Why do people deliberately injure themselves?

Drowning in the dark blood of would-be brothers who, beyond the pressing of fingers, those for whom the slice is only the beginning, and a different kind of light comes in, begs recognition and peace of mind. -- Judybats

This may be the aspect of self-harm that is most puzzling to those who do not do it. Why would anyone choose to inflict physical damage on him or herself? There is evidence that self-injurers, when faced with strong emotion or overwhelming situations, choose to harm themselves because it brings them a rapid release from tension and anxiety. These situations cause an increase in physiological arousal, and self-injury quickly drops that level of arousal close to baseline. The self-injurer may feel release,but even if s/he feels guilty or angry afterward, it won't be an oppressive, pushing, demanding tension-filled feeling like it was before.

More insights into the reasons behind self-injury can be gained from two valuable sources: objective and subjective.

Subjective: What self-injurers say SI does for them

Miller (1994) and Favazza (1986, 1996). among others, discuss several possible motivations:

  • Escape from emptiness, depression, and feelings of unreality.
  • In order to ease tension.
  • Relief: when intense feelings build, self-injurers are overwhelmed and unable to cope. By causing pain, they reduce the level of emotional and physiological arousal to a bearable one.
  • Expression of emotional pain
  • Escaping numbness: many of those who self-injure say they do it in order to feel something, to know that they're still alive.
  • Obtaining a feeling of euphoria
  • Continuing abusive patterns: self-injurers tend to have been abused as children. Sometimes self-mutilation is a way of punishing oneself for being "bad."
  • Relief of anger: many self-injurers have enormous amounts of rage within. Afraid to express it outwardly, they injure themselves as a way of venting these feelings.
  • Biochemical relief: there is some thought that adults who were repeatedly traumatized as children have a hard time returning to a "normal" baseline level of arousal and are, in some sense, addicted to crisis behavior.
  • Obtaining or maintaining influence over the behavior of others
  • Exerting a sense of control over one's body
  • Grounding in reality, as a way of dealing with feelings of depersonalization and dissociation
  • Maintaining a sense of security or feeling of uniqueness
  • Expressing or repressing sexuality
  • Expressing or coping with feeling of alienation

Miller also notes one explanation for why such a large majority of these patients are female: women are not socialized to express violence externally. When confronted with the vast rage many self-injurers feel, women tend to vent on themselves. She quotes the feminist poet Adrienne Rich:

"Most women have not even been able to touch this anger except to drive it inward like a rusted nail."
As Miller says, "Men act out. Women act out by acting in." Another reason fewer men self-injure may be that men are socialized in a way that makes repressing feelings the norm. Linehan's (1993a) theory that self-harm results in part from chronic invalidation, from always being told that your feelings are bad or wrong or inappropriate, could explain the gender disparity in self-injury; men are generally brought up to hold emotion in.

Objective: What the researchers have found

People who self-injure tend to be dysphoric -- experiencing a depressed mood with a high degree of irritability and sensitivity to rejection and some underlying tension -- even when not actively hurting themselves. The pattern found by Herpertz (1995) indicates that something, usually some sort of interpersonal stressor, increases the level of dysphoria and tension to an unbearable degree. The painful feelings become overwhelming: it's as if the usual underlying uncomfortable affect is escalated to a critical maximum point. "SIB has the function of bringing about a transient relief from these [high levels of irritability and sensitivity to rejection]," Herpertz said. This conclusion is supported by the work of Haines and her colleagues.

In a fascinating study, Haines et al. (1995) led groups of self-injuring and non-self-injuring subjects through guided imagery sessions. Each subject experienced the same four scenarios in random order: a scene in which aggression was imagined, a neutral scene, a scene of accidental injury, and one in which self-injury was imagined. The scripts had four stages: scene-setting, approach, incident, and consequence. During the guided imagery sessions, physiological arousal and subjective arousal were measured.

The results were striking. Subject reactions across groups didn't differ on the aggression, accident, and neutral scripts. In the self-injury script, though, the control groups went to a high level of arousal and stayed there throughout the script, in spite of relaxation instructions contained in the "consequences" stage. In contrast, self-injurers experienced increased arousal through the scene-setting and approach stages, until the the decision to self-injure was made. Their tension then dropped, dropping even more at the incident stage and remaining low.

These results provide strong evidence that self-injury provides a quick, effective release of physiological tension, which would include the physiological arousal brought on by negative or overwhelming psychological states. As Haines et al. say

Self-mutilators often are unable to provide explanations for their own self-mutilative behavior. . . . Participants reported continued negative feelings despite reduced psychophysiological arousal. This result suggests that it is the alteration of psychophysiological arousal that may operate to reinforce and maintain the behavior, not the psychological response. (1995, p. 481)
In other words, self-injury may be a preferred coping mechanism because it quickly and dramatically calms the body, even though people who self-injure may have very negative feelings after an episode. They feel bad, but the overwhelming psychophysiological pressure and tension is gone. Herpertz et al. (1995) explain this:
"We may surmise that self-mutilators usually disapprove of aggressive feelings and impulses. If they fail to suppress these, our findings indicate that they direct them inwardly. . . . This is in agreement with patients' reports, where they often regard their self-mutilative acts as ways of relieving intolerable tension resulting from interpersonal stressors. (p. 70)."
Herman (1992) says that most children who are abused discover that a serious jolt to the body, like that produced by self-injury, can make intolerable feelings go away temporarily.

Brain chemistry may play a role in determining who self-injures and who doesn't. Simeon et al. (1992) found that people who self-injure tend to be extremely angry, impulsive, anxious, and aggressive, and presented evidence that some of these traits may be linked to deficits in the brain's serotonin system. Favazza (1993) refers to this study and to work by Coccaro on irritability to posit that perhaps irritable people with relatively normal serotonin function express their irritation outwardly, by screaming or throwing things; people with low serotonin function turn the irritability inward by self-damaging or suicidal acts. Zweig-Frank et al. (1994) also suggest that degree of self-injury is related to serotonin dysfunction. More information on the likely role of serotonin in self-injury can be found on the [1]psychopharmacology page.

Those who self-injure may have personality characteristics that increase the likelihood of their self-injury. Haines and Williams (1997) found that self-mutilators reported more use of problem avoidance as a coping strategy and perceived themselves to have less control over problem-solving options. This feeling of disempowerment may in turn be related to the chronic invalidation many self-injurers have experienced.

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