What is SI?

Self-Injury (SI) has been around for quite some time, despite the fact that it has only recently been recognised as a problem in its own right. The practises of saints, monks and nuns in the Middle Ages in particular, who "motified the flesh" by flagellating and otherwise abusing their bodies, may well be classified as self-injurous behaviour. SI has been understood either in a religious context or as failed suicide attempts for most of its history.

However, SI is generally used as a safety mechanism to prevent suicide, rather than being a form of para-suicide. Many, if not most, SIers suffer from suicidal feelings some or all of the time, but most do not view SI as an attempt to take their own lives which has failed.

SI is defined as the deliberate injuring of the body - by headbanging, breaking bones, burning, cutting or amputation. The motivations behind it are varied, but sufferers generally feel some sort of release of tension, anger or other negative emotions when they harm themselves. It is also known as self-harm, self-mutilation or just simply as "cutting" (though not all people cut).

The foremost researcher on this topic, Favazza (Bodies Under Seige) came up with three forms of SI:

• Major SI This is the most serious and least common form of SI. This includes amputation of limbs, removal of eyes, removal of genitals and other forms of severe bodily injury. It often has a religious component, with sufferers feeling the need to injure themselves to obey Christ's commandments to be eunuchs for the Kingdom of God or pluck out an eye which offends you. This type of SI can be caused by retardation, schizophrenia, bipolar disorder (manic depression) or by hyper-religiosity among other factors. This is, not surprisingly, not the sort of SI which can be hidden, and generally results in the sufferer being admitted to a mental hospital.


• Stereotypic SI This involves repetitive and/or rhythmic SI, such as head-banging, hair-pulling or hitting, and is often associated with mental retardation, autism or Tourette's. Young children can be seen suffering from this form of SI - the widely shown reportage of children in Romanian orphanages banging their heads against the bars of their cots is a good example.


• Superficial SI This is the most common form of SI. For all that this is called "superficial", quite severe injuries can be inflicted, and may be life-threatening, especially in men, who seem to cut deeper. There are three types of superficial SI, compulsive, episodic and repetitive. Those who suffer from compulsive SI may be unaware of what they are doing until later, unconsciously picking at the skin or pulling out hair (the most common forms of this) as a form of compulsion. It is observed in sufferers from obsessive-compulsive disorder. Episodic SI is when a sufferer injures themselves several times, but without defining their identity as a "cutter", "burner", etc. This often involves cutting the skin, burning, interfering with wounds, bone-breaking, and other types of SI. It is sometimes seen as a symptom of Borderline Personality Disorder, though this view seems to be changing as more research has been done. Repetitive SI is a form of SI where the sense of self is defined by the SI, and it becomes an overwhelming preoccupation. Quite a number of people shift from being episodic SIers to being repetitive. During this stage, sufferers may describe themselves as being "addicted" to SI, unable to resist the impulse to harm themselves, and ritualise their actions.

Researchers have found that around 60% of SIers have been physically or sexually abused as children, though it should be remembered that that still leaves 40% of people (including me!) who have not been so abused. Some researchers have theorised that cutting/burning the arms reflects injuring the arms of a mother, or that the child has come to view pain as love and so hurts themselves.

SI is a complex disorder, which should not be underestimated - practises in the past where doctors have assumed someone has a Borderline Personality Disorder because they SI should not carry on. With the increased visability and understanding of SI, this misdiagnosis (not all of the time) should stop. I, personally, have had a most understanding doctor, whose research speciality is SI & depression, and so have not had to suffer under misconceptions of what SI is.