| More quotes from the article Here are more notes about self-harm and
abuse from the Healthy Place article -
(with a few of my comments - S. Hein)
--
Etiology (history and causes)
Past trauma/invalidation as an antecedent
Van der Kolk, Perry, and Herman
(1991) conducted a study of patients
who exhibited cutting behavior and suicidality. They
found that exposure to
physical abuse or sexual abuse, physical or emotional
neglect, and chaotic
family conditions during childhood, latency and
adolescence were reliable
predictors of the amount and severity of cutting. The
earlier the abuse
began, the more likely the subjects were to cut and the
more severe their
cutting was. Sexual abuse victims were most likely of all
to cut. They
summarize, ...
neglect [was] the most powerful
predictor of self-destructive behavior. This
implies that although childhood trauma contributes
heavily to the initiation
of self-destructive behavior, lack of secure
attachments maintains it.
Those ... who could not remember feeling special or
loved by anyone as
children were least able to ...control their
self-destructive behavior.
In this same paper, van der Kolk et
al. note that dissociation and frequency
of dissociative experiences appear to be related to the
presence of
self-injurious behavior. Dissociation in adulthood has
also been positively
linked to abuse, neglect, or trauma as a child.
More support for the theory that physical or sexual abuse
or trauma is an
important antecedent to this behavior comes from a 1989
article in the
American Journal of Psychiatry. Greenspan and Samuel
present three
cases in which women who seemed to have no prior
psychopathology
presented as self-cutters following a traumatic rape.
Invalidation independent of abuse
Although sexual and physical abuse and neglect can
seemingly precipitate
self-injurious behavior, the converse does not hold: many
of those who
hurt themselves have suffered no childhood abuse. A 1994
study by
Zweig-Frank et al. showed no relationship at all between
abuse,
dissociation, and self-injury among patients diagnosed
with borderline
personality disorder.
A followup study by Brodsky, et al. (1995) also showed
that abuse as a
child is not a marker for dissociation and self-injury as
an adult. Because of
these and other studies as well as personal observations,
it's become
obvious to me that there is some basic characteristic
present in people
who self-injure that is not present in those who don't,
and that the factor is
something more subtle than abuse as a child. Reading
Linehan's work
provides a good idea of what the factor is.
Linehan (1993a) talks about people who SI having grown up
in "invalidating
environments." While an abusive home certainly
qualifies as invalidating,
so do other, "normal," situations. She says:
An invalidating environment is
one in which communication of private
experiences is met by erratic, inappropriate, or
extreme responses. In
other words, the expression of private experiences is
not validated;
instead it is often punished and/or trivialized. the
experience of painful
emotions [is] disregarded. The individual's
interpretations of her own
behavior, including the experience of the intents and
motivations of the
behavior, are dismissed...
Invalidation has two primary
characteristics. First, it tells the individual that
she is wrong in both her description and her analyses of
her own
experiences, particularly in her views of what is causing
her own emotions,
beliefs, and actions. Second, it attributes her
experiences to socially
unacceptable characteristics or personality traits.
This invalidation can take many forms:
"You're angry but you just
won't admit it."
"You say no but you mean yes, I know."
"You really did do (something you in truth
hadn't). Stop lying."
"You're being hypersensitive."
"You're just lazy." "
"I won't let you manipulate me like that."
"Cheer up. Snap out of it. You can get over
this."
"If you'd just look on the bright side and stop
being a pessimist..."
"You're just not trying hard enough."
"I'll give you something to cry about!"
Everyone experiences invalidations
like these at some time or another, but
for people brought up in invalidating environments, these
messages are
constantly received. Parents may mean well but be too
uncomfortable with
negative emotion to allow their children to express it,
and the result is
unintentional invalidation. Chronic invalidation can lead
to almost
subconscious self-invalidation and self-distrust, and to
the "I never
mattered" feelings van der Kolk et al. describe.
--
Then there was a section on
"Biological Considerations and Neurochemistry"
It has been demonstrated
(Carlson, 1986) that reduced levels of serotonin
lead to increased aggressive behavior in mice. In
this study, serotonin
inhibitors produced increased aggression and
serotonin exciters
decreased aggression in mice. Since serotonin levels
have also been
linked to depression, and depression has been
positively identified as one
of the long-term consequences of childhood physical
abuse
(Malinosky-Rummell and Hansen, 1993), this could
explain why
self-injurious behaviors are seen more frequently
among those abused as
children than among the general population
(Malinosky-Rummel and
Hansen, 1993).
