Open Space
Self-injury, self-mutilation, and self-aggression. The same definition?
Abstract
Often expressions such as self-mutilation, self-injury, and self-aggression are believed to have a common definition. The present article aims to make these concepts clearer and draw attention to what society accepts and what it condemns.
Introduction
History has given us various examples of self-aggressive behaviours associated to various cultures throughout time. This includes finger amputation in the Pacific and in Africa, nasal septum piercing among some African and American tribes, the stretching of the neck and lips in a few cultures in Africa, foot binding in small shoes to prevent them from growing in a tribe in Asia, crucification and self-flagellation in a religious context in the Philippines, ear lobe piercing, tattoos, and body piercing in western cultures (Cordeiro & Venâncio, 2004).
It is necessary to put self-aggressive behaviours into context, because if some are connected with cultural and religious practices and beliefs, others belong to the realm of psychiatry.
The former are associated to rituals and have a symbolic component that underlies the subject’s link to his culture. They may have several objectives, such as healing or identifying a social position, or be a demonstration of spirituality. They reflect a tradition of community and are a means for the subject to be part of it. Practices have the purpose of acting as ornaments or to show an identity towards a particular cultural group. They are short-lived and, for this reason, mean little to the subject (Bolognini, Plancherel, Laget, Stéphan & Halfon, 2003; Favazza, 1996). In this type of self-aggression, it seems there is no affective-emotional component, rather a socio-cultural and religious one.
Body piercing and tattoos tend to be socially accepted (Cordeiro & Venâncio, 2004), despite being acts of self-aggression. Nevertheless, self-injury and self-mutilating behaviours, suicide attempts, suicide or other actions with a harmful long-term effect, where the immediate physical harm is not the desired objective (such as with addictive behaviours), constitute self-aggression actions perceived as being pathological, both by society and in psychiatric terms. They do not have any symbolic value in their socio-cultural or religious environment, and they are not carried out by a majority group belonging to this milieu (Simeon & Hollander, 2001).
Definition
Aggression is a characteristic that may arise under the form of hetero-aggression when directed at objects/other animals, either verbally or physically. When enforced on the self, it takes the form of self-aggression, through self-injury, self-mutilation, suicide attempts, and suicide.
Self-injuries are moderate body injuries inflicted upon oneself, without any suicidal (Stanley, Gameroff, Michaelsen & Mann, 2001; Klonsky & Olino, 2008) or sexual pleasure intentions. They are made without the intervention of others, cause physical harm and bring relief of previously felt tension. Normally, they are not failed suicide attempts, but an effort to maintain the subject’s psychological identity, who has no appropriate strategies to cope with all the feelings that are unbearable to him, nor with the tensions they cause (Maltesberg & Lovett, 1992). Russ et al. mentions that the objective of self-injuries is to release tension, and that they act as a means of “diverting” attention from extremely painful feelings perceived as unbearable (quoted by Millon & Davis, 2001). Examples include ingesting sharp objects and pieces of clothing, pulling out skin/hair, hitting oneself, interfering with the healing of wounds, inserting objects in wounds, self-suffocation, and biting oneself. The most frequent are burns, cuts on wrists, legs, and arms, as well as scratches.
The word self-mutilation is often used incorrectly when in the presence of self-injury (Simeon & Favazza, 2001; Walsh, 2006). Self-mutilations are more serious self-aggressive behaviours, such as limb amputation, enucleation of the eye, and castration. They lead to an irreversible destruction of the body and are, frequently, life threatening. They tend to emerge in a context of hallucination during which the subject obeys commanding voices, or in a situation of delirium where the theme is sin, salvation, self-punishment, and temptation of a sexual nature (Scharbach, 1986).
For Kreitman, parasuicide is characterised by deliberate acts with non-fatal consequences (quoted by Cordeiro & Venâncio, 2004) and it includes self-injury (where the ingestion of substances/objects, interference in healing, such in Munchausen’s syndrome, are included), addictive behaviours (such as chronic alcoholism and drug-abuse), self-mutilation, eating disorders, or refusal to take medical treatment, amongst others described previously. However, if this refusal to accept treatment takes place in the face of a terminal disease with the purpose of speeding up death, it should be considered a suicide attempt.
Gardner & Cowdry argue that, despite the absence of suicide ideation, an accidental suicide may occur as a result of the increase in the rate of recurrence or severity of the behaviour (quoted by Maltsberger & Lovett, 1992). However, in self-injuries and self-mutilations, some of these individuals may, later on, attempt suicide, using a method that is different from the one they normally use in their self-injury behaviours. Others may still reveal an ambivalent feeling regarding the intention of the act, which makes evaluating suicide ideation difficult (Cordeiro & Venâncio, 2004).
