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Self-injury is described as a behavior in which a person causes deliberate harm to his or her body without suicidal intent. People who self-injure use a variety of methods to cause harm, such as cutting, burning, and hitting themselves with objects. It is estimated that two million people engage in such acts in the United States (Favazza & Conterio, 1988; Favazza, DeRosear, & Conterio, 1989).
Several theoretical functions of self-injurious behavior (SIB) have been suggested (Suyemoto, 1998), including affect regulation, to prevent suicide or harm to others, and coping with dissociative states. Additional rationales that have been proposed include sexual gratification or, conversely, suppressing sexual feelings, protection against loss of personal boundaries, and the result of modeling abusive patterns (Suyemoto, 1998).
Much of the research investigating functions of SIB has relied on a constraining set of reasons stipulated by the researcher. Very little research has allowed individuals to freely communicate their motivations for SIB without choosing from selective responses. These have generally been studies based on interviews of small samples of participants.
The main goal of this investigation was to gain a clearer portrait of the kind of individuals who inflict self-injury, and to understand why they do so. However, instead of giving individuals potentially constraining choices, we have allowed free expression of their reasons for SIB. We have chosen this qualitative method because we are interested in understanding people’s reasons for self-injury from their own perspective rather than imposing pre-conceived notions. Thus, we took a phenomenological approach in which we were interested in how individuals who self-injure defined their own experiences and attempted to see things from their point of view (Taylor & Bogdan, 1998).
One hundred and fifty four subjects were recruited from a self-injury self-help website. A link was provided on this website inviting users to participate in this research study. There were 139 females and 16 males who ranged in age from 18 to 47 years old (M=22.67, SD=6.15). We asked whether these individuals had received a professional psychiatric diagnosis and 63% of the sample reported they had.
Only 16% self-reported a diagnosis of Borderline Personality Disorder. Thirty three percent reported a diagnosis of Major Depressive Disorder, 20% indicated a diagnosis of Bipolar Disorder, and 8% reported a diagnosis of an Anxiety Disorder. Sixteen percent of the sample listed other disorders including: obsessive-compulsive disorder, post-traumatic stress disorder, dissociative identity disorder, and attention deficit hyperactivity disorder. Thirteen percent of the participants indicated they had been diagnosed with two or more disorders.
Of the 154 participants, 51.6% of the participants self-injured at least once a week, 24.5% once a day, 16.1% once a month and 7.8% once a year. When asked how much pain they felt during self-injury, 16.8% reported no pain, 47.7% little pain, 32.3% some pain and 3.2% reported a great amount of pain. The vast majority of the participants reported cutting as their primary method of self-injury (93.5%). An additional 2.6% disclosed that they utilize burning, 1.3% reported hitting themselves, and 2.5% reported using ‘‘other’’ methods.
This sample was comprised of largely young adult females who engaged in SIB at least one time a week, and felt little to no pain. Many of the participants reported never having received a psychological diagnosis, and although the validity of self-reported diagnoses remains unknown, only 16% of self-reported diagnoses were Borderline Personality Disorder.
The functions of SIB reported by our participants were similar to those given by the individuals in a study with BPD (Brown et al., 2002). Those respondents disclosed that mitigating negative emotional states, expressing anger, evoking feelings, self-punishment, and distraction, were reasons for self-mutilation. Their description of ‘‘generating feelings’’ appeared similar to our characterization of SIB to reduce dissociation or to stop feeling numb or dead. However, dissociation was not explicitly discussed in the Brown et al., investigation. Thus, it appears that the functions of self-injury among borderline patients are similar to the aims of our more varied sample, of which only 16% reported diagnoses of BPD.
Our participants’ reasons for self-injury were consistent with the Experiential Avoidance Model (Chapman et al., 2006). This model is based on the notion that individuals hurt themselves in order to relieve negative emotional states. Our qualitative data indicate that the majority of participants specifically say they self-injure in order to express some sort of emotion. This is also consistent with the relationship between self-injury and alexithymia that has been frequently reported in the literature (e.g., Polk & Liss, 2007; Zlotnick et al., 1996; Zlotnick et al., 2001). Individuals who do not have an adequate emotional vocabulary to describe their negative affect might therefore be at increased risk for self-injury.
Our data are also consistent with research that has shown a relationship between self-injury and dissociation (e.g., Saxe et al., 2002; Zlotnick et al., 2001), although the nature of that relationship remains unclear. Some researchers have suggested that individuals self-injure in order to cope with dissociation (Suyemoto, 1998). However, research has shown a link between analgesia during self-injury and dissociation, suggesting that certain individuals dissociate while they self-injure (e.g., Bohus et al., 2000; Kemperman, Russ, & Shearin, 1997; Russ et al., 1996; Shearer, 1994).
Our participants reported that they inflicted pain on themselves in order to relieve dissociation, consistent with Suyemoto’s (1998) analysis. Many reported that feeling numb and unreal produced an uncomfortable state, and SIB may have been their method of relieving the discomfort. This suggests that, for these participants, SIB itself does not bring on a state of dissociation, but, rather, attenuates it. There are more questions that remain about the timing of dissociation (before, during or after self-injury) and the characteristics of those individuals who do feel pain during self-injury versus those who do not.
Rates of self-injury are rising among the adolescent and young adult population (Favazza, 1992; Favazza & Conterio, 1988) and many such individuals are not in an inpatient facility. On the other hand, our sample represents a group of people specifically seeking help or information about their problem. It is not clear whether individuals who seek help and have Internet access differ from those who self-injure but do not seek help. More research utilizing non-selected community samples of all age groups is warranted.
-Polk, E; Liss, M; Exploring the Motivations behind Self-Injury; Counselling Psychology Quarterly; June 2009; 22(2); 233-241
Reflection Exercise Explanation
Personal Reflection Exercise #1