Reasons why people self-injure
By Jessika Endsley
Deliberate self-injury is intentional harming of ones own body without suicidal intent. The behavior has been brought into the public light very recently in comparison to how long it has indeed been common, and some even go as far as to call self-injury an "epidemic." But there are many questions and misconceptions that must be addressed before self-injury (also called self-harm and self-mutilation) can indeed be treated as a public issue or as an epidemic. What is self injury, why does it happen, and does it really need treatment? Unfortunately, the professionals who are supposed to educate the public about such issues often do not understand the function nearly as much as they need in order to be genuinely helpful. If the professionals are misinformed, the self-injurers have nowhere to turn other than towards a misdiagnosis and a misunderstanding of their own nature.
Are self-harmers suicidal?
Some of the most astounding misconceptions about self-injury involve what type of person is perceived as being inclined to participate in the behaviors. The public as well as mental health professionals have their own ideas of who self-injures, and both parties are consistently narrow in their analysis. The general consensus is that self-harm is synonymous with suicidality and is brought on by depression. In fact, in many places, if a self-injurer seeks emergency assistance (such as stitches for cutting) they will be immediately placed in a psychiatric ward on "suicide watch" and put on medication for depression or even psychosis. It does not matter if the individual was not actually suicidal, whether they have ever been seen by a psychiatrist, or what their mood and demeanor were like upon arrival to the facility - a psychiatric hold for several days is likely to be part of protocol. Of course, this deters many self-injurers from acquiring emergency assistance when needed. Being (mis)treated as mentally ill is uncomfortable even for those who truly are, and is frustrating on a different level for those who are not.
Mental illness does lend itself to less socially-acceptable coping mechanisms, and more often than not, that is how a mentally ill person uses self-harm. Self-harm is most common in Cluster B Personality Disorders, which include Anti-Social, Borderline, Histrionic, and Narcissist Personalities. Independent of personality, Depression, Bi-Polar, and other mood disorders that are thought to be chemical can lend themselves to self-destructive coping methods. Research indicates that self-injury does indeed help to regulate emotions, so it is no mystery as to why those with mood-related disorders would habitually use self-harm as self-help. These individuals are not harming themselves out of despair or because they are testing the suicidal waters; they are regulating their moods, which is exactly what professionals often (unsuccessfully) attempt to do with so many medications. But most depression individuals do not self-mutilate, and most people who self-harm are not mentally ill, and those with mental illness or Personality Disorders who do self-injure are rarely suicidal.
Suicidal self-harm is very different from chronic self-harm and the demographic differs a bit as well. Whereas most completed suicides are committed by white men over age fifty by firearms, most chronic self-injurers are white women under twenty-five (although statistics are surely skewed due to less men seeking help than women.) The most common methods of non-suicidal self-harm are scratching, impact with objects (such as hitting the head or punching walls) and cutting, all of which are far cries from a bullet to the head or hanging. But the suicidality of everyday life is not nearly as limited to the mentally ill as many perceive self-injury to be; if you have ever participated in a dangerous activity, whether for the thrill, to show off, or on a dare, you have toyed with suicidal behavior. If you have ever gone on a risky diet, drank a bit too much, or played a dangerous sport, you have certainly stood on the line of self-injury. Self-injury has little to do with being suicidal when indeed it is more rare than suicidality.
The Borderline Scapegoat
Borderline Personality Disorder is an Axis 2 Personality Disorder that is marked by a pervasive pattern of unstable relationships and a tendency toward self-destruction. A key component of the disorder is the fact that when Borderlines feel an emotion, it has a much longer half-life than in non-disordered individuals, and is felt much more deeply. While self-harm has been proven to help regulate emotions (and therefore makes sense for a Borderline to use for coping) another two traits of Borderline are lack of cognitive empathy and manipulation. Many professionals will take the stance that someone with Borderline Personality Disorder uses threats of suicide and self-harm to manipulate loved ones and even the professionals themselves. This is a very serious accusation, and once Borderline Personality Disorder is on the self-injurers chart, they will forever be handled somewhat like an active grenade that happens to lie a lot. This would not be as big of a deal with Borderline Personality Disorder was not lazily over-diagnosed.
