Introduction

Definitions

There are several theories as to why people indulge in self-mutilation. One is that it's a control issue. When children are abused, they are in a situation of no control. Their abuser(s) can hurt them any time, and the children are largely (if not completely) powerless to stop it. When the child grows older and is faced with stressful situations, there is often a strong desire/expectation for some sort of pain, since pain is associated with stress in that person's mind. People who have had these associations forced on them frequently cut themselves because this is a pain that satisfies the psychological desire for pain, and is *also* a pain that the victim can stop. At last the person is in control. And while the cutting itself is harmful and can cause shame and guilt later, I can tell you that the control feels good.

Another theory is that people who were abused as children often have been taught (by their abusers, or by others who have denied the child's experiences as being valid) that they are bad people, who should by all rights be punished. Sometimes people like this turn to behaviors like sado-masochism, or bondage-and-dominance in order to get the punishment that they want. Others can't ask others to punish them, so they punish themselves with cutting.

A third theory is that cutting is a manifestation of a desire to become physically unattractive. This is often true of girls who are constantly bombarded with messages (overt and subtle) that they are beautiful and therefore desirable. They naturally reason that if they make themselves unattractive, no one will rape them because they will be undesirable. This chain of reasoning can also lead to compulsive eating behaviors that leave the abuse victim overweight and thus outside of what this society calls attractive.

Of course, every person is different, and there are many less common theories as to why people are cutters. If a cutter doesn't fit any of the above models, that doesn't mean their situation is fundamentally different or less valid. Also, it is common for more than one of these thought patterns acting in concert to produce some very complicated rationales for self-mutilation. These desires can be quite strong, and often a cutter will not know why s/he indulges in such behavior. (1)

Readings
Readings available on this site:

Self-Injury—Transcript from online Concerned Counselling

Nonlethal forms of self-injury are often discussed together with suicide attempts as though they belonged on a continuum of self-harm. Both types of self-injury are common in prisons, which have a predominantly male population; however, most studies of nonlethal self-injury have been done with female subjects. This exploratory study tested the hypothesis that prisoners who injured themselves without intending to die would differ clinically from prisoners who had attempted suicide. Inmates admitted to the prison unit of a public hospital for treatment of self-inflicted wounds or who had a history of previous self-injury were administered a standardized intake protocol by the first author, which included asking about their intent at the time they injured themselves. Patients were classified as self-mutilators or suicide attempters on the basis of intent. Fifteen patients reported that they had attempted to take their own lives, while 16 reported other reasons for harming themselves. Suicide attempt was associated with adult affective disorder 13/15 versus 2/16 mutilators); self-mutilation with a history of childhood hyperactivity (12/16 versus 1/15 suicide attempters) and a mixed dysthymia/anxiety syndrome that began in childhood or early adolescence (9/16). Prison self-mutilators and suicide attempters had very different clinical presentations and histories. The history of childhood hyperactivity in self-mutilators deserves further study in both correctional and noncorrectional populations.

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Alderman, T. (1997). The Scarred Soul: Understanding and Ending Self-Inflicted Violence. Oakland: New Harbinger.

Allardyce, Jason. ( 1997): Fears over child self-mutilation: funds plea as study shows rise in youngsters in care scarring themselves, Edinburgh

Arnold, Lois. ( 1997): Working with people who self-injure: a training pack, Bristol, Bristol Crisis Centre for Women

Babiker, Gloria. ( 1997); Arnold, Lois: The language of injury: comprehending self-mutilation, Leicester, British Psychological Society

Barnes, R. (1985). Women and self-injury. International Journal of Women's Studies, 8(5), 465-475.

Batty, D. (1998). Coping by Cutting. Nursing Standards, 12(29), 25-6.

Bifulco, Antonia Moran, Patricia. ( 1998 ): Wednesday's child: research into women's experience of neglect and abuse in childhood, and adult depression. London Routlege

Brodsky, B. S., Cliotre, M, & Dulit, R. A. (1995). Relationship of dissociation to self-mutilation and childhood abuse in borderline personality disorder. American Journal of Psychiatry, 152, 1788-92.

Clarke, L. & Whittaker, M. (1998). Self-mutilation: culture, contexts, and nursing responses. Journal of Clinical Nursing, 7(2), 129-37.