Conclusion
As a set of deliberate actions with the intent of causing injury or even death, self-aggression is formed by several types: parasuicide, suicide attempts, and suicide. In turn, parasuicide includes self-injury and self-mutilation. In this differentiation, it is equally important to know how to identify and frame these actions, to avoid considering that a particular behaviour is pathological, when it is part of a socio-cultural or religious symbolic setting.
Above all, it is important to acknowledge the suffering that this aggressive behaviour causes on the individual and on the others around him or her.
Carla Maria Almeida
Medical Psychology Laboratory of the Faculty of Medicine of Lisbon
cmalmeida@fm.ul.pt
Purificação Horta
Coordinator of the Medical Psychology Laboratory of the Faculty of Medicine of Lisbon
horta@fm.ul.pt
_________________
References
Bolognini, M., Plancherel, B., Laget, J., Stéphan, P., & Halfon, O. (2003). Adolescents’
self-mutilation –relationship with dependent behaviour. Swiss Journal of Psychology 62 (4), 241–249.
Cordeiro, A. M. & Venâncio, A. (2004). Automutilação: para lá do sintoma. Psiquiatria Clínica, 25 (3), 173-184.
Favazza, A. R. (1996). Bodies Under siege: Self-mutilation and body modification in culture and psychiatry. Baltimore and London: The Johns Hopkins University Press.
Klonsky, E. D., & Olino, T. M. (2008). Identifying clinically distinct subgroups of self-injurers among young adults: a latent class analysis. Journal of Consulting and Clinical Psychology, 76, (1), 22–27.
Maltsberger, J. T., & Lovett, C. G. (1992). Suicide in borderline personality disorder. In D. Silver & M. Rosenbluth, (Eds.), Handbook of borderline disorders (pp.335-387). Madison: IUP.
Millon, T., & Davis, R. (2001). Transtornos de la personalidad em la vida moderna. Barcelona: Masson.
Simeon, D., & Favazza, A. (2001). Self-injurious behaviors: Phenomenology and assessment. In D.Simeon & E. Hollander (Eds.), Self-injurious behaviours, assessment and treatment (pp. 1–28). Washington, DC: American Psychiatric Publishing.
Simeon, D., & Hollander, E. (2001). Self-injurious behaviours, assessment and treatment. American Psychiatric Publishing, Inc.
Scharbach, H. (1986). Auto-mutilations et auto-offenses. Paris : Presses Universitaires de France.
Stanley, B., Gameroff, M. J., Michalsen, V., & Mann, J. J. (2001). Are suicide attempters who self-mutilate a unique population? American Journal of Psychiatry, 158 (3), 427-432.
Walsh, B. W. (2006). Treating self-injury: A practical guide. New York: Guilford Press.
Often expressions such as self-mutilation, self-injury, and self-aggression are believed to have a common definition. The present article aims to make these concepts clearer and draw attention to what society accepts and what it condemns.
Introduction
History has given us various examples of self-aggressive behaviours associated to various cultures throughout time. This includes finger amputation in the Pacific and in Africa, nasal septum piercing among some African and American tribes, the stretching of the neck and lips in a few cultures in Africa, foot binding in small shoes to prevent them from growing in a tribe in Asia, crucification and self-flagellation in a religious context in the Philippines, ear lobe piercing, tattoos, and body piercing in western cultures (Cordeiro & Venâncio, 2004).
It is necessary to put self-aggressive behaviours into context, because if some are connected with cultural and religious practices and beliefs, others belong to the realm of psychiatry.
The former are associated to rituals and have a symbolic component that underlies the subject’s link to his culture. They may have several objectives, such as healing or identifying a social position, or be a demonstration of spirituality. They reflect a tradition of community and are a means for the subject to be part of it. Practices have the purpose of acting as ornaments or to show an identity towards a particular cultural group. They are short-lived and, for this reason, mean little to the subject (Bolognini, Plancherel, Laget, Stéphan & Halfon, 2003; Favazza, 1996). In this type of self-aggression, it seems there is no affective-emotional component, rather a socio-cultural and religious one.
