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Deliberate self-harm (DSH) or self-injurious behavior (SIB) involves intentional self-poisoning or injury, irrespective of the apparent purpose of the act. (Vela, Harris and Wright, 1983) Self-mutilation is also used interchangeably with self-mutilation, though self-mutilation is one aspect of DSH. 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. There are different ways in which DSH is manifested: cutting, burning, and abusing drugs, alcohol or other substances. This occurs at times of extreme anger, distress and low self-esteem, in order to either create a physical manifestation of the negative feelings which can then be dealt with, or alternatively to punish yourself. Extremely emotional distress can also cause DSH -- this is sometimes linked with hearing voices, particularly as a way of stopping the voices.
DSH is also often called parasuicide, but it is important to distinguish it from suicide. DSH is not an attempt at suicide, though people who harm themselves have a greater propensity for suicide. DSH was not as widely recognized as an independent affliction. DSH "victims" were often overlooked for people who were in accidents or did not have self inflicted wounds.
The issue is becoming more widely recognized. But it's difficult to say whether the numbers of people self-harming are themselves increasing. It is much more common than could be seen from the only available statistics but it is very probable that it there have been high numbers for a long time - it's not something that's suddenly started happening. What's changing is the increasing willingness on the part of service users to talk about the issue and their dissatisfaction with services.
Self-harming is basically identified as a coping mechanism. This mechanism is similar to alcohol abuse or even (using a distant analogy) taking a vacation to deal with the stress of everyday life. This is not to say that there are no extreme cases. Self-harming as a coping or self-management strategy can (and should) be seen as similar to the control that people with anorexia feel over their bodies. Self-harming, similar to anorexia, can become habitual. It can manifest at particular points of a regular cycle of mental distress. Again, like anorexia, it is usually only a visible condition when extreme. Self-harm is often associated with depression, low self-esteem and a poor physical self- image. There is also a strong association with sexual abuse.
People who self-harm find a variety of personal strategies useful to minimize or manage their approach including: Having a better understanding of why and when one self-harm; and identifying those people who are supportive; in addition, it is important to build up a strong support network. People who are prone to DSH can be trained to make a small cut rather than a big one, using clean implements. This may mean cutting earlier rather than later when the distress has built up. People can also be counseled to do something else. Distraction can be important. Another method is to avoid putting oneself in a self-harming situation. A good idea is to remove sharp objects like razor blades in the house. On the other hand, deterrence may also be key. A self-injuring person may want to keep the object they use (may be at a comfortable distance) in order to serve as a reminder not to use it.
People who are in a position to help may not always understand. They might patronize or blame the self-harming person. This is one of the primary reasons why DSH victims do not actively seek help. Anybody who is concerned about somebody who is self-harming should be aware that they couldn't necessarily change their friend or relative's life or coping mechanisms. Instead they should simply try to be caring, respectful and willing to listen (if that is what is wanted) while allowing their friend or relative to retain their dignity. In emergency rooms, people with self-inflicted wounds are often told directly and indirectly, that they are not as deserving of care as someone who has an accidental injury. They are treated badly by the same doctors who would not hesitate to do everything possible to preserve the life of an overweight, sedentary heart-attack patient. Doctors in emergency rooms and urgent-care clinics should be sensitive to the needs of patients who come in to have self-inflicted wounds treated. If the patient is calm, denies suicidal intent, and has a history of self-inflicted violence, the doctor should treat the wounds as they would treat non-self-inflicted injuries. Refusing to give anesthesia for stitches, making disparaging remarks, and treating the patient as an inconvenient nuisance simply further the feelings of invalidation and unworthiness the self-injurer already feels.
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. Knowing that DSH people inflict self-injury for physical or emotional reasons is important. It is not per se, a voluntary act. Therefore it should be distinguished between other forms of body mutilation. These forms are body piercing, tattooing and scalding patterns in the body. These are voluntary acts. They are performed either for sexual gratification or for body decoration. Sometimes these acts make people one of a crowd or it enables others to fit in among their peers. Several cultures view body painting, piercing, tattooing and other forms of body mutilation as rites of passage. Other times, they are parts of cultural or religious rituals. These voluntary acts are not self-injurious behaviors.
As contradictory as it may sound, self-injury actually makes 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, and know that hurting themselves will reduce the emotional discomfort extremely quickly.
One factor common to most people who self-injure is invalidation. For example, in abusive homes, children 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.
Self-injurers come from all walks of life and all economic brackets. People who harm themselves can be male or female; straight, gay, or bisexual; people with a doctoral level of education 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; they are teachers, therapists, medical professionals, lawyers, professors and engineers. Some are on disability. Their ages range from early teens to early 60s.
Self-injury may be called parasuicide but it is a maladaptive coping mechanism, which a way to stay alive. People who inflict physical harm on themselves are often doing it in an attempt to maintain psychological integrity. They release unbearable feelings and pressures through self-harm. This eases their urge toward suicide. And, although some people who self-injure do later attempt suicide, they almost always use a method different from their preferred method of self-harm.
Many new therapeutic approaches have been and are being developed to help self-harmers learn new coping mechanisms and teach them how to start using those techniques instead of self-injury. These approaches reflect a growing belief among mental-health workers that once a client's patterns of self-inflicted violence stabilize, real work can be done on the problems and issues underlying the self-injury. Also, research into medications that stabilize mood, ease depression, and calm anxiety is being done; some of these drugs may help reduce the urge to self-harm.
It is important to note that individuals should not be coerced into stopping self-injury. Any attempts to reduce or control the amount of self-harm a person does should be based on the person's willingness to undertake the difficult work of controlling and/or stopping self-injury. Treatment should not be based on a practitioner's personal feelings about the practice of self-harm. People who self-injure do generally do so because of an internal dynamic, and not in order to anger or irritate others. Their self-injury is a behavioral response to an emotional state, and is usually not done in order to frustrate caretakers.
Although offering mental-health follow-up services is appropriate, psychological evaluations with an eye toward hospitalization should be avoided in the emergency room unless the person is clearly a danger to his/her own life or to others. In places where people know that…[continue]
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