Coleman, John; Lyon, Juliet; Piper, Roz; Piper, Dorothy.(1995): Teenage suicide and self-harm, Brighton, Trust for the study of adolescence, Tapewise

Crawford, M. J., Turnbull, G., & Wessely, S. (1998). Deliberate self harm assessment by accident and emergency staff -- an intervention study. Journal of Accident and Emergency Medicine, 15(1), 18-22.

Dace, Eleanor et al. (1998 ).The Hurt Yourself Less workbook .London National Self-harm network

Dallam, S. J. (1997). The identification and management of self-mutilating patients in primary care. The Nurse Practitioner, 22(5), 151-158.

DiClemente, R., Ponton, L., & Hartley, D. (1991). Prevalence and correlates of cutting behavior: risk for HIV transmission. Journal of the American Academy of Child and Adolescent Psychiatry, 30 (5), 735-739.

Elliott, Julian Place, Maurice (1998 ). Children in difficulty: a guide to understanding and helping . London Routlege

Favaro, A. & Santonastaso, P. (1998). Impulsive and compulsive self-injurious behavior in bulimia nervosa: prevalence and psychological correlates. Journal of Nervous and Mental Disease, 186(3), 157-65.

Favazza, A. R. (1998). The coming of age of self-mutilation. Journal of Nervous and Mental Disease, 186(5), 259-68.

Favazza, A. R. (1996). Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry, 2nd ed. Baltimore: The Johns Hopkins University Press.

Favazza, A. R. (1989). Why patients mutilate themselves. Hospital and Community Psychiatry.

Favazza, A. R. (1987). Bodies Under Siege: Self-Mutilation in Culture and Psychiatry. Baltimore: The Johns Hopkins University Press.

Favazza, A. R. & Conterio, K. (1988). The plight of chronic self-mutilators. Community Mental Health Journal, 24, 22-30.

Favazza, A. R. & Conterio, K. (1988). Self mutilation and eating disorders. Suicide and Life Threatening Behavior, Fall.

Favazza, A. R. & Rosenthal, R. J. (1993). Diagnostic issues in self-mutilation. Hospital and Community Psychiatry. 44(2), 134-140.

Ferreira de Castro, E., Cunha, M. A., Pimenta, F., & Costa, I. (1998). Parasuicide and mental disorders. Acta Psychiatrica Scandinavica, 97(1), 25-31.

Golden, B. & Walker-O'Keefe, J. (1986). Self-injury: Hidden pain in the workplace. EAP Digest, Nov/Dec, 13, 68-69.

Haines, J. & Williams, C. L. (1997). Coping and problem solving of self-mutilators. Journal of Clinical Psychology, 53(2), 177-186.

Haines, J., Williams, C. L., Brain, K. L., Wilson, G. V. (1995). The psychophysiology of self-mutilation. Journal of Abnormal Psychology, 104(3), 471-489.

Hartgrove Hospital. (1995). Self-Injury Information Packet.

Hawton, K. (1990). Self-cutting: Can it be prevented? In Hawton, K. & Cowen, P. J. (ed) Dilemmas and difficulties in the management of psychiatric patients. Oxford: Oxford University Press.

Hawton, K., Arensman, E., Townsend, E., Bremner, S., Feldman, E., Goldney, R., Gunnell, D., Hazell, P., van Heeringen, K., House, A., Owens, D., Safinosky, I., & Traskman-Bendz, L. (1998). Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. BMJ, 317(7156), 441-7.

Herpertz, S., Sass, H., & Favazza, A. R. (1997). Impulsivity in self-mutilative behavior: psychometric and biological findings. Journal of Psychiatric Research, 31(4), 451-465.

Herpertz, S., Steinmeyer, S. M., Marx, D., Oidtmann, A., & Sass, H. (1995). The significance of aggression and impulsivity for self-mutilative behavior. Pharmacopsychiatry, 28(Suppl 2), 64-72

Hogg, C. & Burke, M. (1998). Many people think self-injury is just a form of attention seeking. Nursing Times, 94(5), 53.

Kahan, J. & Pattison, E. M. (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867-872.

Kahan, J. & Pattison, E. M. (1984). Proposal for a distinctive diagnosis: the Deliberate Self-Harm Syndrome. Suicide and Life Threatening Behavior, 14, 17-35.

Kehrberg, C. (1997). Self-mutilating behavior. Journal of Child and Adolescent Psychiatric Nursing, 10(3), 35-40.

