Self-injury itself as a diagnosis
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.
The diagnostic criteria for Repetitive Self-Harm Syndrome include:
preoccupation with physically harming oneself
repeated failure to resist impulses to destroy or alter one's body tissue
increasing tension right before, and a sense of relief after, self-harm
no association between suicidal intent and the act of self-harm
not a response to mental retardation, delusion, hallucination
Miller (1994) suggests that many self-harmers suffer from what
she calls Trauma Reenactment Syndrome.
As described in Women Who Hurt Themselves, TRS sufferers have
four common characteristics:
a sense of being at war with their bodies ("my body, my enemy")
excessive secrecy as a guiding principle of life
inability to self-protect (often seen in a specific kind of
fragmentation of self, and relationships dominated by a struggle
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 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 tandem
with another disorder or alone, there are effective ways of
treating those who harm themselves and helping them find more
productive ways of coping.
Varieties of Self-Harm
Self-injury is separated by Favazza (1986) into three types.
Major self-mutilation (including such things as castration,
amputation of limbs, enucleation of eyes, etc) is fairly rare
and usually associated with psychotic states. Stereotypic
self-injury comprises the sort of rhythmic head-banging, etc,
seen in autistic, mentally retarded, and psychotic people.
The most common forms of self-mutilation include:
Compulsive self-harm
Favazza (1996) further breaks down superficial/moderate self-injury
into three types: compulsive, episodic, and repetitive. Compulsive
self-injury differs in character from the other two types and is
more closely associated with obsessive-compulsive disorder (OCD).
Compulsive self-harm comprises hair-pulling (trichotillomania),
skin picking, and excoriation when it is done to remove perceived
faults or blemishes in the skin. These acts may be part of an OCD
ritual involving obsessional thoughts; the person tries to relieve
tension and prevent some bad thing from happening by engaging in
these self-harm behaviors. Compulsive self-harm has a somewhat
different nature and different roots from the impulsive (episodic
and repetitive types).
Impulsive self-harm
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 and Rosenthal,
1993; Kahan and Pattison, 1984; Miller, 1994; among others)
believe should be classified as a separate Axis I impulse-control
disorder.
Repetitive self-harm is marked by a shift toward ruminating
on self-injury even when not actually doing it and
self-identification as a self-injurer (Favazza, 1996). Episodic
self-harm becomes repetitive when what was formerly a symptom
becomes a disease in itself. It is impulsive in nature, and
often becomes a reflex response to any sort of stress, positive
or negative.
Should self-injurious acts be considered botched or
manipulative suicide attempts?
Favazza (1998) states, quite definitively, that ... self-mutilation
is distinct from suicide. Major reviews have upheld this distinction
. . . A basic understanding is that a person who truly attempts
suicide seeks to end all feelings whereas a person who self-mutilates
seeks to feel better. Although these behaviors are sometimes
referred to as parasuicide most
researchers recognize that the self-injurer generally does
not intend to die as a result of his/her acts. Many professionals
continue to define acts of self-harm as merely and totally
being symptomatic of Borderline Personality Disorder instead
of considering that they may well be disorders in their own
right.
Many of those who injure themselves are strongly aware of the
fine line they walk, but are also resentful of doctors and
mental health professionals who define their incidents of
self-harm as suicide attempts instead of seeing them as
the desperate attempts to release the pain that needs to
be released in order to not end up suicidal.
Self Harm Defeated How and Why I Stopped
Please note: Some of the poems, expressions and/or articles in this section are
very blunt and may be disturbing so use your best judgment or caution when choosing
to read anything below.
Art of Blood-letting - self-mutilation
Self Harm How I started it and ended it
Poems Self Harm By Rayne
as of November 25, 2001
This page was moved to this domain on September 1, 2002 - last updated January 19, 2007 and is © Soul's Self Help
Central 1996-2003. © Borderlinepersonality.ca 2002-2007
By A.J. Mahari © 2005-2007
