Term Paper: Deliberate Self-Harm (Dsh) or Self-Injurious

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[. . .] Types of Self-harm

Favazza (Favazza, 1989; Pies and Popli, 1995)

Favazza (Favazza, 1996) further breaks down superficial/moderate self-injury into three types: compulsive, episodic, and repetitive. Compulsive self-injury comprises hair-pulling (trichotillomania), skin picking, and excoriation when it is done to remove perceived faults or blemishes in the skin. Both episodic and repetitive self-harm are impulsive acts, and the difference between them seems to be a matter of degree. Episodic self-harm is self-injurious behavior engaged in every so often by people who don't think about it otherwise and don't see themselves as "self-injurers." It generally is a symptom of some other psychological disorder.

What begins as episodic self-harm can escalate into repetitive self-harm, which many practitioners (Favazza, 1996).

Additionally, self-injurious behavior may be divided into two dimensions: nondissociative and dissociative. Self-mutilative behavior often stems from events that occur in the first six years of a child's development. Nondissociative self-mutilators usually experience a childhood in which they are required to provide nurturance and support for parents or caretakers. If a child experiences this reversal of dependence during formative years, that child perceives that she can only feel anger toward self, but never toward others. Self-mutilation will later be used as a means to express anger. Dissociative self-mutilation occurs when a child feels a lack of warmth or caring, or cruelty by parents or caretakers. A child in this situation feels disconnected in his/her relationships with parents and significant others. Disconnection leads to a sense of "mental disintegration." (Levenkron, 1998)

Physiological Manifestation

Favazza and Rosenthal (Vogel, Krajci and Anderson, "Adults with Pediatric-Onset Spinal Cord Injury: Part 2: Musculoskeletal and Neurological Complications," 2002; Vogel, Krajci and Anderson, "Adults with Pediatric-Onset Spinal Cord Injury: Part 1: Prevalence of Medical Complications," 2002)

Self-biting with multiple finger amputations was reported in two adult males with complete C4 (Arons et al., 1984; Altman, Haavik and Higgins, 1983)

The majority of literature on self-injurious behavior relates to individuals with developmental delays. (1) In particular, self-injurious behavior has been well described in children with Lesch-Nyhan syndrome (A sex-linked recessive inherited disease in humans that results from mutation in the gene for the purine salvage enzyme hypoxanthine phosphoribosyltransferase (HGPRT), located on the X chromosome). (Nyhan et al., 1980; Goldstein et al., 1985)

There are many possible genetic causes of SIB. When looking at brain functions and behavior, genetic origins are certainly important. The role of the environment cannot be overlooked either. The circumstances of life ultimately affect the expression of any chemical imbalance in the brain. Traumatic life events, eating, stress, even learning are all factors that can bring out - or control - a genetic condition like SIB. Many forms of mental retardation are genetic. In certain kinds, SIB is so predictable that it is considered part of the disorder. In fact, scientists learn about SIB just from studying the origins of mental retardation. Mental retardation and SIB are linked in these genetic conditions: Lesch-Nyhan, Prader-Willi (A condition in children with floppiness (hypotonia), obesity, small hands and feet and mental retardation. It is due to loss of part or all of chromosome 15), de Lange (A congenital anomaly characterized by impaired development, mental retardation, characteristic facies with snyophrys and hairline well down on forehead, depressed bridge of nose with uptilted tip of nose, small head with low-set ears, and flat spade like hands with simian crease and short tapering fingers), and Fragile X (Lubs, 1969) (X chromosome with a fragile site associated with a frequent form of mental retardation. The fragile X is also called FRAXA (the second A signifies it was the first fragile site found on the X chromosome). It is due a trinucleotide repeat (a recurring motif of 3 bases) in the DNA at that spot.)

Psychological Manifestation

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. 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.