Khouzam, H. R., & Donnelly, N. J. (1997). Remission of self-mutilation in a patient with borderline personality during risperidone therapy. Journal of Nervous and Mental Disease, 185(5), 348-349.

Kreisman, J. & Straus, H. (1989). I Hate You -- Don't Leave Me! New York: Avon Press.

Kubetin, C. & Mallory, J. D. (1992). Beyond the Darkness. Dallas: Word/Rapha.

Loughrey, L., Jackson, J., Molla, P., & Wobbleton, J. (1997). Patient self-mutilation: when nursing becomes a nightmare. Journal of Psychosocial Nursing, 35(4), 30-4.

Luiselli, J. K., Matson, J. L. & Singh, N. N., eds. (1992). Self-injurious behavior: analysis, assessment, and treatment. New York: Springer-Verlag.

MacDermid, Alan Walker, Sophie Sinclair, Keith (1997 ). The suicidal generation. Glasgow .

Malinosky-Rummell, R. & Hansen, D. J. (1993). Long-term consequences of childhood physical abuse. Psychological Bulletin 114(1), 68-79.

Malon, D. W. & Berardi, D. (1987). Hypnosis with self-cutters. American Journal of Psychotherapy, 50(4), 531-541.

Miller, D. (1994). Women Who Hurt Themselves: A Book of Hope and Understanding. New York: BasicBooks.

Morgan, H. (1979). Death Wishes? The Understanding and Management of Deliberate Self-Harm. New York: Wiley.

Moskovitz, R. A. (1996). Lost in the Mirror. Dallas: Taylor.

New, A. S., Trestman, R. L., Mitropoulou, V., Benishay, D. S., Coccaro, E., Silverman, J., & Siever, L. J. (1997). Serotonergic function and self-injurious behavior in personality disorder patients. Psychiatry Research, 69(1), 17-26.

Ricketts, R. W., Goza, A. B., Ellis, C. R., Singh, Y. N., Singh, N. N., & Cooke J. C. 3d. (1993). Fluoxetine treatment of severe self-injury in young adults with mental retardation. Journal of the American Academy of Child and Adolescent Psychiatry, 32(4), 865-869.

Roberts, A. R., ed. (1975). Self-destructive Behavior. Springfield, IL: Thomas.

Simeon, D., Stanley, B., Frances, A., Mann, J. J., Winchel, R., & Stanley, M. (1992). Self-mutilation in personality disorders: psychological and biological correlates. American Journal of Psychiatry, 149(2), 221-226.

Smith, Gerrilyn; Cox, Dee; Saradjian, Jacqui. ( 1998); Women and self-harm, London, Women's press

Smith, Heather (1995). Unhappy children: reasons and remedies . London Free Association Books

Solomon, Y. & Farrand, J. (1996). "Why don't you do it properly?" Young women who self-injure. Journal of Adolescence, 19(2), 111-119.

Spandler, Helen (1996). Who's hurting who? Young people, self-harm, and suicide .Manchester. 42nd Street

Wakefield, H. & Underwager, R. (1994). Return of the Furies: An investigation into recovered memory therapy. Chicago: Open Court Publishing Company.

Walsh, B. W. & Rosen, P. M. (1988). Self-Mutilation: Theory, Research, and Treatment. New York: Guilford Press.

Winchel, R. M. & Stanley, M. (1991). Self-Injurious behavior: A review of the behavior and biology of self-mutilation. American Journal of Psychiatry, 148(3), 306-315.

Witherspoon, T. (1990). Self destruction. Employee Assistance, March, 11-12, 14.

Yaryura-Tobias. J. A., Neziroglu F A., & Kaplan S. (1995). Self-mutilation, anorexia, and dysmenorrhea in obsessive compulsive disorder. International Journal of Eating Disorders, 17(1), 33-38.

Zweig-Frank, H., Paris, J., & Guzder, J. (1994). Psychological risk factors for dissociation and self-mutilation in female patients with borderline personality disorder. Canadian Journal of Psychiatry, 39(5), 259-264.

Articles:

Colthup, Neil; Prison initiative reduces juvenile custody numbers; Community care, 1115, 11-17 Apr 1996, 14
Letter from the Delinquency management co-ordinator for Humberside SSD regarding methods adopted to prevent self-harm in juvenile remand centres.

Downey, Rachel; Young and alone; Community care, 1111, 14-20 Mar 1996, 23; 
The author goes behind the walls of Hull Prison to assess a radical new method of preventing self-harm and suicide among juveniles on remand.

