Self-Mutilation, Self-Injury and Eating Disorders
Self-mutilation and Eating Disorders
A study by Favazza and Conterio (1989) states that episodic and repetitive self-mutilation are frequently seen in conjunction with, or as a replacement for, eating disorders. In a study of 290 self-mutilating women, they found that 22% of the subjects suffered from only bulimia nervosa, 15% from anorexia nervosa and 13% from both disorders, for a total of 50%.
Among these subjects, the average age when the eating disorder first became evident was 16 years. Adolescence is also when superficial self-mutilation is usually first displayed.
One woman in Jennifer Harris's 2000 study was quoted as saying, "When I started to emerge from my anorexia, I needed some other way of dealing with the pain and hurt, so I started cutting instead. It is a way of gaining temporary relief. As the blood flows down the sink, so does the anger and the anguish." Some women use purging as a form of self-mutilation. Their purging is a literal form of self-mutilation from the inside out, as it lacerates organs and causes internal injuries and bleeding. They attack their bodies internally to find the same relief that cutters or burners do in attacking their bodies externally.
The link between superficial self-mutilation and eating disorders can create serious complication in treatment. According to Steven Levenkron, author of Cutting: Understanding and Overcoming Self-Mutilation, self-mutilating behavior is frequently "at the top of the pyramid of psychological problems that an individual may suffer from, the tip of the iceberg." This means that self-mutilation may develop from another problem, frequently anorexia or bulimia. In this case, as the patient in therapy begins to limit or stop their self-mutilating behavior, they will begin to lose weight or resume previously halted use of laxatives or drugs. According to Levenkron, treating such a patient, requires a uniquely strong therapist-patient relationship. Complete trust of the therapist is intrinsic to ensuring that the patient does not resume self-mutilating behaviors when they are again consumed by other destructive behaviors that neither they, nor the therapist can predict. Such psychotherapy is "no less than an undertaking to change one's mental and emotional personality organization."
Self-Injury and Eating Disorders
Many people with eating disorders also engage in the act of self-injury. Just like the eating disorders are used to help the individual cope, the act of injuring oneself is also used to help cope with, block out, and release built up feelings and emotions. Self-injury is probably the most widely misunderstood forms of self harm and there are many myths associated with it, which can make it difficult for people to reach out and ask for help.
Self-injury (self-harm, self-mutilation) can be defined as the attempt to deliberately cause harm to one's own body and the injury is usually severe enough to cause tissue damage. This is not a conscious attempt at suicide, though some people may see it that way.
It has been reported that many people who self-injure have a history of sexual or physical abuse, but that is not always the case. Some may come from broken homes, alcoholic homes, have emotionally absent parents, etc. There are many factors that could cause someone to self-injure as a way to cope.
There are three types of self-injury. The rarest and most extreme form is Major self-mutilation. This form usually results in permanent disfigurement, i.e. castration or limb amputation. Another form is Stereo typic self-mutilation which usually consists of head banging, eyeball pressing and biting. The third and most common form is Superficial self-mutilation which usually involves cutting, burning, hair-pulling, bone breaking, hitting, interference with wound healing and basically any method used to harm oneself.
Most people who self-injure tend to be perfectionists, are unable to handle intense feelings, are unable to express their emotions verbally, have dislike for themselves and their bodies, and can experience severe mood swings. They may turn to self-injury as a way to express their feelings and emotions, or as a way to punish themselves.
You may be wondering why someone would intentionally harm themselves. Self-injury can help someone relieve intense feelings such as anger, sadness, loneliness, shame, guilt and emotional pain. Many people who cut themselves, do this in an attempt to try and release all the emotions they are feeling internally. Others may feel so numb, that seeing their own blood when they cut themselves, helps them to feel alive because they usually feel so dead inside. Some people find that dealing with physical pain is easier than dealing with emotional pain. Self-injury is also used as a way to punish oneself. If they were abused, they may feel ashamed, guilty and blame themselves for the abuse, which in turn causes them to feel the need to punish themselves by inflicting pain to their bodies. Some people have such hatred for themselves and their bodies that they will carve demeaning names on their bodies as a way to remind themselves of how terrible they are. Whatever form of self-injury is used, the person is usually left with a peaceful and calm feeling afterwards. Since those feelings are only temporary, the person will probably continue to self-injure until they deal with the underlying issues and finds healthier ways to cope.
