Jennifer J. Muehlenkamp, PhD, Assistant Professor of Psychology
University of Wisconsin-Eau Claire
Self-injury is difficult for many to understand as it is human nature to avoid pain and injury at all costs. Yet there is a growing number of people who seem to ignore this inherit self-preservation and intentionally cut, burn, and abrade their skin or engage in purposeful self-battery. These behaviors are known as self-injury, defined as the intentional destruction of body tissue without suicidal intent, for purposes not socially sanctioned.
Age of Onset
Research conducted in Canada, the United States, and select countries throughout Europe are reporting consistent rates of self-injury within populations of adolescents of around 20 to 23 percent. While much of the research suggests that the age of onset for self-injury is typically around 13 or 14 years, many young college students, ages 18 to 19 years have also been found to report engaging in self-injury for the first time.
Is there Gender Gap?
Current research suggests the gender gap among those who self-injure may not be as large as originally believed. It appears that there are gender differences in the methods used for self-injury; females seem to be much more likely to use self-cutting, the prototypical form of self-injury. However, when other methods are considered such as burning and self-battery, some studies find an equal prevalence of self-injury between males and females or find that males to more likely to self-injure.
There are striking differences found in the rates of self-injury across racial/ethnic groups with Caucasians being significantly more likely to report self-injury than non-Caucasians. Few to no differences have been found within non-Caucasian ethnic groups.
People who engage in self-injury also appear to share similar psychological features. These individuals commonly report experiencing intense, frequent, aversive emotions in their daily lives. They appear to be much more likely to suffer from symptoms of depression, anxiety, and post-traumatic stress disorder. Self-injurers also experience significant difficulties in identifying and expressing their emotions, they appear to be highly self-critical and to experience significant levels of self-directed anger or dislike.
Two common myths about self-injury are that self-injurers have a history of childhood abuse and that self-injurers are practicing for a suicide attempt, but the research suggests otherwise. A large review found that the direct relationship between child sexual abuse and self-injury was rather weak. Instead, it appears that these two experiences are correlated because of other shared psychological risk factors. Current studies on the relationship between self-injury and suicide show that while the two behaviors are related to each other, they are distinct in their primary characteristics and motivations. People who engage in chronic, repetitive self-injury do appear to be at greater risk for attempting suicide during their lifetime, but the person's self-injury is separate from suicide.
Understanding the Motivation
Overall, self-injury appears to be motivated by a number of reasons within each individual. Research suggests that the more functions served by the self-injury, the more likely a person is to engage in repetitive self-injury and the more difficult it may be to treat.
People who self-injure repeatedly identify using self-injury as a strategy to alleviate intense, overwhelming negative emotions such as anger, anxiety, or frustration, as well as a way to manage stress. Many report feelings of relief or calm immediately after they self-injure thus providing a strong reinforcement for continuing to use the behavior to cope.
Related to the desire to cope with negative emotions, self-punishment also appears to be a frequent reason for why people self-injure. Motivations often cited for self-injury include things such as "to express anger at myself" and "because I deserved it." This self-punishment motivation is strongly connected to the self-derogation and criticism characteristic of self-injurers.
Although less common than emotional control or punishment reasons, some individuals report engaging in self-injury to communicate to or influence others. People who self-injure often experience difficulties sharing the extent of their distress with others and may feel they need to self-injure in effort to elicit affection or a caring from others. In some cases, self-injury may also provide a way to connect with friends who self-injure.
Is Recovery Possible?
While there has not been extensive research to date on specific treatments for self-injury, research appears to support the effectiveness of a range of psychotherapies originally developed to treat other related disorders. Therapies that focus on understanding the reasons for the self-injury, challenging self-defeating thoughts, teaching effective communication and coping skills appear to have the most success. Overall, there appears to be a great deal of hope that self-injury can be overcome and successfully treated.
Jennifer Muehlenkamp, PhD, is a licensed clinical psychologist and assistant professor at the University of Wisconsin-Eau Claire. Dr. Muehlenkamp completed her degree at Northern Illinois University in 2005, specializing in understanding and prevention suicidal and non-suicidal self-injurious behaviors in youth and young adults. She has published numerous articles and book chapters on self-injury, some of which have helped inform the creation of the non-suicidal self-injury diagnostic category for DSM-V. Dr. Muehlenkamp's research and clinical guidelines for treating self-injury are internationally recognized and she frequently provides educational and clinically oriented workshops on the topic. Dr. Muehlenkamp has also assisted with the creation and evaluation of the Signs of Self-Injury Prevention Program distributed by Screening for Mental Health. You may contact her at: firstname.lastname@example.org
Suggested Additional Reading:
Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27, 226-239.
Klonsky, E.D., & Muehlenkamp, J. J. (2007). Non-suicidal self-injury: A research review for the practitioner. Journal of Clinical Psychology/In Session, 63, 1045-1056.
Muehlenkamp, J. J. (2006). Empirically supported treatments and general therapy guidelines for non-suicidal self-injury. Journal of Mental Health Counseling, 28, 166-185.
Nixon, M.K., & Heath, N. L. (2009). Self-Injury in Youth: The Essential Guide to Assessment and Intervention. New York, NY: Routledge Taylor & Francis Group
Muehlenkamp, J. J., & Kerr, P. K. (2010). Untangling the Self-Harm Web: How Non-suicidal Self-Injury and Suicide Attempts Differ. The Prevention Researcher