Although it is associated with suicide and borderline personality disorder, self-harm is a separate disorder characterized by a distinct list of behaviors.
Identifying self-injury
PHOENIX, Ariz. – With its proposed separation from attempted suicide and mental disorders, self-injury is given recognition as an independent, ritualistic disorder with a list of specific behaviors.
According to the Mayo Clinic, self-injury is the act of deliberately harming one's own body. It's also known as self-mutilation, deliberate self-harm, or self-injurious behavior.
Self-harm is not included as a separate disorder in American Psychiatric Association's (APA) current Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), but instead it is identified as a characteristic of suicide attempts and other disorders.
Conversely, Arizona State University associate professor of social work Dominique Roe-Sepowitz said self-harm often occurs apart from these illnesses and should receive a classification of its own.
"In the current DSM, self-injury goes along with borderline personality disorder and suicide," Roe-Sepowitz said. "However, it is much more prevalent than these."
A proposed revision by APA's DSM-V Development on March 4, 2010, suggested to detach self-harm from its associations. It distinguished it as non-suicidal self-injury (NSSI), eliminating DSM-IV's self-mutilation connotation and incorporating behavior repetition into its definition.
NSSI is defined as the repetitive, intentional, self-infliction of damage to the surface of one's body that is likely to induce bleeding, bruising, or pain. It is often associated with the onset of negative emotions and a determination to alleviate them. It frequently involves preoccupation prior to engagement and an urge to engage in the behavior regardless of fulfilling the action.
The behaviors of NSSINSSI is not limited to cutting. It includes a long list of destructive behaviors, such as carving, puncturing, or burning of the skin, ripping or pulling of the hair, ingesting poisons and self-bruising.
Arizona State University professor of social work Melissa M. Del-Colle, PhD, said NSSI also includes interfering with wound healing, bone breaking and picking of the skin.
Individuals who use NSSI adopt specific systems of carrying out their behaviors and adhere to these systems each time they self-injure, creating a habitual process. This is referred to as ritual or an episode.
Janis Whitlock, director of the Cornell Research Program regarding self-injury, said episodes often occur as a response to a specific trigger. Once triggered, the practitioner feels compelled to carry out the behavior. The next step involves completing the action.
“There’s this compulsion to make external what is internal,” Whitlock said. “They manifest their uncontrollable emotions to get control.”
Oftentimes self-injurers have a distinct place, like the shower or one’s bedroom, and an organized tool kit they use each time they self-injure.
The ritual continues with the healing process.
Tending to the wound allows practitioners to maintain authority. They are not only the inflictors, but also the bearers and the healers. Ushering themselves through the healing process allows them to prolong control.
An individual with NSSI can perform a distinct ritual during an episode, but that doesn’t mean the behavior is limited to one type or to one area of the body.
A study regarding the topography and functions of NSSI in United States adults said out of 439 participants, 67 percent of self-injurers endorsed more than one functional item.
“There’s really no behavior and no place that’s exempt,” Whitlock said. “Especially when you get yourself going in a destructive episode.”
The marks of NSSI
According to an article for the Cornell Research Program of Self Injurious Behavior, more than 16 NSSI behaviors apart from the ones listed have been documented in a college population.
With the extensive list of behaviors and the rituals associated with NSSI, there are several objects used to accompany its process.
Blades, knives, staples, safety pins, poisons, and paper clips are used to inflict pain. Other unique objects used are pencil erasers, towels, ice and salt.
"Practitioners use practically everything," Whitlock said. "If it's capable of being a medium for self-injury, then it's game."
The most common areas affected by NSSI are arms, inner thighs, stomach, hands, ankles and the head.
To detect self-injurious behavior, one should assess the common areas for scar wounds. Other signs are inappropriate seasonal attire, constant use of wristbands, and frequent bandages, the article continued. Showing resistance toward body-exposing activities and portraying increased anxiety are other ways to spot this disorder.
Photo Credits:
Safety pin photo provided by Anders Bornholm.
Erasers photo provided by smlp.co.uk.
Towel photo provided by kirstyhal.
Ice photo provided by Kyle May.
Salt photo provided by Chris Blakeley.
Paper clips photo provided by Jamiesrabbits.
Knife photo provided by Mykl Roventine.