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What is Self-Injury - Part I of a series - Page 2

© Sheri Wallace

Repetition refers to whether of not the act is done only once or is repeated frequently over a period of time It is defined simply by whether or not the act is done repeatedly. The following table gives examples of each combination of these factors: Repetitive In Nature? Direct Behaviors Indirect Behaviors High lethality Low lethality High lethality Low lethality yes taking small doses of arsenic over time self-injury: cutting, burning, hitting, etc. type 1 diabetic not injecting insulin smoking, alcoholism no gunshot wound to head major self-mutilation terminal cancer patient refusing chemo walking around downtown alone at 3 a.m.

Definitions of moderate/superficial self-injury

Perhaps the best definition of self-injury is found in Winchel and Stanley (1991), who define it as ...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.

Mosby's Medical, Nursing, and Allied Health Dictionary (1994) contains the following definition:

Self-mutilation, high risk for

A nursing diagnosis . . . defined as a state in which an individual is at high risk to injure but not kill himself or herself, and that produces tissue damage and tension relief. Risk factors include being a member of an at-risk group, inability to cope with increased psychological/physiological tension in a healthy manner, feelings of depression, rejection, self-hatred, separation anxiety, guilt, and depersonalization, command hallucinations, need for sensory stimuli, parental emotional deprivation, and a dysfunctional family. Groups at risk include clients with borderlines personality disorder (especially females 16 to 25 years of age), clients in a psychotic state (frequently males in young adulthood), emotionally disturbed and/or battered children, mentally retarded and autistic children, clients with a history of self-injury, and clients with a history of physical, emotional, or sexual abuse.

Malon and Berardi (1987) summarize the process they believe underlies self-injury:

Investigators have discovered a common pattern in the cutting behavior. The stimulus...appears to be a threat of separation, rejection, or disappointment. A feeling of overwhelming tension and isolation deriving from fear of abandonment, self-hatred, and apprehension about being unable to control one's own aggression seems to take hold. The anxiety increases and culminates in a sense of unreality and emptiness that produces an emotional numbness or depersonalization. The cutting is a primitive means for combating the frightening depersonalization.

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