Self Injury -- An Update
As professionals we run into the issue of self-injury in our patients, clients, colleagues or their children—or ours, students, or simply our neighbors. The current literature indicates only a 1% incidence rate but those working with teens would often question this and suggest it is too low and actually occurs much more frequently. Together with the question about incidence are many questions about what it actually is, why it occurs, and how to deal with it as a therapist, educator, doctor, parent, or clergy. This paper is a brief attempt at clarifying what we know at the present time.
Karen Conterio and Wendy Lader, identify it as “deliberate mutilation of the body or a body part, not with the intent to commit suicide but as a way of managing emotions that seem too painful for words to express” (1998, p. 16). This debunking one myth that self-injury or self-mutilation is related to a desire or failed attempt at suicide. It is very different and we need, even in our fearful or anxious response, to remember and clarify this difference. The American Academy of Child and Adolescent Psychiatry sums up the forms of this behavior as follows:
*carving
*marking
*biting
*bruising
*tattooing *scratching
*burning/abrasions
*cutting
*hitting *branding
*picking, and pulling skin and hair
*head banging
*excessive body piercing
The background of the individuals who begin self-mutilating behaviors include neglect, sexual, physical or emotional abuse, parents who have alcoholism, drug addition, or mental health problems, rigid households with no allowance for emotions, strict religious or militaristic type homes, and those with no guidance. That said, it is not uncommon for adolescents to begin such behavior based solely on experience with peers who also self-injure and thus the frequency of these behaviors due to mimicking or from “contagion” is growing. In fact, consider the lyrics to some of the current music, the piercings and other self-mutilation worn by athletes and entertainers, and one begins to see just how the contagious aspect of this is spreading.
The field of psychology and counseling has suggested in the past that there are 5 reasons for such behavior: boundary definition by mutilating one’s body thus drawing the line between self and other’s control of one’s behavior and body; mastery of penetration and other sexual impulses particularly when one has been abused sexually in the past; mastery over death; reduction of internal tension; and communication with others. A recent study by Nock & Prinstein (2005) attempted to better identify the contextual features of the incidence of self-mutilating behavior. This study found that there are actually four reinforcers for the behavior:
This study also confirmed the prior writings of the American Academy of Child and Adolescent Psychiatry, Centerio, and others that suggested:
So, what do we do?
First, pay attention—do not ignore this behavior. It won’t just go away!
Second, state your concerns to the young person. Let them know what you’ve seen, what you suspect, offer help, and assure them they will not be punished for this.
Third, deal with your feelings separately. This is a difficult issue for the person who identifies it as well as for the person self-mutilating. But the adult must deal with their feelings and fears separately and not put them on the teen.
Fourth, help the teen find resources.
Fifth, do not get into a power struggle over her cutting, burning, etc. Work with a professional who can help the teen find more effective means of coping and dealing with their feelings and the self-mutilation will reduce.
Six, help the teen talk with their parent and get the parent involved.
Finally, help the adolescent see they are not just hurting themselves—but also others around them.
This is an issue that can be resolved. Sometimes it takes quite some time, but working with a professional counselor or psychologist who is experienced with this can bring change both in the behavior and the internal experience of the young person or adult.
References:
American Academy of Child and Adolescent Psychiatry. (1999). Self-injury in adolescents. Retrieved April, 2005, from http://www.aacap.org/publications/factsfam/73.htm.
Conterio, K. and Lader, W. (1998). Bodily harm: The breakthrough healing program for self-injurers. New York: Hyperion.
Nock, M.K. and Prinstein, M.J. (2005). Contextual features and behavioral functions of self-mutilation among adolescents. Journal of Abnormal Psychology, 114(1), 140-146.
Self-Injury: A quick guide to the basics. (n.d.). Retrieved April 13, 2005, from http://www.selfinjury.org/docs/factsht.html.
Zila, L.M. and Kiselica, M.S. (2001). Understanding and counseling self-mutilation in female adolescents and young adults. Journal of Counseling and Development, 79, 45-52.