A person who is psychologically normal, who shows no signs of diluted empathy or of disordered personality, walks into a psychologists office. A concerned friend talked them into it. After several short tests and a session with the therapist, the psychologist asks why their friend suggested they seek psychological help. The patient rolls up her left sleeve and is suddenly diagnosed with Borderline Personality Disorder.
Unfortunately, this is how many supposed Borderlines end up with their diagnosis. While there is evidence that points to self-injury being inclusive of both men and women equally, Borderline Personality Disorder is primarily diagnosed in women and professionals are very eager to give the diagnosis to any female who self injures. Use self-injury to feel because you are very detached from reality, which indicates a Dissociative Disorder? A professional will label you Borderline. Have no emotion whatsoever and only cut yourself to feel pain? You could be diagnosed Borderline, and if you argue that you do not use self-harm to regulate your emotions since you have none, you will be called a liar because Borderlines are manipulative and lie. Like to beat yourself in the head because bruises are cute? Must be Borderline! While mental health professionals abuse the Borderline Personality Disorder diagnosis, real Borderlines are not being offered the attention they need and many self-injurers are not being given the correct treatment for the real underlying cause of their dysfunctional coping mechanism. The bottom line is that self-injury is not limited to one diagnosis (or any diagnosis at all) and despite the fact that many professionals find it uncomfortable to address, they are helping no one by using Borderline Personality Disorder as a catch-all self-harm scapegoat.
Types of self-injurers
There are many types of self-injurers, but most can benefit more from being identified by their reason for self-injuring than from their overall psychiatric diagnosis. Since mental illness can be present without self-harm being a primary coping skill, the self-harm itself needs to be addressed as the coping mechanism it is rather than a simple side-effect of their psychological makeup.
Detachment-injuced self injury
Disassociation is a disturbance of awareness, identity, and consciousness that appears both within and beyond mental illness and can lead to a decidedly detached way of experiencing the world. Disassociation and derealization are common in anxiety disorders, Schiz-Spectrum disorders (Schizoid, Schizotypal, Schizophrenia, and Schizoaffective) as well as Dissociative Identity Disorder (or Multiple Personality Disorder) or even in the Autistic Spectrum as a way to cope with sensory-overload, and is often described as an out of body experience. It is a surreal way in which the mind copes with excessive stimuli, whether sensory or emotional. When Dissociation becomes habitual, a person can feel so depersonalized that they do not recognize themselves in the mirror immediately, and they may lose the ability to experience emotions as themselves.
In cases of Detached self-injurers, the phrase "I cut myself to to feel real" comes to mind. In prolonged phases of detachment, a person may begin to feel like they are in a movie, a dream, or like they are watching themselves exist in the world. To see blood is tangible, relieving proof that they are indeed alive and not just plastic mannequins going through the motions of daily life. Any kind of physical pain may ground the Detached individual to themselves for a short period of time, relieving the disorientation they experience.
While Detachment-induced self-injurers can indeed feel suicidal due to the prolonged feeling of nothingness and unreality they experience, it is much more common for those with Dissociative disorders to chronically self-harm without suicidal intent. Professionals may attempts to treat Disassociation with cognitive-behavioral therapy and medication, the latter often leaving the Detached self-injurer in a zombie-like, if not depressive state. Unless the Disassociation is chronic in nature due to a chemical imbalance, Detached self-injurers may benefit more from altering their methods of attaching to reality or even altering their self-injury methods. Squeezing ice-cubes can have a great grounding effect to alleviate the Detachment while the individual looks to uncover and treat the underlying reason for their perception-distorting tendencies.
Self-injury to regulate emotion
The majority of mental-illness related self-injury occurs in Regulators who use self-harm as a way to control, alter, and regulate their negative emotions. This is the classification that those with severe Depression, Bi-Polar, Borderline, PTSD, Eating Disordered, and others tend to fall under. Self-harm (especially any kind that leaves a mark) is a very tangible way for a person to take control of and own their inner-chaos. Those with a chemical imbalance that causes a series of negative emotions, those with overly-intense emotions, and those with invasive thoughts or traumatic memories take note of a great relief that comes from their self-destructive coping mechanism, although it is very temporary. And the relief is not imagined.
