The DSM groups many disorders under the heading of "Anxiety Disorders." The symptoms and diagnoses of these vary greatly, and sometimes people with them use self-injury as a self-soothing coping mechanism. They've found that it brings fast temporary relief from the incredible tension and arousal that build up as they grow progressively more anxious. For a good selection of writings and links about anxiety, try tAPir (the Anxiety-Panic internet resource).
Not Otherwise Specified I include this diagnosis simply because it is becoming a preferred diagnosis for self-injurers among some clinicians. This makes excellent sense when you consider that the defining criteria of any impulse-control disorder are (APA, 1995):
- Failure to resist an impulse, drive, or temptation to perform some act that is harmful to the person or others. There may or may not be conscious resistance to the impulse. The act may or may not be planned.
- An increasing sense of tension or [physiological or psychological] arousal before committing the act.
- An experience of either pleasure, gratification, or release at the time of committing the act. The act . . . is consistent with the immediate conscious wish of the individual. Immediately following the act there may or may not be genuine regret, self-reproach, or guilt.
This describes the cycle of self-injury for many of the people I've talked to.
Favazza and Rosenthal, in a 1993 article in Hospital and Community Psychiatry, suggest defining self-injury as a disease and not merely a symptom. They created a diagnostic category called Repetitive Self-Harm Syndrome. This would be an Axis I impulse-control syndrome (similar to OCD), not an Axis II personality disorder. Favazza (1996) pursues this idea further in Bodies Under Siege. Given that it often occurs without any apparent disease and sometimes persists after other symptoms of a particular psychological disorder have subsided, it makes sense to finally recognize that self-injury can and does become a disorder in its own right. Alderman (1997) also advocates recognizing self-inflicted violence as a disease rather than a symptom.
Miller (1994) suggests that many self-harmers suffer from what she calls Trauma Reenactment Syndrome. Miller proposes that women who've been traumatized suffer a sort of internal split of consciousness; when they go into a self-harming episode, their conscious and subconscious minds take on three roles: the abuser (the one who harms), the victim, and the non-protecting bystander. Favazza, Alderman, Herman (1992) and Miller suggest that, contrary to popular therapeutic opinion, there is hope for those who self-injure. Whether self-injury occurs in concert with another disorder or alone, there are effective ways of treating those who harm themselves and helping them find more productive ways of coping.
About the author: Deb Martinson has a B.S. in Psychology, has compiled extension information on self-injury and co-authored a book on self-harm entitled "Because I Hurt." Martinson is the creator of the "Secret Shame" self-injury website.
Source: Secret Shame website
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