Who self-injures?
Psychological characteristics common in self-injurers
The overall picture seems to be of people who:
- strongly dislike/invalidate themselves
- are hypersensitive to rejection
- are chronically angry, usually at themselves
- tend to suppress their anger
- have high levels of aggressive feelings, which they disapprove of
strongly and often suppress or direct inward
- are more impulsive and more lacking in impulse control
- tend to act in accordance with their mood of the moment
- tend not to plan for the future
- are depressed and suicidal/self-destructive
- suffer chronic anxiety
- tend toward irritability
- do not see themselves as skilled at coping
- do not have a flexible repertoire of coping skills
- do not think they have much control over how/whether they cope with life
- tend to be avoidant
- do not see themselves as empowered
People who self-injure tend not to be able to regulate their emotions
well, and there seems to be a biologically-based impulsivity. They
tend to be somewhat aggressive and their mood at the time of the
injurious acts is likely to be a greatly intensified version of a
longstanding underlying mood, according to Herpertz (1995). Similar
findings appear in Simeon et al. (1992); they found that two major
emotional states most commonly present in self-injurers at the time
of injury -- anger and anxiety -- also appeared as longstanding
personality traits. Linehan (1993a) found that most self-injurers
exhibit mood-dependent behavior, acting in accordance with the demands
of their current feeling state rather than considering long-term
desires and goals.
In another study, Herpertz et al. (1995) found, in addition to the
poor affect regulation, impulsivity, and aggression noted earlier,
disordered affect, a great deal of suppressed anger, high levels of
self-directed hostility, and a lack of planning among
self-injurers:
We may surmise that self-mutilators usually disapprove of
aggressive feelings and impulses. If they fail to suppress these, our
findings indicate that they direct them inwardly. . . . This is in
agreement with patients' reports, where they often regard their
self-mutilative acts as ways of relieving intolerable tension
resulting from interpersonal stressors. (p. 70).
And Dulit et al. (1994) found several common characteristics in
self-injuring subjects with borderline personality disorder (as
opposed to non-SI BPD subjects):
- more likely to be in psychotherapy or on medications
- more likely to have additional diagnoses of depression or bulimia
- more acute and chronic suicidality
- more lifetime suicide attempts
- less sexual interest and activity
In a study of bulimics who self-injure (Favaro and Santonastaso,
1998), subjects whose SIB was partially or mostly impulsive had higher
scores on measures of obsession-compulsion, somatization, depression,
anxiety, and hostility.
Simeon et al. (1992) found that the tendency to self-injure increased
as levels of impulsivity, chronic anger, and somatic anxiety
increased. The higher the level of chronic inappropriate anger, the
more severe the degree of self-injury. They also found a combination
of high aggression and poor impulse control. Haines and Williams (1995)
found that people engaging in SIB tended to use problem avoidance as a
coping mechanism and perceived themselves as having less control over
their coping. In addition, they had low self-esteem and low optimism
about life.
Demographics
Conterio and Favazza estimate that 750 per 100,000 population exhibit
self-injurious behavior (more recent estimates are that 1000 per
100,000, or 1%, of Americans self-injure). In their 1986 survey, they
found that 97% of respondents were female, and they compiled a
"portrait" of the typical self-injurer. She is female, in her mid-20s
to early 30s, and has been hurting herself since her teens. She tends
to be middle- or upper-middle-class, intelligent, well-educated, and
from a background of physical and/or sexual abuse or from a home with
at least one alcoholic parent. Eating disorders were often
reported.
Types of self-injurious behavior reported were as follows:
- Cutting: 72 percent
- Burning: 35 percent
- Self-hitting: 30 percent
- Interference w/wound healing: 22 percent
- Hair pulling: 10 percent
- Bone breaking: 8 percent
- Multiple methods: 78 percent (included in above)
On average, respondents admitted to 50 acts of self-mutilation;
two-thirds admitted to having performed an act within the past
month. It's worth noting that 57 percent had taken a drug overdose,
half of those had overdosed at least four times, and a full third of
the complete sample expected to be dead within five years.
Half the sample had been hospitalized for the problem (the median
number of days was 105 and the mean 240). Only 14% said the
hospitalization had helped a lot (44 percent said it helped a little
and 42 percent not at all). Outpatient therapy (75 sessions was the
median, 60 the mean) had been tried by 64 percent of the sample, with
29 percent of those saying it helped a lot, 47 percent a little, and
24 percent not at all. Thirty-eight percent had been to a hospital
emergency room for treatment of self-inflicted injuries (the median
number of visits was 3, the mean 9.5).
Why so many women?
Although the results of an informal net survey and the
composition of an e-mail support mailing list for self-injurers don't
show quite as strong a female bias as Conterio's numbers do (the
survey population turned out to be about 85/15 percent female, and the
list is closer to 67/34 percent), it is clear that women tend to
resort to this behavior more often than men do. Miller (1994) is
undoubtedly onto something with her theories about how women are
socialized to internalize anger and men to externalize it. It is also
possible that because men are socialized to repress emotion, they may
have less trouble keeping things inside when overwhelmed by emotion or
externalizing it in seemingly unrelated violence.
As early as 1985, Barnes recognized that gender role
expectations played a significant role in how self-injurious patients
were treated. Her study showed only two statistically significant
diagnoses among self-harmers who were seen at a general hospital in
Toronto: women were much more likely to receive a diagnosis of
"transient situational disturbance" and men were more likely to be
diagnosed as substance abusers. Overall, about a quarter of both men
and women in this study were diagnosed with personality disorder.
Barnes suggests that men who self-injure get taken more
"seriously" by physicians; only 3.4 percent of the men in the study
were considered to have transient and situational problems, as
compared to 11.8 percent of the women.
