Self-Injury Is Not Necessarily 'Attention Seeking'

Vijai P. Sharma, Ph.D

A child trapped in a bad situation may continue bearing the pain in silence for years. One day that child discovers another way of easing that pain. Can you imagine that someone might seek relief by inflicting more pain upon one's own self? It's rare but it happens.

The pain you inflict on yourself, even when intense, may give you a sense of self-control over a situation in which you had been feeling helpless. Once you discover an "outlet," however unhealthy it may be, you tend to use it. You continue using it even when the situation no longer exists and in spit of you having greater resources and means at your command.

Someone once shared her inability to quit her old ways of easing pain in these words, "I started cutting myself in 6th grade. I used a razor blade. My mother was abusive and raised me as a single mother. She married my stepfather who was violent and a molester. I was and outcast at school. Now I am reaching forty. I have kids of my own. I am married to a really sweet guy. But, today I want to cut myself. Things are just pilling up inside but I can't cut--my kids are home. When will it stop?"

Some behaviors indeed are attention seeking but deliberately injuring oneself by cutting, burning or using some other means of self-mutilation is not one of them. One who resorts to an act of self-injury is basically trying to relieve oneself of unbearable pain and tension.

Deliberate and conscious acts of injury to one's own body can assume any of the following forms: cutting; burning; violent hair pulling; bone breaking; hitting or bruising self by fist or an object; head banging (excluding the ones associated with brain damage); wound poking and digging; excessive body piercing or tattooing.

For convenience of expression, we will refer to such behaviors as "self-mutilation," acknowledging that the acts of mutilation may greatly vary in the intensity and frequency.

Some people view the habit of excessive and severe skin picking as a form of self-mutilation. Sometimes, it may be component of obsessive-compulsive disorder.

Unintentional and repetitive acts of face slapping, hitting or head banging carried out publicly or privately are often a feature of pervasive developmental disorder and likely to manifest in early childhood.

Self-mutilation is not an expression of suicidal intention unless the individual specifically expresses suicidal thoughts or feelings. More common reasons expressed by self-mutilators are as follow:
Reducing numbness as numbness became unbearable
Creating numbness because physical sensations or feelings became extremely intense
Wanting to put a stop to the turmoil and confusion resulting from tempestuous emotions
Punishing self because of self-hate and contempt towards one's own self
Communicating one's needs or a cry for help
Reaching the point when the stress and pressure becomes unbearable

Some self-mutilators totally dissociate themselves from their body and don't really know what they were doing during those moments of self-mutilation. A rare minority of people ritualistically perpetrate acts of self-mutilation, which may be part of their cult tradition.

A comprehensive evaluation should consider potential causes and the contributory circumstances that lead to acts of self-mutilation. Is there a history of abuse or neglect? Is the self-injurer currently in an unbearable and inescapable situation? What was happening that day or immediately prior to the act of self-injury?

Sometimes chronic and untreated psychiatric disorders such as anxiety, depression, bipolar disorder or a personality disorder may instigate self-mutilation especially when emotions overwhelm and create a "deafening noise" in one's head. Continuing social isolation and alienation from peers compounded by low self-esteem, self-criticism, anger and hate towards self and others may also trigger self-mutilation behaviors.

Self-injury is a coping mechanism. Often, when the stress becomes unbearable or the emotional pain of betrayal, neglect, abuse or abandonment becomes intensely painful, than self-inflicted physical pain relieves tension and brings peace like the peace after a storm. After all, it's simple and uncomplicated physical pain. It is less painful because there is no outside perpetrator and the action is under your control.

As stated in the beginning, self-mutilation could as well be an effort to gain a symbolic control over a situation that feels out of control or a way to counteract the feelings of emptiness, numbness or boredom.

How can self-injurers heal? In order to heal, they need a highly supportive environment wherein significant others respect them and acknowledge and validate their feelings. For their part, they need to learn skills to communicate their feelings, manage stress effectively, tolerate tension and find constructive ways to express their emotions.

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Copyright 2005, Mind Publications 
Posted November 2005