into their bodies.  It would make perfect sense that those young women would choose sewing needles as their tool of choice to practice self-injury because as young women, learning to sew was an activity common to their upbringing.

Doctors at the time had a name for women such as these - “needle girls”.  The “needle girl” phenomenon was documented in the 1890s by American Doctors George Gould and Walter Pyle who reported that women all over Western Europe were puncturing themselves with sewing needles - some embedding the needles beneath their skin.  The common diagnosis for these women at the time was “hysteria”.

Cutters

This still often used epithet, is only somewhat accurate.  Though cutting the skin – usually with a razor blade – is the most often used method of self-injury, it does nothing but label and dismiss the deep underlying emotional distress that those who self-injure seek to soothe.

What the non-practitioner must first understand is that self-injury is most often a way to reduce pain, not cause it.  As a very dear friend put it; “The pain is a byproduct”.

Self-injury takes on many forms.  In my own interaction with those who are in recovery from self-injury or still practice it, most give the age they started as some point in their early to mid teens.  Yet further questioning often reveals that as small children when they were overwhelmed by strong emotions they were sent to their room by parents who failed to teach healthy ways for their children to self-regulate big feelings.  Once there, unable to calm themselves, they would resort to pulling their hair, banging their head against the wall or floor, and even biting themselves.  These too are acts of self-injury.

More Than Human

Self injury is not solely the domain of human beings.

Moluccan_Cockatoo plucking chest feathers

Many animals will display self-injurious behaviour when in a state of chronic or acute distress.  Birds are known to pluck out their own feathers when experiencing the stress of captivity or isolation.  Other animals have been known to self-injure when experiencing acute stress by biting or chewing on their own limbs.

Horse breeders and Veterinarians are well aware of Equine Self-Mutilation Syndrome, where-in horses will bite their own limbs and flanks.

Macaque monkeys that have been raised in laboratories have demonstrated that isolation is a predisposing factor to self-injury and the seriousness of their self-inflicted injury is in direct proportion to the intensity of a stimulating event.

In Closing …

Self-injury has been part of the human – and animal - condition from the beginnings of time.  A conclusion as to why it exists can be stated by the over simplified statement; “Because it works”.  The myriad ways it works will be examined in the next article in the series;

Next up: Self-Injury – The Spectrum of Function

Previous articles in the Self-Injury series;

• Introduction
• Mythbusting

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