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Eating Disorders: Self Injury

What is self-injury?

It's called many things - self-inflicted violence, self-injury, self-harm, parasuicide, delicate cutting, self-abuse, self-mutilation. This is a posible comorbid disorder with an eating disorder.It's called many things - self-inflicted violence, self-injury, self-harm, parasuicide, delicate cutting, self-abuse, self-mutilation (this last particularly seems to annoy people who self-injure).

Self-injury is also called the "new age anorexia," the practice of self-abuse or mutilating behavior is on the rise.

Broadly speaking self-injury is the act of attempting to alter a mood state by inflicting physical harm serious enough to cause tissue damage to one's body.

Approximately 1% of the United States population uses physical self-injury as a way of dealing with overwhelming feelings or situations, often using it to speak when no words will come.

The forms and severity of self-injury can vary, although the most commonly seen behavior is cutting, burning, and head-banging.

Other forms of self-injurious behavior include:

  • carving
  • scratching
  • branding
  • marking
  • burning/abrasions
  • biting
  • bruising
  • hitting
  • picking, and pulling skin and hair

It's not self-injury if the primary purpose is:

  • sexual gratification
  • body decoration (e.g., body piercing, tattooing)
  • spiritual enlightenment via ritual
  • fitting in or being cool

Why does self-injury make some people feel better?

  • It reduces physiological and psychological tension rapidly.
    • Studies have suggested that when people who self-injure get emotionally overwhelmed, an act of self-harm brings their levels of psychological and physiological tension and arousal back to a bearable baseline level almost immediately. In other words, they feel a strong uncomfortable emotion, don't know how to handle it (indeed, often do not have a name for it), and know that hurting themselves will reduce the emotional discomfort extremely quickly. They may still feel bad (or not), but they don't have that panicky jittery trapped feeling; it's a calm bad feeling.
  • Some people never get a chance to learn how to cope effectively.
    • One factor common to most people who self-injure, whether they were abused or not, is invalidation. They were taught at an early age that their interpretations and feelings about the things around them were bad and wrong. They learned that certain feelings weren't allowed. In abusive homes, they may have been severely punished for expressing certain thoughts and feelings. At the same time, they had no good role models for coping. You can't learn to cope effectively with distress unless you grow up around people who are coping effectively with distress. Although a history of abuse is common about self-injurers, not everyone who self-injures was abused. Sometimes invalidation and lack of role models for coping are enough, especially if the person's brain chemistry has already primed them for choosing this sort of coping.
  • Problems with neurotransmitters may play a role.
    • Just as it's suspected that they way the brain uses serotonin may play a role in depression, so scientists think that problems in the serotonin system may predispose some people to self-injury by making them tend to be more aggressive and impulsive than most people. This tendency toward impulsive aggression, combined with a belief that their feelings are bad or wrong, can lead to the aggression being turned on the self. Of course, once this happens, the person harming himself learns that self-injury reduces his level of distress, and the cycle begins. Some researchers theorize that a desire to release endorphins, the body's natural painkillers, is involved.

What kinds of people self-injure?

Self-injurers come from all walks of life and all economic brackets. People who harm themselves can be male or female; gay, straight, or bisexual; Ph.D.'s or high-school dropouts or high-school students; rich or poor; from any country in the world. Some people who self-injure manage to function effectively in demanding jobs; professors, engineers. Some are on disability. Their ages range from early teens to early 60s.

In fact, the incidence of self-injury is about the same as that of eating disorders, but because it's so highly stigmatized, most people hide their scars, burns, and bruises carefully. They also have excuses ready when someone asks about the scars.

Last Updated: 14 January 2014
Reviewed by Harry Croft, MD

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