Karen Conterio and Wendy Lader, identify it as “deliberate mutilation of the body or a body part, not with the intent to commit suicide but as a way of managing emotions that seem too painful for words to express” (1998, p. 16). This debunking one myth that self-injury or self-mutilation is related to a desire or failed attempt at suicide. It is very different and we need, even in our fearful or anxious response, to remember and clarify this difference. The American Academy of Child and Adolescent Psychiatry sums up the forms of this behavior as follows:
*carving
*marking
*biting
*bruising
*tattooing *scratching
*burning/abrasions
*cutting
*hitting *branding
*picking, and pulling skin and hair
*head banging
*excessive body piercing
The background of the individuals who begin self-mutilating behaviors include neglect, sexual, physical or emotional abuse, parents who have alcoholism, drug addition, or mental health problems, rigid households with no allowance for emotions, strict religious or militaristic type homes, and those with no guidance. That said, it is not uncommon for adolescents to begin such behavior based solely on experience with peers who also self-injure and thus the frequency of these behaviors due to mimicking or from “contagion” is growing. In fact, consider the lyrics to some of the current music, the piercings and other self-mutilation worn by athletes and entertainers, and one begins to see just how the contagious aspect of this is spreading.
The field of psychology and counseling has suggested in the past that there are 5 reasons for such behavior: boundary definition by mutilating one’s body thus drawing the line between self and other’s control of one’s behavior and body; mastery of penetration and other sexual impulses particularly when one has been abused sexually in the past; mastery over death; reduction of internal tension; and communication with others. A recent study by Nock & Prinstein (2005) attempted to better identify the contextual features of the incidence of self-mutilating behavior. This study found that there are actually four reinforcers for the behavior:
- Automatic negative reinforcement that allows the person to “stop feeling bad”;
- Automatic positive reinforcement that allows the person to “feel something”;
- Social negative reinforcement that allows the person to “avoid doing something unpleasant”; and
- Social positive reinforcement that allows the person to “get attention”.
This study also confirmed the prior writings of the American Academy of Child and Adolescent Psychiatry, Centerio, and others that suggested:
- Teens do not contemplate this for long. In fact, in one study 77.4% of all teens stated they contemplated the act for less than a few seconds.
- It is not associated with alcohol or drug use in the vast majority of cases.
- Less than 20% of those reporting self-injury actually feel physical pain when mutilating themselves.
- 82.1% of teens who self-mutilate have a friend who also does.
- There is no impact of age, gender, ethnicity, or socioeconomic status on the percentiles.
- Self-injury is associated with depression and post-traumatic stress disorder frequently and particularly when the individual is acting in hopes of gaining attention, as they have not received treatment for the other issues.
- The individual’s need for perfection is generally associated with those who self-injure for social reasons, i.e.: to avoid something or to get attention.
So, what do we do?
First, pay attention—do not ignore this behavior. It won’t just go away!
Second, state your concerns to the young person. Let them know what you’ve seen, what you suspect, offer help, and assure them they will not be punished for this.
Third, deal with your feelings separately. This is a difficult issue for the person who identifies it as well as for the person self-mutilating. But the adult must deal with their feelings and fears separately and not put them on the teen.
Fourth, help the teen find resources.
Fifth, do not get into a power struggle over her cutting, burning, etc. Work with a professional who can help the teen find more effective means of coping and dealing with their feelings and the self-mutilation will reduce.
Six, help the teen talk with their parent and get the parent involved.
Finally, help the adolescent see they are not just hurting themselves—but also others around them.
This is an issue that can be resolved. Sometimes it takes quite some time, but working with a professional counselor or psychologist who is experienced with this can bring change both in the behavior and the internal experience of the young person or adult.
References:
American Academy of Child and Adolescent Psychiatry. (1999). Self-injury in adolescents. Retrieved April, 2005, from http://www.aacap.org/publications/factsfam/73.htm.
Conterio, K. and Lader, W. (1998). Bodily harm: The breakthrough healing program for self-injurers. New York: Hyperion.
Nock, M.K. and Prinstein, M.J. (2005). Contextual features and behavioral functions of self-mutilation among adolescents. Journal of Abnormal Psychology, 114(1), 140-146.
Self-Injury: A quick guide to the basics. (n.d.). Retrieved April 13, 2005, from http://www.selfinjury.org/docs/factsht.html.
Zila, L.M. and Kiselica, M.S. (2001). Understanding and counseling self-mutilation in female adolescents and young adults. Journal of Counseling and Development, 79, 45-52.