Francis, Joy. ( 1995); Hurting only myself; Community Care, 1053, 2-8 Feb. 10;
Disturbing evidence suggests practitioners are not equipped to meet the growing challenge of adolescent self-harm. Report on a Hackney initiative to address the needs in this small and under-researched area.

Harrison, Diane; Scarred by pain; Community care,1135, 29 Aug-4 Sep 1996,17
A young woman inflicts pain on herself because she feels it is the only part of her life over which she has any control. For that young woman and others like her, self-harm is a way of expressing the unspeakable.

Hartman, David; Cutting among young people in adolescent units; Therapeutic Communities, 17/1, Spring 1996, 5-17; Discussion of deliberate non-suicidal cutting by adolescents in psychiatric units.

Professional Social Work. ( Sept 1996) No.2
A study of admissions at the Warneford Hospital in Oxford has found that teenage girls are more likely to inflict harm on themselves than boys, and that self-harm is rare under the age of 12.

Thompson, Audrey; Miah, Humerah . (1999). Wounds that never heal .Community care, 18-24. pp. 18-20
Most of us recoil from the idea of self-harm and those who inflict it on themselves. Unfortunately, many health and care professionals have the same reaction. Report and description of how it feels to be so desperate that you harm yourself.

Wrate, R M; Suicidal tendencies; Scottish Child, November/December 1995, 8-11;
Analyses the reasons behind the increase in suicide and attempted suicide among children and adolescents. Teenage girls are more likely to harm themselves

Internet

A number of helping resources are listed at these web sites:
NBC25 Special Report: Teenage Girls Who Hurt Themselves

People, Resources

You can read an interesting TRANSCRIPT of an on-line question-and-answer conference.
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Newsletters
The Cutting Edge 
PO Box 20819, Cleveland, Oh 44120 
A self-injury newsletter. 

SHOUT (Self-Harm overcome by understanding and tolerance) 
Bi-monthly newsletter which aims to break down isolation and provide support – includes articles, pen-pals/contacts, letters, poems, cartoons, book reviews, plus details of help lines, groups and resources. The mailing list is confidential and copies will be sent in a plain envelope. 
To subscribe, contact SHOUT, PO Box 654, Bristol BS99 1XH UK
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Internet Support
The Samaritans E-mail: jo@samaritans.org – Anonymous E-mail: samaritans@anon.twwells.com 
The Samaritans are a non-religious charity that have been offering emotional support to the suicidal and despairing for over 40 years by phone, visit and letter. Callers are guaranteed absolute confidentiality and retain the right to make their own decisions including the decision to end their life. The service is now available via E-mail, run from Cheltenham, England, and can be reached from anywhere with Internet access. Trained volunteers read and reply to mail once a day, every day of the year. 
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Organisations
S.A.F.E. Alternatives
7115 W. North Avenue, Suite 319, Oak Park, Illinois 60302
24 hour information line, (800) DONT CUT or (708) 783-0167.
New Book: Bodily Harm:The Breakthough Healing Program, for Self Injurers

S.A.F.E. in Canada
306-241 Simcoe Street, London, Ontario N6B 3L4 
Provides therapy and support for self-injurers in Canada, teen programs, professional education, workshops (including one for family and friends), and literature. Cognitive-behavioral community-based model. 

42nd Street – Suicide/Self-Harm worker 
2nd Floor, Swan Buildings, 20 Swan Street, Manchester M4 5JW UK
0161 862 0170 
42nd Street is a mental health service for Manchester young people aged fifteen to twenty-five who face wide and varied problems including self-harm and suicide. They offer a variety of individual support alongside a range of groups based at the resource and within the local community. They have initiated specific projects including a suicide/self-harm project which itself offers individual and group support to young people. They completed a research project on young people, self-harm and suicide and produced an excellent book based on their findings. 

Bristol Crisis Service for Women 
PO Box 654, Bristol BS99 1XH 
0117 925 1119 
Resources for women who self-harm, including several booklets and information sheets and help line service on Friday and Saturday nights between 9.00 p.m. and 12.30 a.m. They recently published "The Hurt Yourself Less" Workbook, written by people who self-injure, for people who self-injure. 

Input
Please use the INPUT facility to suggest any other material which you feel is useful to this subject area.

1. Jason Black: Cutting and Self-Mutilation, Anonymous Sexual Abuse Recovery, Canada.