If you feel the urge to injure yourself, below is a list of suggestions that might help you to overcome that urge. Please be advised that not all of these suggestions will be helpful to everyone. What is helpful to one person, may not be helpful to someone else. These suggestions have been provided by individuals who self injured and what they found helpful to them. If you feel that a certain suggestion may in fact cause you to want to self injure even more, do NOT use that suggestion. Find ones that are helpful for you. Again, these are only suggestions and may not be helpful to everyone.
- deep breathing
- relaxation techniques
- call a friend, your therapist or a crisis line
- try not be be alone (visit a friend, go shopping, etc.)
- take a hot bath
- listen to music
- go for a walk
- write in a journal
- wear an elastic around wrist and snap it when you have the urge to harm yourself
- some people find it helpful to draw red lines on themselves with washable markers instead of cutting themselves
- hold ice cubes in your hands - the cold causes pain in your hands, but it is not dangerous or harmful (some people find it relieves the urge to harm themselves for that moment)
- punching a bed or a pillow (when nothing but a physical outlet for your anger and frustration will work).
- scratch draw a picture on a thick piece of wood or use a screw driver and stab at the piece of wood. (can be another physical way to release your emotions without harming yourself.)
- avoid temptation (i.e. avoiding the area in CVS where the razor blades are kept, etc.)
- try to find your own creative ways as outlets for emotions.
- learn to confront others/making your own feelings known instead of keeping them inside
- go outside and scream and yell
- take up a sport (a form of exercise can help you release tension, etc.)
- work with paint, clay, play-doo, etc. (the person who suggested this mentioned that they would make a big sculpture and do whatever they wanted to it. They said it was helpful to calm the urge to self-injure, plus it gave them some idea of what might be underlying the pain.
- draw a picture of what or who is making you angry
- instead of harming yourself, try massaging the area you want to harm with massage oils or creams, reminding yourself that you are special and you deserve to treat yourself and your body with love and respect
- go to church or your place of worship
- wear a pipe cleaner or something that will fit on the places that you injure. One person did this as a way to remind herself that she could call someone instead of hurting herself and that she had other ways to cope.
- break the object that you use to self-injure as a way to show that you have control over it.
- write a letter to the person(s) that have hurt you and express how they made you feel. Theses letters do not have to be in perfect form and you do not have to please anyone but yourself. You do not have to give these letters to the people, but it is a great way to release the feelings that you are carrying within. After you write the letters, you can decide then what to do with them. Some people find destroying the letters help (i.e. tear them up, throw them in a lake, etc.)
- do some household chores (i.e. cleaning)
- do some cooking
- try some sewing, cross stitch, etc.
- recite a poem, prayer or anything else familiar the comforts you multiple times
- write down all your positive points and why you do not deserve to be hurt
- write in your journal why you want to hurt yourself and if you have hurt yourself, write down what caused it to happen so in the future you can prevent it from happenings - or find out what your triggers were
- Play some kind of musical instrument. Even if you don't really know how to play, picking out tunes is a way to concentrate and help get rid of the urge to harm yourself.
- allow yourself to cry. Getting the tears out can make you feel better. It allows the inside to release, as opposed to self abuse. Picture your "ickies" pouring out as you cry.
- Take a shower
- write down a word best associated with what you are feeling (i.e. horrible, sad, lonely, angry) and continue to write it down, over and over. Sometimes when you do that, the words looks silly etc., and it puts humor or a smile in your life.
- sing a song on what you are feeling. It's another way to get it outside. Shout if you are made, etc. Let the words just come to you.
- Scribble on paper. Clutch the pen in your fist. It's a way to diffuse it on to paper. (Get a few sheets so they don't tear.)
- Take item you are self injuring with and use it against something else. For example, if you are using a razor blade, rip it across a towel. Sometimes seeing what "can" be done to an object can make a person think twice about using it on themselves. Can also give the feeling of "doing it"...the tangible aspect.
- Make a list of reasons why you are going to stop cutting. Every time you get the urge, read the list to remind yourself why you shouldn't. Also remember to put on that list that you do not deserve to hurt yourself. You are important and special and you do not deserve to be hurt.
If you have any suggestions that have helped you in the past and feel might be helpful to someone else, please email firstname.lastname@example.org and we will add it to the list.
It is very difficult for people to admit to someone that they harm themselves because there is usually so much shame and guilt that goes along with it. It's important to try and remind yourself that there is no shame in what you are doing and that it's okay to reach out and ask for help. In order to help yourself overcome this, you need to want to stop the behavior and you need to find a therapist that you like and trust to help you deal with the underlying issues causing you to do this to yourself. Sometimes treatment may also involve the use of medications such as Xanax and Klonopin. Hypnosis and relaxation techniques can also be helpful, and in extreme cases, hospitalization might be required for a short period of time. If there are support groups in your area, you may want to think about joining them for extra support.