Pain releases endorphins with a similar effect of morphine that reduces the amount of pain felt when a person is injured or hurt. These endorphins are responsible for the "high" that is felt by Emotion Regulators after a self-injuring act and can create a euphoric, peaceful, or even aroused state. For Regulators who chronically use one form of self-mutilation, tolerance can be built up and often leads to an escalation in the methods used, such as cutting deeper or altering methods entirely. The endorphins are also extremely addictive, which can cause Emotion Regulators to self-harm, even after the underlying cause of their negative emotions has been addressed or even treated and can make Eating Disorders even more difficult to fully treat. Self-harm is indeed chemically addictive!
Self-injury in Regulators often deters the individual from suicide more often than it actually leads to suicide. However, if the issue behind the negative emotions fails to be addressed, the addictive nature of self-injury and the endorphins involved can lead to hospitalization or even accidental suicide as the tolerance to a particular form of self-injury builds. Although the self-injury can be effective in regulating the emotions, running and other physical exercise will cause the same "high" without physical damage but the release is a bit less immediate, and self-injury is often a very accessible "security blanket." Professionals must be very diligent in identifying and treating the intensity and frequency of negative emotions in Emotion Regulators if they wish to stop the increase in self-harm as a coping skill.
Self-harm by "Death-Hasteners"
Perhaps the most common, most overlooked, and most self-dangerous form of self-injurers are the Death Hasteners, or Death Experimenters. A Death Hastener brings about self-injury or premature death via lifestyle and treatment noncompliance decisions as well as habitually living "on the edge." These people are absolutely everywhere and they encompass the actual suicidality of self-harm. These are the people who refuse to alter their diets, people who repeatedly drive under the influence of alcohol or drugs, those who hurt themselves to see how much pain they can take before dying, and those who refuse medical treatment or a physical illness, addiction, or anything else that is life-threatening. Death Hastening is not particularly socially-unacceptable because what they do is rarely direct, but chronic Death Hasteners are often a serious threat to themselves, and sometimes the people around them. They are often the unnoticed suicides, because they go about accomplishing their deaths so indirectly. Death Hasteners often just want to see what will happen if they press further into self-abuse and need to experience the "thrills" can intensify.
Death Hasteners often have no psychiatric diagnosis; many times, they are only called "addicts" or dare-devils, and sometimes their behavior goes entirely unnoticed until they do die. Unlike Detached self-injurers and Emotion Regulators, Death Hasteners are passive-aggressively suicidal for various reasons they often are unaware of themselves. Experimenting with death can be a byproduct of chronic boredom, which is often linked to Depression, or in more extreme cases, Narcissist Personality Disorder and Psychopathy. Death Hastening can be the final product of untreated psychological conditions, inability to abandon destructive coping skills, and an overall lack of hope or motivation to stay alive. Death Hasteners repeatedly run to the edge of life and then step back, daring the process itself to finally kill them.
The emphasis on self-injury "leaving a mark" prevents many Death Hasteners from being recognized and treated or self-harm. While some Death Hasteners may participate in classic self-mutilation, most abandon their health or test it through escalated abuse of substances, of situations, and of their own existence. Addressing the underlying reason that the individual does not value their own life is the only method of ending their behavior, and this often requires much uncomfortable psychological digging, seeing as they have hidden their motives so deeply.
How to deal with self-injurers?
The general consensus of the public and of mental health professionals is that self-harm is bad and should be prevent and ended at all costs. But why? It is seen with the acceptance of the Death Hasteners that perhaps the perceived anti-suicide agenda of the psychological world is actually an uncomfortability with self-harm as a coping mechanism or society's preference not to recognize self-mutilation as a natural part of the human psyche. Piercings and tattoos are commonplace, but they are no different from socially unacceptable forms of self-harm. What a person chooses to do to his or her own body, whether for coping or for art, is a choice that should only be left up to the individual.
Given the underlying emotional anguish that accompanies Detached, Emotion Regulators, and Death Hasteners, it is rather safe to say that treatment options should be available for all self-harmers. Whether a person has lost touch with reality, their emotions are casing them severe pain, or they have lost the concept of their own life-value, each chronic self-injurer should be able to receive psychological assistance on their own terms and without losing their value as a human being. The umbrella-use of one or two psychiatric labels and restraining a self-injurer against his or her will can only deter more self-injurers from seeking help if they do want it. Mass uncomfortability with an act should not act as an excuse for lazy psychology or imprisonment.