Perhaps it is inconceivable to you that someone would deliberately cut her wrists, not to take her own life, but specifically to inflict an injury. You find it horrifying to even consider that an individual would burn his own skin with cigarettes, matches or a lighter. Maybe you've seen the scars which run the length of a friend's or loved one's arm, but you have pretended not to notice...or perhaps you understand perfectly. Perhaps you have personal experience with this. From whichever side of experience you view this picture, the truth remains that self-injury is a very real and painful issue. It is a serious problem for an estimated 1% of the population in the United States alone, or 1000 people in every 100,000! ([L=http://www.palace.net/~llama/psych/who.html]Demographics of Who Self-Injures[EL])

What is Self-Injury?

This question is not as easy to answer as it may seem. There is an incredible spectrum of self-injurious behavior and a great many diversified opinions on what should be classified as pathological. However, the author of [L=http://www.palace.net/~llama/psych/injury.html]Secret Shame[EL] (a very well-researched and organized Web site) offers the opinion that the best definition of self-injury comes from Winchel and Stanley - "the commission of deliberate harm to one's own body. The injury is done to oneself, without the aid of another person, and the injury is severe enough for tissue damage (such as scarring) to result. Acts that are committed with conscious suicidal intent or are associated with sexual arousal are excluded."

It should be noted, however, that this definition may be a bit too all-encompassing in some circumstances. [L=http://www.angelfire.com/or/kharreshome/]Kharre[EL], the author of another Internet resource, offers that some behavior does not actually fall into this category, for example, socially accepted practices such as piercing and tattooing.

Finally, [L=http://www.self-injury.net]Gabrielle[EL] offers this definition: "Self-Injury (SI) 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 in their bodies that make them feel happier and more relaxed."

Why do people self-injure?

There are many opinions and theories, but research does seem to indicate that some mechanisms such as an imbalance in serotonin and alterations in physiological arousal may play a role. However, I believe the best answers to this question come from those who have firsthand experience. In [L=http://bipolar.about.com/library/qa/bl-qa-cutting-menu.htm]When the Urge to Hurt Yourself Wins[EL], members of our forum share their personal experiences with the needs to injure themselves. These offer a rather poignant picture of the intense emotional and even physiological drive to find solace, to find a calm if even for a brief moment, or in some cases, to use pain as relief from numbness.



[font color=CC0000Who self-injures?[/font]

By far the majority of people who self-injure are women, usually in their teens to thirties. Typically those who self-injure are intelligent and well-educated. They come from the middle- to upper-middle-class, and all too often they have been raised by an alcoholic parent and have usually been subjected to physical and/or sexual abuse (Secret Shame). It should be noted, however, that some reports now indicate that the percentage of men is quite a bit higher then initially thought (Kharre). Secret Shame has compiled a psychological profile of those who tend toward this type of behavior. Some of the included characteristics are:

[UL]
* strongly dislike/invalidate themselves
* are hypersensitive to rejection
* are chronically angry, usually at themselves
* suppress or direct inward
* tend to act in accordance with their mood of the moment
* are depressed and suicidal/self-destructive
* suffer chronic anxiety
* tend toward irritability
* do not think they have much control over how/whether they cope with life
* do not see themselves as empowered



Why do so many with bipolar disorder self-injure?

Within the ranks of those who have bipolar disorder, this seems to be a common phenomenon. Why? To date, I have not been able to find any specific research dedicated to finding a common causality. However, in my opinion, the duality of self-injury and a diagnosis of bipolar disorder should hardly come as a surprise. Consider again the list of common psychological characteristics outlined above. This could almost read as a list of symptoms for bipolar disorder (see our [L=http://bipolar.about.com/library/weekly/topicsub-flags.htm]Red Flags[EL] series) most especially as it relates to those who struggle with dysphoria - that very difficult emotional state which combines the worst features of both mania and depression.
In addition, self-injury can be associated with many other disorders that frequently co-occur with bipolar disorder, including borderline personality disorder, post-traumatic stress disorder and others.



Regardless of the roots of this problem, regardless of the cause, this is a serious concern for those with this disorder. It is a very painful, very scary, very real situation. For those who fight this overwhelming condition, please take a minute to read the beautiful [L=http://bipolar.about.com/library/qa/bl-qa-cutting-hope.htm]Words of Encouragement[EL] from a member of our forum.