Many people who self-injure keep it a secret because they feel like they are crazy, insane and evil. They fear if they tell anyone, they might be locked away forever. The truth is, people who intentionally harm themselves are in fact very normal and sane people, who are in a lot of emotional pain. They self-injure as a way to cope, because they were probably never taught how to deal with intense feelings and emotions in healthy ways. Unfortunately, when people hear about this form of self-harm, they do tend to place labels on these people as being psychotic and crazy, which is why so many people do not come forward and ask for help. Until society dispels all the myths surrounding self-injury and start to educate themselves on this subject, sufferers will continue to keep quiet and this form of abuse will continue to be a secret for a long time to come.
Taken from the Mirror-Mirror Eating Disorder Web Site
Self-Injury: Types, Causes and Treatment
Self-injury (SI) – also known as self-harm or self-mutilation – is defined as any intentional injury to one's own body. It usually either leaves marks or causes tissue damage. It is hard for most people to understand why someone would want to cut or burn himself/herself). The mere idea of intentionally inflicting wounds to oneself makes people cringe. Yet there are growing numbers of young people who do intentionally hurt themselves. Understanding the phenomenon is the first step in changing it.
There is no simple portrait of a person who intentionally injures him/herself. This behavior is not limited by gender, race, education, age, sexual orientation, socio-economics, or religion. However, there are some commonly seen factors:
- Self-injury more commonly occurs in adolescent females.
- Many self-injurers have a history of physical, emotional or sexual abuse.
- Many self-injurers have co-existing problems of substance abuse, obsessive-compulsive disorder (or compulsive alone), or eating disorders.
- Self-injuring individuals were often raised in families that discouraged expression of anger, and tend to lack skills to express their emotions.
- Self-injurers often lack a good social support network.
The most common ways that people self-injure are:
- burning (or "branding" with hot objects)
- picking at skin or re-opening wounds
- hair-pulling (trichotillomania)
- hitting (with hammer or other object)
- head-banging (more often seen in autistic, severely retarded or psychotic people)
- multiple piercing or multiple tattooing
Throughout history, various cultures have intentionally created marks on the body for cultural or religious purposes. Some adolescents, especially if they are with a group engaging in such practices, may see this as a ritual or rite of passage into the group. However, beyond a first experiment in such behavior, continued bodily harm is self-abusive. Most self-injuring adolescents act alone, not in groups, and hide their behavior. There are also some more extreme types of self-mutilation, such as castration or amputation, which are rare and are associated with psychosis.
A person who becomes a habitual self-injurer usually follows a common progression:
- the first incident may occur by accident, or after seeing or hearing of others who engage in self-injury
- the person has strong feelings such as anger, fear, anxiety, or dread before an injuring event
- these feelings build, and the person has no way to express or address them directly
- cutting or other self-injury provides a sense of relief, a release of the mounting tension
- a feeling of guilt and shame usually follows the event
- the person hides the tools used to injure, and covers up the evidence, often by wearing long sleeves
- the next time a similar strong feeling arises, the person has been "conditioned" to seek relief in the same way
- the feelings of shame paradoxically lead to continued self-injurious behavior
- the person feels compelled to repeat self-harm, which is likely to increase in frequency and degree
Even though there is the possibility that a self-inflicted injury may result in life-threatening damage, self injury is not suicidal behavior. Although the person may not recognize the connection, SI usually occurs when facing what seems like overwhelming or distressing feelings. The reasons self-injurers give for this behavior vary:
- self-injury temporarily relieves intense feelings, pressure or anxiety
- self-injury provides a sense of being real, being alive – of feeling something
- injuring oneself is a way to externalize emotional internal pain – to feel pain on the outside instead of the inside
- self-injury is a way to control and manage pain – unlike the pain experienced through physical or sexual abuse
- self-injury is a way to break emotional numbness (the self-anesthesia that allows someone to cut without feeling pain)
- self-abuse is self-soothing behavior for someone who does not have other means to calm intense emotions
- self-loathing – some self-injurers are punishing themselves for having strong feelings (which they were usually not allowed to express as children), or for a sense that somehow they are bad and undeserving (an outgrowth of abuse and a belief that it was deserved)
- self-injury followed by tending to wounds is a way to express self-care, to be self-nurturing, for someone who never learned how to do that in a more direct way
- harming oneself can be a way to draw attention to the need for help, to ask for assistance in an indirect way
- sometimes self-injury is an attempt to affect others – to manipulate them, make them feel guilty or bad, make them care, or make them go away
Self-injury is not suicidal behavior. In fact, it may be a way to reduce the tension that, left unattended, could result in an actual suicide attempt. Self-injury is the best way the individual knows to self-sooth. It may represent the best attempt the person has at creating the least damage. However, self-injury is highly linked to poor sense of self-worth, and over time, that depressed feeling can evolve into suicidal attempts. And sometimes self-harm may accidentally go farther than intended, and a life-threatening injury may result.
