Understanding self-harm
Page 7
Executive summary
Evolving motives and harming without reason - is self-harm an addiction?
It appears that self-harm is something that, once begun, tends to go on for quite some time. Of those who were still harming when they filled in our survey, nearly half had been harming for longer than five years and a quarter for longer than eleven years.
Nearly half of participants had noticed a change in their motives to harm over the years, and many found that they were now, or recently, applying self-harm as a remedy more widely, than they had when they had first started. Quite often this seemed to be the result of the individual learning more about the effect of self-harm and how it can help with a variety of uncomfortable experiences that had previously seemed unconnected.
However, a significant proportion of participants said that they had at some point harmed without clear motivation such as emotion regulation, self-punishment, suicide prevention and so on. Sometimes this meant engaging in pre-emptive or experimental harming, and some participants had harmed in order to prove to themselves that self-harm would still be an effective option if emotions became intolerable.
Most commonly, however, ‘harming without reason’ was a case of self-harm having become habitual or routine (n=54), and some participants went as far as conceptualising their self-harm as an addiction.
References are made to the idea that self-harm is addictive in academic literature(3), on internet sites and chat rooms dedicated to self-harm(4), and in the media, which recount real-life stories with titles such as the BBC's “I was addicted to self-harm”(5).
Self-harm behaviour certainly exhibits many of the characteristics that define addictive behaviour(6): regular cravings or urges to harm, feelings of relief when one does so, tension and dysphoria when abstaining, wanting to cease harming but being unable to do so, struggle for self-control, cue dependence (being ‘triggered’ by sight of sharp objects etc.), belief dependence (i.e. urge to harm whenever opportunity arises), and ‘crowding out’ – the inability to think about anything else when feeling the urge to harm.
Some participants had noticed an increase across time in the severity and frequency of their harm, suggesting a build up of tolerance, and frequent harming was found to be associated with feeling compelled to harm. However, we also learned from our participants about how very difficult it is to make a clear distinction between someone harming habitually or routinely because it has become part of her regular strategy for processing emotions, and someone being addicted to harm. Nor is it clear when a craving is addictive and when it is simply an impulse to cut in order to put some un-nameable wrong to rights. It is also very difficult to say whether the tension and dysphoria experienced by someone prior to harming is addictive withdrawal, or whether it is emotional distress deriving from some other source.
Conceptualising a behaviour as an addiction may not always be helpful to the person in question, if s/he takes it to imply that s/he is not in control of his/her actions – this can create a feeling of helplessness. In addition, explanation of a behaviour purely in terms of addiction tends to ignore the personal reasons and experiences that the individual feels are driving it. Perhaps the best option would be to think of self-harm as motivated behaviour with a long-term function in a person’s life, whilst being alert to its apparent addictive qualities. What do you think?
3. Tantam, D; Whittaker, J (1992) Personality disorder and self-wounding. British Journal of Psychiatry 161: 451-64
Nixon, MK; Cloutier, PF; Aggarwal, S (2002) Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 41(11): 1333-1341
4. Whitlock, JL; Powers, JL; Eckenrode, J (2006) The virtual cutting edge: The internet and adolescent self-injury. Developmental Psychology 42(30): 407-417
5. Last checked 10 March 2008
6. Elster, J. (1999) Strong feelings: emotion, addiction and human behaviour. London: MIT Press