The overall picture seems to be of people who: strongly dislike/invalidate themselves, are hypersensitive to rejection; they are chronically angry, usually at themselves tend to suppress their anger have high levels of aggressive feelings, which they disapprove of strongly and often suppress or direct inward are more impulsive and more lacking in impulse control tend to act in accordance with their mood of the moment tend not to plan for the future are depressed and suicidal/self-destructive suffer chronic anxiety tend toward irritability do not see themselves as skilled at coping do not have a flexible repertoire of coping skills do not think they have much control over how/whether they cope with life tend to be avoidant do not see themselves as empowered. People who self-injure tend not to be able to regulate their emotions well, and there seems to be a biologically-based impulsivity. They tend to be somewhat aggressive and their mood at the time of the injurious acts is likely to be a greatly intensified version of a longstanding underlying mood, according to Herpertz (Linehan, 1993) found that most self-injurers exhibit mood-dependent behavior, acting in accordance with the demands of their current feeling state rather than considering long-term desires and goals.

Dulit (Haines et al., 1995) found that people engaging in SIB tended to use problem avoidance as a coping mechanism and perceived themselves as having less control over their coping.


Self-mutilating behavior has been studied in a variety of racial, chronological, ethnic, gender, and socioeconomic populations. DSH transcends most of these demographics. If a specific group were to be picked to have the largest number of cases, it would include middle to upper class adolescent girls or young women. Conterio and Favazza (Favazza and Conterio, 1988) estimated that 750 per 100,000 population exhibit self-injurious behavior. They found that 97% of respondents were female. Across the United Kingdom, the best estimate (from emergency room data) is 1 in 130 people - 446,000 or nearly half a million.

People who participate in self-injurious behavior are usually likeable, intelligent, and functional. At times of high stress, these individuals often report an inability to think, the presence of inexpressible rage, and a sense of powerlessness. An additional characteristic identified by researchers and therapists is the inability to verbally express feelings.

Suyemoto and MacDonald (American Psychiatric Association. And American Psychiatric Association. Task Force on DSM-IV., 2000).

Miller (Miller, 1994) suggests that many self-harmers suffer from Trauma Reenactment Syndrome. TRS sufferers have common characteristics: (1) They feel a sense of being at war with their bodies; (2) excessive secrecy as a guiding principle of life; (3) inability to self-protect for control. 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 the roles of the abuser, the victim and the bystander.

In patients with borderline personality disorder, self-mutilation typically begins in adolescence and may persist for decades (Coid, Allolio and Rees, 1983).

Psychiatric inpatients with personality disorders and schizophrenia seem to be particularly susceptible to parasuicide behavior as a contagion -- emulating the behavior of others. (B. Ross and McKay, 1976) reported that some self-mutilating acts in a training school for delinquent girls occurred in a context of an initiation rite. Rosen and Walsh came to the conclusion that contagious self-mutilation may be viewed as a concrete display of affinity between two people. Adolescents appeared to use self-mutilation to communicate feelings and to ensure a tight bond within a relationship.

Methods of Alleviating Self-Injurious Behavior

The primary step in alleviating the problems associated with self-injurious behavior is to avoid pre-cognitive notions and misconceptions (discussed in the next section). Two distinct approaches can be followed in the treatment of DHS:


When self-injurious behavior connects to untreated depression or anxiety, medication can be extremely useful. Anti-depressants can dramatically reduce the negative feelings and cognitions associated with the cycle of self-harm. Anxiolytics prevent the escalation of panic and generalized anxiety, which decreases the need for dissociation and self-injury. Providing a pharmacological safety net also helps to process painful trauma memories without becoming flooded or overwhelmed.

Medications such as carbamazepine and gabapentin have been particularly useful. These had reduced DSH symptoms significantly. In several cases, especially for those children and adolescents whose DSH behavior came from spinal cord injuries, carbamazepine has been particularly useful. Significant relapses occurred after the medication was stopped. This has been shown to be especially effective in treating children and adolescents. When the carbamazepine treatment was resumed, the DSH… [END OF PREVIEW]

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