In terms of psychiatric diagnosis, self-injury falls under the realm of an impulse control disorder. Although cutting is perhaps the most common form of self-injury, it takes a variety of other forms, including head banging, skin picking, biting, repetitious rubbing or scratching, hitting, or burning with anything from a cigarette lighter to a curling iron. Typically, the injury is caused on the arms or legs, even though other body parts are also targeted.
Certainly, the most commonly posed question is “why?” As with most psychiatric illnesses, the behaviors involved with the disorder are mystifying to those who witness them and often to those who engage in them as well.
For some people, self-harm and eating disorders are a form of punishment and an expression of self-hatred towards their own body. Girls who have a poor body image and suffer from an eating disorder in all likelihood experience feelings of self-hatred which leads to a lack of respect of their body, and in turn, makes self-harm all the more probable.
Although eating disorders and impulse control disorder are completely separate from one another, they often manifest together. The prevalence of self-harm in people with eating disorders is thought to be about 25% and is particularly high among individuals with binge and purge disorder. At The Meadows Ranch, a full 50% of our patients have engaged in self-injury either prior to admission or in the past several years.
Control and routine often consume the world of disordered eating. A girl who engages in self-harm may use this behavior as a way of punishing themselves for not sticking to a strict routine, or as a means to provide relief from the restrictiveness of that routine.
Dr. Kevin Wandler, the medical director of The Meadows Ranch has seen an increase in self-injury over the past 19 years. Dialectical Behavioral Therapy (DBT) and other therapies have been very effective for self-harm. He reports that self-injury usually falls into one of a few categories: Self-Punishment, Diversion/Distraction or Relaxation.
Self-Punishment
The need to punish oneself is usually connected to feelings of great shame and inadequacy. The person feels that she doesn’t do things well enough. The focus is sometimes the eating disorder itself. She feels she hasn’t displayed enough discipline and should be “better” at being bulimic or anorexic. This shame leads to anger at oneself, which leads to a need for self-punishment, often expressed through self-harm.
Diversion/Distraction
If an individual also suffers from Post Traumatic Stress Disorder (PTSD), she might find herself thinking about or remembering things that were highly traumatic. In order to return to the here and now and reground in the present, she may self-injure. The pain will distract her from thoughts or emotions that are deemed even more painful.
Relaxation
Strange as this may seem, self-injury can have a relaxing quality for the person; this is physiological in nature. The brain releases chemicals to combat the pain caused by the self-injury. These chemicals are soothing in nature, diminishing the person’s tension and stress level.
In trying to understand self-injury or to endeavor to deal with a person who engages in the behavior, it is important to remember that a person self-injures because it works. Cutting, burning or biting serves a true purpose, a real function in their life. They usually do not do it for attention, or because it is the “in” thing to do—they do it because it helps them feel better. Often, it provides a release, allows a person to feel calm and less anxious. And because it works, there is an addictive quality to it. It is possible to eliminate the behavior, but it must be replaced with a different, healthier, behavior.
We Can Help
Self-harm can be an extremely complex issue; therefore, professional help is recommended. The Meadows Ranch has treated eating disorders for more than 20 years. We know recovery from an eating disorder is possible. Based on feedback from patients, families and professionals, the vast majority of our patients remain committed to a life of health, balance and purpose.
For additional information about the treatment of eating disorders, please call to speak to a Counselor at 866-390-5100 and we will contact you with the information you need.