Onset, Frequency, Duration

Cornell University reports that early onset of self-injury usually occurs around the age of seven!  The group of early adolescents between the ages of twelve and fifteen is where self-injury more commonly begins to be seen but the age of seventeen has been found to be the most frequently self-reported age for the first act of self-injury.  Later onset spanning twenty year olds is also seen but less frequently.

Since self-injury is such a private affair and often kept secret it is hard to determine the frequency at which it is engaged.  Statistics rely solely upon self-reported behaviors which often lack objective and subjective validity considering the emotional struggles of those masking or expressing through SI.  Depending on the stressors  and the strength and frequency of SI inducing triggers that are encountered, harming oneself could range from multiple times a day to occasional once a month releases.

The most common duration of self-harming has been found to be around five years.  Acts of self-injury are more cyclic than linear.  Periods of frequent use of SI followed by weeks or months of abandonment… only to resume it again is normal.  Although it can last well into adulthood, this would be the exception and not the norm.

Who is at risk?

Self-injury or those who admit to self-injury are growing in numbers.  1 in 4 college students admit to purposefully injuring themselves in some way at one time or another.   For those who might use SI, the Mayo Clinic identifies these common risk factors:

• Age. Most people who self-injure are teenagers. Self-injury often starts in the early teen years, when emotions are more volatile and children face increasing peer pressure, loneliness, and conflicts with parents or other authority figures.
• Having friends who self-injure. People who have friends who intentionally harm themselves are more likely to begin self-injuring.
• Life issues. Some people who injure themselves were sexually, physically or emotionally abused as children or adults. They may also have experienced neglect in childhood.
• Mental health issues. Among those at highest risk are people who experience many negative emotions and are highly self-critical. People who self-injure are more likely to be impulsive and to have poor problem-solving skills. In addition, self-injury is commonly associated with certain mental illnesses, including borderline personality disorder, depression, anxiety disorders, substance abuse disorders, post-traumatic stress disorder and eating disorders.
• Alcohol or substance use. People who harm themselves often do so while under the influence of alcohol or illegal drugs.
• Magical thinking. You may believe that your physical wounds prove your emotional pain is real, or that if you harm yourself, no greater harm will come to you.
• Growing up in a family where emotions weren’t allowed. You may have been discouraged from expressions of anger while growing up, and as a result be unsure what to do with strong feelings.

People who fall into these at risk categories will be particularly susceptible if they have difficulty expressing emotion.  Some common emotional reasons that people self-injure have been identified by helpguide.org

• Regulate strong emotions. If you are experiencing high stress, self-harm can—temporarily—calm your nerves.
• Distract yourself from emotional pain. You may feel emotionally “numbed” by past traumas and need a way to force yourself into feeling something.
• Express things that cannot be put into words. Self-harm may be the only way you know how to display anger or deep sadness.
• Exert a sense of control over your body. You may imagine that hurting yourself will prevent something worse from happening.
• Self-punish or express self-hate. You may have a childhood history of physical, sexual, or emotional abuse and erroneously blame yourself for it. Self-harm can be a way to punish yourself.
• Self-soothe. You may not know any other means to calm intense emotions.

If you know anyone who is at risk or is showing signs of self-injury, talk with them in an open, non-judgmental atmosphere and let them know how common it is and that there are ways to deal with it.  Taking away the shame and secrecy and replacing it with love and acceptance is the most important thing you can do when approaching someone who is at risk or suspected to be self-harming.

Self-harm, Masochism, and Endorphins

In my research on SI, I started coming across another term with which I was not familiar: Masochism.  I quickly realized that it is from this word that “masochist” is derived.  So what is a masochist or sadomasochist?  It is an individual who enjoys the sensation of pain; pain is in fact pleasurable for masochists.  This painful pleasure is often incorporated into practitioners sexual lives and consequently “sadomasochists” is commonly used as a name for a sexual perversion where pain is incorporated into sex acts.

When the body experiences pain, it releases endorphins.  They are produced by the pituitary gland and the hypothalamus and resemble opioids in their effect on the body by producing analgesia, a feeling of well being, a sense of power and control, and a “rush” of excitement/pleasure.  Thrill seekers looking for their next rush are wanting these endorphins.  People who SI, are needing the endorphins to feel that analgesia and sense of well being in an effort to control or have power over themselves or their emotional pain.  Sadomasochist are releasing these same endorphins to feel a rush of opioid-like pleasure.

