“Why would anyone harm themselves?” – Non Suicidal Self Injury, Self Mutilation or Cutting – Part 1

This week’s guest blog is posted by Naghma Khan, a Clinical & Addictions Psychologist in India, she writes the blog:  http://unwrappingminds.wordpress.com/

The million dollar question you might ask is “Who am I & what am I doing writing this blog?” I am a clinical psychologist with a purpose. When I decided to study psychology, it was also due to the fact that my country has only two respected professions, Medicine or Engineering. In a way, my folks were disappointed by my choice. At that young age I didn’t care much about the opinions of others, I had a fire inside me and I believed I could change the world. I started studying psychology with zeal and had an amazing time learning the science of behavior. I completed my Masters in Clinical Psychology and then attained a certification from Rehabilitation Council of India for practicing Psychology. I finally became a psychologist but thought nobody was taking me seriously. I started with a special school where I was supposed to just “take care” of the clients. The frustrations started building up; I had to do something else. I found a job in a renowned hospital as a consulting psychologist. This was the job where I learned the basics of counseling. I then joined an addiction center and bingo; I found the field I have a passion for.

Tina had a friend who used to show up with different kinds of marks on her hands or feet. This friend used to really cover her body well, which Tina presumed was because of religious reasons or parental pressure. Sometimes, they resembled burn marks, while most of the time they were cut marks. Tina used to think her friend was accident prone but after a few years she started connecting the dots. She understood that there was something ‘not right’ with her friend. Tina started researching and she discovered Non Suicidal Self Injury or ‘NSSI’.

Now, because of the lack of research in this field there are different terms or synonyms floating around for NSSI, cutting, self mutilation, self harm and self inflicted violence. Actually there very little difference between these terms, let’s try to understand the behavior in a better way:

• Self Injury is the act of physically hurting yourself on purpose without the intent of committing suicide. It is a method of coping during an emotionally difficult time that helps some people temporarily feel better because they have a way to physically express and release the tension and the pain they hold inside. In other people hurting themselves produces chemical changes, or endorphins, which are the same chemicals that cause a “runners high” in their bodies that make them, feel happier and more relaxed.

• Emotionally or verbally punishing yourself isn’t self-injury, instead it’s what a lot of people call negative self-talk.

• Unprotected sex, getting a piercing or a tattoo for the pain of the act or starving yourself all are self-destructive but they’re not necessarily self-injury.

• Emotional cutters are people who injure themselves on purpose by making scratches or cuts on their body with a sharp object.

• Self-harm includes self-injury (as described above) and self-poisoning is defined as the intentional, the direct injuring of body tissue most often done without suicidal intentions.

• The most common form of self-harm is skin-cutting but self-harm also covers a wide range of behaviors including, but not limited to, burning, scratching, banging or hitting body parts, interfering with wound healing, hair-pulling and the ingestion of toxic substances or objects.

I thought for this article I would use the term ‘Self Mutilation’ but then I found the correct term is ‘Non-Suicidal Self Injury’ (NSSI). Aaron D. McClelland points out, “The term self-mutilation is an antiquated and misapplied descriptor for NSSI that it speaks to intent, however, the vast majority of those who self-injure their intent is for affect regulation, not to cause disfigurement. Many in the self-injury support community consider the term “self-mutilation” to be derogatory, hurtful and only adds to the mythology of the disorder. Most prefer the term self-injury or self-harm.”

In this post I will use NSSI but the title also includes self mutilation and cutting because there are few people who understand and know the proper term is NSSI. If you are one of those who have not seen or heard about it the first question that will crop up in your mind is going to be: “Why anyone will do so, as in harm oneself?”

This is a story from a recovering NSSI person: “Because of my chronic abuse, I began to self injure myself. It was a way to forget about all the pain that was eating me alive. I first began doing this about the age of 8. I would beat my hands with a hammer or take a hot iron and iron my hands or stomach. That worked for a little while and the burns and bruises were easy to cover up. As time passed and the abuse kept on, ironing and beating myself didn’t give me enough pain anymore, so then I began cutting along with the burning and beating. To see the wounds made the pain inside not seem so real. You may say ‘didn’t it hurt?’ My answer would be no! I didn’t feel anything, because the pain inside was just too intense and I had to numb myself to all pain. I didn’t love anyone, not even myself!”

Studies conducted by Nock and Prinstein (in 2004 and 2005) suggest that there are four primary reasons for engaging in NSSI behaviors:

1) to reduce negative emotions,
2) to feel “something” besides numbness or emptiness,
3) to avoid certain social situations, and
4) to receive social support.

Although instances of all of these reasons for Non Suicidal Self Injury (NSSI) are apparent, a common misconception is that NSSI is primarily a form of social manipulation. In reality, a number of studies have found that the primary reason for NSSI is reason number one: to reduce negative emotion. This seems like such a bizarre reason! How is it that inflicting physical pain or injury could be used to deal with emotional pain? Despite how paradoxical this may seem, people most often report the following reasons for using NSSI: to stop bad feelings, to relieve feelings of loneliness, emptiness, or isolation, to distract from other problems, to decrease feelings of rage, to release tension, or to control racing thoughts.

Candance shares, “I’ve worked with adolescents in the foster care system in Orange County, California, for the past 17 years and most often teens who engage in self-mutilation or cutting are not trying to kill themselves. Instead they find superficial cutting relieves the internal emotional pain they are feeling. It’s like releasing a valve that is built up with pressure, as the emotional pain dissolves they feel better. The children who tend to engage in this behavior are often the ones who won’t talk to others about their pain or problems, but rather let it build up internally, which leads to the cutting. This behavior is also contagious, a child who witnesses a peer engaging in the behavior, may try it as well.”

Written by Naghma Khan, a Clinical & Addictions Psychologist in India, she writes the blog: http://unwrappingminds.wordpress.com/