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to analyze at length the childhood dynamics and reasons for starting to self-injure.
But both routes might work.
How rare is self-injury?
There are few studies of the frequency and nature of self-injury. One study (BMJ,
Nov., 2002, Volume 325, pp 1207-1211) of 6000 British 15 and 16-year-olds
reported that 7% had deliberately hurt themselves sometime in the past (only 1 in 8
of that 7% had hurt themselves seriously enough to go to a hospital). Another large
study of teenagers reported that more than 10% had cut themselves sometime in
the past. Hurting yourself may start at any period of life (as early as 6 or 8) but
most commonly it starts in the turmoil years of 11 to 14. Wendy Lader, author of
Bodily Harm, estimates that 1% of Americans use self-injury to deal with emotional
distress but she says the rate is much higher among teens, especially females. Why
more females? Supposedly, according to Lader, partly because females tend to react
inward when upset rather than outward—they would rather hurt themselves than
someone else and, besides, openly going into a rage isn’t a very feminine thing to
do.
Among people who have this tendency, how often do they self-injure? A few
people may hurt themselves every day, e.g., pull out hair or pick at a sore, but more
typically, say with cutting, it may be every few days. Quite often there are several
injuries close together and then a break for perhaps weeks or months. Such an
irregular schedule makes it hard to know if you have finally stopped hurting yourself
or not.
Other causal factors involved in self-injury
Personal characteristics and environmental circumstances sometimes set the
stage for self-injury. For instance, people who observe or hear about self-injury very
often think of the self-abuser as mentally disordered. This social perception could
well contribute to the self-injurer having low self-esteem. And low self-esteem
increases the risk of self-injury. The 2002 BMJ study mentioned above found that
young females hurt themselves four times as often as males. For young women, the
risk is increased if they have had family members or friends who self-harmed, been
very depressed or anxious themselves, had low self-esteem, had abused drugs, or
were impulsive. For young males, high risk situations included having suicidal friends
and relatives, using drugs, and having low self-esteem.
We have seen that self-injury usually starts while a person is extremely upset;
then in a fit of anger or self-hatred or depression or a feeling that everything is going
wrong, the person hits the wall or cuts him/herself or puts a cigarette out on her/his
arm…and finds the intense emotional stress is relieved. This experience—actually the
emotional benefits of self-injury--is remembered and may be used again whenever
the stress becomes intense again.
Often, just the open, intense expression of feelings cleared the air and resulted in
lessening of the stress. In some cases, the person clearly felt guilty—felt they had
been bad—and the self-injury took the form of self-punishment. For others, it wasn’t
self-punishment at all, but it just felt good to escape the hurtful feelings or to
discharge their intense feelings. After emoting, some felt they were finally
communicating and being heard; however, it would be a mistake to dismiss the