Endorphins are neuro-transmitters and are processed differently and produce different sensations within different individuals.  So whether you are sky diving, practicing masochism, or SI, you are manipulating your body to produce endorphins for your own purposes.  Forms of self-manipulation to produce endorphin rushes can be socially acceptable (sky-diving), beneficial, (exercise), harmful (SI), or deviant (masochism).  Although these are all used to reach the same end, I agree with the societal categorizations and feel that some are appropriate and healthy and others are not.  What do you think?

suicide and self-injury

The general population for many years considered SI to be an attempt of or a sign of suicide.  Suicide is not the purpose of self-harm, but the relationship between self-harm and suicide is complex, as self-harming behaviour may be potentially life-threatening. There is also an increased risk of suicide in individuals who self-harm to the extent that self-harm is found in 40–60% of suicides. However, generalising self-harmers to be suicidal is, in the majority of cases, inaccurate.

Suicide does have some basic similarities with SI in so much that mental disorders such as depression, bipolar, and OCD but SI is more commonly associated with self-loathing, punishment, and controlling emotion, suicide is rooted in despair.  Financial troubles, difficulties with relationships and other undesirable situations/circumstances can play a significant role in suicide.  There are other forms of suicide such as self-immolation, used as a form of protest; kamikaze and suicide bombing in military or terrorist tactics; and even Sati, a Hindu funeral practice in which the widow would immolate herself on her husband’s grave, either willingly, or under pressure from the family; but these are rooted in zealot-ism and not so much in mental disorder.

Is hair pulling and plucking a form of self-harm?

Trichotillomania is an irresistible urge to pull out hair from the scalp, eyebrows or other areas of one’s body.  It is officially classified as an impulse control disorder, along the lines of pyromania, kleptomania, and pathological gambling.  People who struggle with eating disorders, self-injury, depression, mood swings, etc. often engage in habitual hair picking.  Is it something different in and of itself, or is it a form of SI?

There is no definitive answer and professionals differ on their opinions.  There is a connection between hair pulling and its associated pain and the body releasing dopamine.  This chemical helps regulate moods/emotions and is often lacking in people with depression or other mental illness.  Is it just a way for people to pathologically increase their low levels of dopamine or is it a form of loathing and self-harm.  The answer, like most things in life, lies with in the motives.  Until motives can be objectively discerned, hair pulling can be a form of self-abuse or just a “bad” habit used to deal with stress and emotion much like nail biting.

Treatment for SI

S.A.F.E. Alternatives’ (Self-Abuse Finally Ends) is a treatment center that focuses on SI.  They note that Self-injury is not in and of itself a psychiatric disorder but merely an expression of  other probable psychiatric issues.  Although people can and do get better on their own, many find it incredibly difficult to stop the behavior as it provides an immediate sense of relief from the “moment” they are suffering from.  The SAFE Alternatives philosophy is based upon the book, Bodily Harm: The Breakthrough Healing Program for Self Injurers, where they state that self injury is a choice; that there is only pain, not relief in self-injury.

There is no “one shoe fits all” specific cure for self-injury and there are no medications designed to treat it.  Often the most successful approach to treating SI is to customize a multi-modal plan with a mental health professional to help alleviate the underlying problems that lead to SI.  CNN Health notes “psychotherapy, also known as talk therapy, counseling or behavior therapy, psychotherapy can help you identify and manage underlying issues that trigger self-injury.” It goes on to state that medications that treat underlying disorders such as OCD, Generalized Anxiety Disorder, Depression, Borderline Personality Disorder, and Bi-Polar Disorder can be prescribed to help alleviate some psycho-triggers that lead to SI.  If SI is particularly sever, a short hospitalization might be necessary to get quick, intensive treatment if the self-injury is becoming life threatening.  Support groups and group therapy/treatment centers like S.A.F.E can be helpful in the long and short term treatment of SI.

These are a few who state what they do…

I first thought about titling this post as “Notable Names” but was uncomfortable with glamorizing something so heart wrenching as self-injury by associating it with media/entertainment icons.  Everyone who struggles with SI (self-injury) is and should be a “notable name.”  Often due to shame or other co-existing disorders or mental illness, those who SI melt into the shadows and do their best to hide their scars and shelter their loved ones–family and friends from the harshness of what brings them a sense of relief or at least a sense of feeling… anything!  Three Days Grace seems to capture the feelings of those who SI in the lyrics of their song “Pain.”