Then some more chemical stuff and
then this paragraph
When these results are
considered in light of work such as that by Stoff et
al. (1987) and Birmaher et al. (1990), which links
reduced numbers of
platelet imipramine binding sites to impulsivity and
aggression, it appears
that the most appropriate classification for
self-injurious behavior might be
as an impulse-control disorder similar to
trichotillomania, kleptomania, or
compulsive gambling.
Comparing cutting to stealing or
gambling and calling it a "disorder" seems
pretty useless, but typical of those in the psychiatry
profession.
Later the article says this, sort
of an chicken and egg question:
It is not clear whether these
abnormalities are caused by the
trauma/abuse/invalidating experiences or whether some
individuals with
these kinds of brain abnormalities have traumatic
life experiences that
prevent their learning effective ways to cope with
distress and that cause
them to feel they have little control over what
happens in their lives and
subsequently resort to self-injury as a way of
coping.
Then the article continues....
--
Knowing when to stop -- pain
doesn't seem to be a factor
Most of those who self-mutilate
can't quite explain it, but they know when to
stop a session. After a certain amount of injury, the
need is somehow
satisfied and the abuser feels peaceful, calm, soothed.
Only 10% of
respondents to Conterio and Favazza's 1986 survey
reported feeling
"great pain"; 23 percent reported moderate pain
and 67% reported feeling
little or no pain at all. Naloxone, a drug that reverses
the effects of opiods
(including endorphins, the body's natural painkillers),
was given to
self-mutilators in one study but did not prove effective
(see Richardson
and Zaleski, 1986).
These findings are intriguing in light of Haines et al.
(1995), a study that
found that reduction of psychophysiological tension may
be the primary
purpose of self-injury. It may be that when a certain
level of physiological
calm is reached, the self-injurer no longer feels an
urgent need to inflict
harm on his/her body. The lack of pain may be due to
dissociation in some
self-injurers, and to the way in which self-injury serves
as a focusing
behavior for others.
Behavioralist explanations
NOTE: most of this applies mainly to stereotypical
self-injury, such as that
seen in retarded and autistic clients.
Much work has been done in behavioral psychology in an
attempt to
explain the etiology of self-injurious behavior. In a
1990 review, Belfiore
and Dattilio examine three possible explanations. They
quote Phillips and
Muzaffer (1961) in describing self-injury as
"measures carried out by an
individual upon him/herself which tend to 'cut off, to
remove, to maim, to
destroy, to render imperfect' some part of the
body."
This study also found that frequency of self-injury was
higher in females
but severity tended to be more extreme in males. Belfiore
and Dattilio also
point out that the terms "self-injury" and
"self-mutilation" are deceiving; the
description given above does not speak to the intent of
the behavior.
Operant Conditioning
It should be noted that explanations involving operant
conditioning are
generally more useful when dealing with stereotypic
self-injury and less
useful with episodic/repetitive behavior.
Two paradigms are put forth by those who wish to explain
self-injury in
terms of operant conditioning. One is that individuals
who self-injure are
positively reinforced by getting attention and thus tend
to repeat the
self-harming acts. Another implication of this theory is
that the sensory
stimulation associated with self-harm could serve as a
positive reinforcer
and thus a stimulus for further self-abuse.
The other posits that individuals self-injure in order to
remove some
aversive stimulus or unpleasant condition (emotional,
physical, whatever).
This negative reinforcement paradigm is supported by
research showing
that intensity of self-injury can be increased by
increasing the "demand" of
a situation. In effect, self-harm is a way to escape
otherwise intolerable
emotional pain.
Sensory Contingencies
One hypothesis long held has been that self-injurers are
attempting to
mediate levels of sensory arousal. Self-injury can
increase sensory
arousal (many respondents to the internet survey said it
made them feel
more real) or decrease it by masking sensory input that
is even more
distressing than the self-harm. This seems related to
what Haines and
Williams (1997) found: self-injury provides a quick and
dramatic release of
physiological tension/arousal. Cataldo and Harris (1982)
concluded that
theories of arousal, though satisfying in their
parsimony, need to take into
consideration biological bases of these factors.
http://www.healthyplace.com/abuse/self-injury/self-injury-childhood-trauma/menu-id-65/
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