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What is Self-Injury - Part I of a series - Page 5

© Sheri Wallace

Further support for the distinct nature of self-injury comes from a study of psychiatric diagnoses among self-injurers as opposed to attempted suicides (Ferreira de Castro et al., 1998). On Axis I, 14% of self-injurers (SI) were diagnosed with major depression, as opposed to 56% of the suicide-attempters (SA). Alcohol dependence was diagnosed in 16% of the SI group, but in 26% of the SA group. Only 2% of the SI group were considered schizophrenic; 9% of the SA group were. The SI group was more likely to be dysthymic (12% vs 7%) or to be diagnosed with adjustment disorder with depressed mood (24% vs 6%). Of course, the fact of a suicide attempt may have influenced the depression-related diagnoses.

This study also revealed similar disparities in Axis II diagnoses of those whose self-harm was directed toward suicide and those whose was not, although 9% of both groups were considered borderline and 0% of each were considered to have avoidant personality disorder. There were sharp differences among rates in the other personality disorders -- dependent: 13% SI, 7% of SA; schizoid: 2% SI, 5% SA; and histrionic: 22% SI, 4% SA. It seems clear, then, that those who self-injure in order to die and those who do it in order to cope present very different psychiatric profiles.

Informal surveys collected via the net reveal that many of those who injure themselves are strongly aware of the fine line they walk, but are also resentful of doctors and mental health professionals who mistake their incidents of self-harm as suicide attempts instead of seeing them as the desperate attempts to stave off suicide that they often are.

Is self-injury the same thing as Munchausen's or some other factitious disorder?

Again, NO. Little research has been done on whether there is a connection between SI and Munchausen's or similar syndromes, but uneducated medical professionals sometimes conflate the two. In SI, the person is injuring to escape unbearable emotional and physiological tension; in Munchausen's the injuries inflicted are deliberate and calculated to produce specific symptoms that will lead to a medical hospital admission. Although some people who self-injure desire hospitalization, it is almost always to a psychiatric ward and not to a general medical floor. Clients with Munchausen's, on the other hand, shy away from psychiatric care and seek to be admitted on the medical service.

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