Pain, without love
Pain, I can’t get enough
Pain, I like it rough
‘Cause I’d rather feel pain than nothing at all

You’re sick of feeling numb
You’re not the only one
I’ll take you by the hand
And I’ll show you a world that you can understand

While some of us may know people who have used SI to cope or to self-loath or maybe have struggled with it ourselves, I was curious to see what famous people might have revealed their own struggles with it.  I was surprised by a few of the names I came across.  Fiona Apple, Drew Barrymore, Johny Depp, Richey Edwards, Angelina Jolie, Marilyn Manson, Courtney Love, Shirley Manson, Princess Diana, Elizabeth Wurtzel, Christina Ricci, Collin Ferrall, Kelly Holmes, Alfred Kinsey, Demi Lovato, and Amy Winehouse are some famous people who have admitted to SI.  While I do not know every name on this list and it is far from exhaustive, I was shocked by a few names on there, most notably  Princess Dianna.  Are there any that were surprising to you?

Social Stigma of Self-injury

There seems to be a lot of shame and social stigma surrounding people who self-injure.  Most people have an inner drive to self-preserve and consequently find it hard to understand those that would purposefully inflict injury on oneself.  The vast majority try to avoid any type of  pain and do not understand why someone would inflict physical pain on themselves… even if it is to mask a different type of emotional pain.  Those who SI (self-injure) go to great lengths to hide their physical scars.  Long sleeves and pants in the summer offer sweaty  “protection” from judgmental stares.  Those who self-injure feel this judgement and shame.  While the general population is becoming more aware of this coping mechanism, the stigma and public shame still exist and influence lives.

Other types of unhealthy coping mechanisms have similar stigmas but I feel they are more common and thus more accepted by the public.  For example: drug usage, alcohol, perscription drug abuse, over-eating, shop-aholics, pornography, etc. all are viewd negatively but are they viewed as negatively as say cutting?  I think not and I am not sure why this is so.  Is there a difference and if so, why?

Embedding – a new form of self-injury

With self-embedding, objects are purposely used to puncture the skin or are embedded in the wound after cutting. Adolescent self-embedding behaviors are not currently recognized in medical literature as an actual form of self-injury. The only prior reporting of self-embedding  involved six cases of adult patients self-embedding in the eye.  Self-embedding was discovered by radiologists.  The only way to “know” of objects under the skin is utilizing fluoroscopy (movable X-rays) or ultrasound to identify foreign objects.  Because of this,  radiologists are at the front line of diagnosing self-embedding behavior and should send up a red flag signaling the need to mobilize help for early, effective intervention and treatment.

Radiologists have found everything from chunks of crayons to paper clips reports Time Magazine.  Self-embedding has recently been identified as a new and more severe form of self-injury.  It’s purpose is the same in that is serves a function in coping with emotions distress and pain for the individual performing it on themselves.  Self-embedding usually has co-morbidity with other psychological problems such as bipolar, depression, and generalized anxiety disorder to name a few as reported by Bloomburge Businessweek.  Some individual teens presented to the ER with as many as 20 objects embedded under their skin.

Although this is a new variation in self-injury and is thought to be more severe, the roots of this behavior remain the same.  Because of this, dealing with it and helping any individual participating in self-embedding should be handled like any other form of self-injury.  Professional medical and psychiatric help should be provided in a supportive, loving, non-judgmental environment.

Should YouTube regulate self-injury content posted on its site?

YouTube in the crosshairs

Many videos about self-injury on sites such as YouTube contain warnings that the images might trigger self-injury in teens who lack better coping mechanisms.  Because of this, a recent CBS News article asks if YouTube should do a better job of regulating the content that is posted.  Others argue that because “cutting” is social taboo that self-injury remains the elephant in the room that nobody wants to acknowledge and that these videos are helping bring it out and into the open so that people and teens in particular who struggle with it are more comfortable talking about it and seeking help.  So does it sensationalize, promote, and trigger the behavior or is it helping it to become common knowledge and promoting awareness?

Self-injury is oddly effective in coping with pain, anxiety, helplessness, etc. and recent studies noted by an ABC News article state that 17 to 40 percent of college students admit to “utilizing” self-harm.  These recent studies seem to indicate that self-injury is becoming more prevalent than in years past or that at least more are willing to admit to it now that it is more out in the open.  Larger questions such as “does society put too much stress on teens” and “why are teens and young adults resorting to self-injury instead of healthier coping mechanisms” loom over our proposed question of  “should YouTube restrict videos on self-injury” or do they benefit society by providing awareness and even education in addition to letting isolated, stress-out teens know they are not alone?