It is very hard to realize that someone you care about is physically harming herself or himself. Your concern may come out in frustration and even comments that can drive the person farther away. Some things that might be helpful are:
- understand that self-harming behavior is an attempt to maintain a certain amount of control, and that it is a way of self-soothing
- let her or him know that you care and that you will listen
- encourage expression of emotions, including anger
- spend time doing enjoyable activities together
- offer to help find a therapist or support group
- do not tell the person to stop the behavior or make judgmental comments – people who feel worthless and powerless are even more likely to self-injure
- if you are the parent of a self-injuring child, prepare yourself to address your family's difficulties with expression of feelings, as this is a common factor in self-injury – this is not about blame, but about a learning process that will help the entire family
Self-injury is a behavior that becomes compulsive and addictive. Like any other addiction, even though other people think the person should stop, most addicts have a hard time just saying no to their behavior – even while realizing it is unhealthy.
There are several things to do to help yourself:
- acknowledge that this IS a problem, that you are hurting on the inside, and that you need professional assistance to stop injuring yourself.
- realize that this is not about being bad or stupid – this is about recognizing that a behavior that somehow was helping you handle your feelings has become as big a problem as the one it was trying to solve in the first place.
- find one person you trust – maybe a friend, teacher, minister, counselor, or relative – and say that you need to talk about something serious that is bothering you.
- get help in identifying what "triggers" your self-harming behaviors and ask for help in developing ways to either avoid or address those triggers
- recognize that self-injury is an attempt to self-sooth, and that you need to develop other, better ways to calm and sooth yourself
- try some substitute activities when you feel like hurting yourself – there are some examples here, and many more that can be found online (links are provided below):
- if cutting is a way to deal with anger that you cannot express openly, try taking those feelings out on something else – running, dancing fast, screaming, punching a pillow, throwing something, ripping something apart
- if cutting is a way to feel something when you feel numb inside, try holding ice or a package of frozen food, taking a very hot or very cold shower, chewing something with a very strong taste (like chili peppers, raw ginger root, or a grapefruit peel), or snapping a rubber band hard on your wrist
- if cutting is a way to calm yourself, try taking a bubble bath, doing deep breathing, writing in a journal, drawing, or doing some yoga
- if cutting involves your having to see blood, try drawing a red ink line where you would usually cut yourself, in combination with other suggestions above
One danger connected with self-injury is that it tends to become an addictive behavior, a habit that is difficult to break even when the individual wants to stop. As with other addictions, qualified professional help us almost always necessary. It is important to find a therapist who understands this behavior and is not upset or repulsed by it. Some of the online resources below offer links for referrals to therapists experienced with self-injury.
- Cognitive-behavioral therapy may be used to help the person learn to recognize and address triggering feelings in healthier ways.
- Because a history of abuse or incest may be at the core of an individual's self-injuring behavior, post-traumatic stress therapies may be helpful.
- Interpersonal therapy is also the main treatment for the underlying issues of low self-worth that allowed this behavior to develop.
- Hypnosis or other self-relaxation techniques are helpful in reducing the stress and tension that often precede injuring incidents.
- Group therapy may be helpful in decreasing the shame associated with self-harm, and in supporting healthy expression of emotions.
- Family therapy may be useful, both in addressing any history of family stress related to the behavior, and also in helping family members learn to communicate more directly and non-judgmentally with each other.
- In some situations, an antidepressant or anti-anxiety medication may be used to reduce the initial impulsive response to stress, while other coping strategies are developed.
- A recent treatment involves an in-patient hospitalization program, with a multi-disciplinary team approach.
More Information on the Internet
Self-Abuse Finally Ends (SAFE) Alternatives
Self-Injury: You Are NOT the Only One
Kids Health - Cutting