Long a subterranean topic, the deliberate, nonsuicidal, violent destruction of one’s own body tissue emerged from obscurity in the 1990s and began to spread dramatically as fairly typical behavior among adolescents. Self-injury has gone by several names including self-harm or deliberate self-harm syndrome, self-mutilation, self-destruction, self-cutting, self injurious behavior, and self-wounding. Although a range of behaviors may be considered self-injurious, including eating disorders, excessive laxative use, and extreme body modification among others, the psychiatric and medical community has defined this syndrome as self-cutting, burning, branding, scratching, picking at skin or re-opening wounds, biting, head banging, hair-pulling (trichotillomania), hitting (with a hammer or other object), and bone-breaking.
Self-injury was considered for many years a suicidal gesture, although it is now recognized as a morbid, but effective coping strategy. These behaviors provide immediate release from anxiety, depersonalization, racing thoughts, and rapidly fluctuating emotions. Self-injury tends to lead to the lessening of tension, cessation of depersonalization (grounding), euphoria, improved sexual feelings, diminution of anger, satisfaction of self-punishment urges, security, uniqueness, manipulation of others, and relief from feelings of depression, loneliness, loss, and alienation. It provides a sense of control, reconfirms the presence of one’s body, dulls feelings, and converts unbearable emotional pain into manageable physical pain. As such, it represents an emotion regulation strategy and a grounding technique to end dissociative episodes.
Psycho-Medical View of Causes
Psychiatrists and clinicians view self-injury as a symptom of several impulse-control disorders. Lodged primarily within the dramatic-emotional cluster, it is associated as an occasional side-effect of borderline personality disorder (inappropriate anger and impulsive self-harming behavior), antisocial personality disorder (the tendency to be aggressive, to have reckless disregard for personal safety), histrionic personality disorder (a pervasive pattern of excessive emotionality and attention-seeking behavior often enacted through physical appearance), posttraumatic stress disorder (sometimes due to rape or war), various dissociative disorders (including multiple personality disorder), eating disorders, and a range of other conditions such as kleptomania, Addison’s disease, depersonalization, substance abuse, alcohol dependence, and various depressive disorders.
The traditional literature on self-injury has posited the typical demographics of self-injury as starting in early adolescence, with most practitioners desisting after adolescence. Girls are generally considered more frequent practitioners than boys, with some three quarters or more of the population consisting of women. At the same time, others assert that male practitioners are more plentiful or equal in numbers to women. Traditionally, like eating disorders, self-injury is seen as located primarily among an intelligent, middle or upper-class population that is disproportionately Caucasian. Finally, psychologists view it as a short-term, adolescent phenomenon.
Three significant historical periods exist that affect the population, prevalence, meaning, and practice of self-injury. Self-injury has existed for a long time, although throughout most of history there has been little public awareness of the phenomenon. Practitioners acted alone, in a social vacuum. Somewhere in the vicinity of 1996, public knowledge of self-injury began to arise, with depictions of it appearing in books, films, television shows, magazines, newspapers, and other media. Several celebrities came out in public and admitted their self-injury, and discussions of it flourished in high schools. This burgeoning awareness, although limited in scope, spread fairly rapidly through segments of the population that were most likely to come into contact with self-injurers: adolescents, young adults, educators, doctors, and psychologists. It affected the way self-injurers thought about themselves and were regarded by others, but they still mainly kept to themselves. A third period dawned around 2001–2002, when Web sites began to appear on the Internet focused on self-injury (self-mutilation, self-harm) complete with public chat rooms where people could interact with fellow and former self-injurers.
Sociological View of Causes
Sociologists assert that the psycho-medical model is doubly flawed: It has always been overly narrow, missing the experiences of people outside of inpatient clinical settings, but it has more recently failed to capture the explosion of the behavior outside of treatment facilities. They suggest that with the rise of awareness about self-injury, transmission has increasingly occurred through social learning, with people hearing about it from friends, in school, in movies, TV shows, magazines, and documentaries. Not only do people hear about it and want to try it, but also through these means they learn how to perceive and interpret its effects. Self-injury, they argue, is a silently exploding epidemic, moving to take its place as the next teenage angst. It offers youth an opportunity to express their frustrations over their lives and lack of control. Consequently, they form identities and social groups around the behavior.
Research in the 21st century suggests that the practice has become widespread among a broader range of people: prisoners, especially juvenile delinquents; homeless street youth and others who suffer and lack control over themselves; boys and men; people of color; those from lower socioeconomic statuses; members of alternative youth subcultures; youth suffering typical adolescent stress; and a growing group of older hard-core users who begin the practice to seek relief but settle into a lifetime pattern of chronic self-injury. Many of these people operate as loner deviants, hiding their behavior and practicing it alone, but the rise of Internet self-injury chat rooms, Web sites, and groups has created cyber subcultures and cyber relationships where communities of self-injurers flourish and grow.
- Adler, P. A., & Adler, P. (2005). Self-injurers as loners: The social organization of solitary deviance. Deviant Behavior, 26, 345–378.
- Favazza, A. R. (1998). The coming of age of self-mutilation.
- The Journal of Nervous and Mental Disease, 186, 259–268. Ross, S., & Heath, N. (2002). A study of the frequency of self-mutilation in a community sample of adolescents.
- Journal of Youth and Adolescence, 31, 67–77. Suyemoto, K. L., & MacDonald, M. L. (1995). Self-cutting in female adolescents. Psychotherapy, 32, 162–171.
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