Body piercing and tattoos tend to be socially accepted (Cordeiro & Venâncio, 2004), despite being acts of self-aggression. Nevertheless, self-injury and self-mutilating behaviours, suicide attempts, suicide or other actions with a harmful long-term effect, where the immediate physical harm is not the desired objective (such as with addictive behaviours), constitute self-aggression actions perceived as being pathological, both by society and in psychiatric terms. They do not have any symbolic value in their socio-cultural or religious environment, and they are not carried out by a majority group belonging to this milieu (Simeon & Hollander, 2001).
Definition
Aggression is a characteristic that may arise under the form of hetero-aggression when directed at objects/other animals, either verbally or physically. When enforced on the self, it takes the form of self-aggression, through self-injury, self-mutilation, suicide attempts, and suicide.
Self-injuries are moderate body injuries inflicted upon oneself, without any suicidal (Stanley, Gameroff, Michaelsen & Mann, 2001; Klonsky & Olino, 2008) or sexual pleasure intentions. They are made without the intervention of others, cause physical harm and bring relief of previously felt tension. Normally, they are not failed suicide attempts, but an effort to maintain the subject’s psychological identity, who has no appropriate strategies to cope with all the feelings that are unbearable to him, nor with the tensions they cause (Maltesberg & Lovett, 1992). Russ et al. mentions that the objective of self-injuries is to release tension, and that they act as a means of “diverting” attention from extremely painful feelings perceived as unbearable (quoted by Millon & Davis, 2001). Examples include ingesting sharp objects and pieces of clothing, pulling out skin/hair, hitting oneself, interfering with the healing of wounds, inserting objects in wounds, self-suffocation, and biting oneself. The most frequent are burns, cuts on wrists, legs, and arms, as well as scratches.
The word self-mutilation is often used incorrectly when in the presence of self-injury (Simeon & Favazza, 2001; Walsh, 2006). Self-mutilations are more serious self-aggressive behaviours, such as limb amputation, enucleation of the eye, and castration. They lead to an irreversible destruction of the body and are, frequently, life threatening. They tend to emerge in a context of hallucination during which the subject obeys commanding voices, or in a situation of delirium where the theme is sin, salvation, self-punishment, and temptation of a sexual nature (Scharbach, 1986).
For Kreitman, parasuicide is characterised by deliberate acts with non-fatal consequences (quoted by Cordeiro & Venâncio, 2004) and it includes self-injury (where the ingestion of substances/objects, interference in healing, such in Munchausen’s syndrome, are included), addictive behaviours (such as chronic alcoholism and drug-abuse), self-mutilation, eating disorders, or refusal to take medical treatment, amongst others described previously. However, if this refusal to accept treatment takes place in the face of a terminal disease with the purpose of speeding up death, it should be considered a suicide attempt.
Gardner & Cowdry argue that, despite the absence of suicide ideation, an accidental suicide may occur as a result of the increase in the rate of recurrence or severity of the behaviour (quoted by Maltsberger & Lovett, 1992). However, in self-injuries and self-mutilations, some of these individuals may, later on, attempt suicide, using a method that is different from the one they normally use in their self-injury behaviours. Others may still reveal an ambivalent feeling regarding the intention of the act, which makes evaluating suicide ideation difficult (Cordeiro & Venâncio, 2004).
Conclusion
As a set of deliberate actions with the intent of causing injury or even death, self-aggression is formed by several types: parasuicide, suicide attempts, and suicide. In turn, parasuicide includes self-injury and self-mutilation. In this differentiation, it is equally important to know how to identify and frame these actions, to avoid considering that a particular behaviour is pathological, when it is part of a socio-cultural or religious symbolic setting.
Above all, it is important to acknowledge the suffering that this aggressive behaviour causes on the individual and on the others around him or her.
Carla Maria Almeida
Medical Psychology Laboratory of the Faculty of Medicine of Lisbon
cmalmeida@fm.ul.pt
Purificação Horta
Coordinator of the Medical Psychology Laboratory of the Faculty of Medicine of Lisbon
horta@fm.ul.pt
_________________
References
Bolognini, M., Plancherel, B., Laget, J., Stéphan, P., & Halfon, O. (2003). Adolescents’
self-mutilation –relationship with dependent behaviour. Swiss Journal of Psychology 62 (4), 241–249.
Cordeiro, A. M. & Venâncio, A. (2004). Automutilação: para lá do sintoma. Psiquiatria Clínica, 25 (3), 173-184.
Favazza, A. R. (1996). Bodies Under siege: Self-mutilation and body modification in culture and psychiatry. Baltimore and London: The Johns Hopkins University Press.
Klonsky, E. D., & Olino, T. M. (2008). Identifying clinically distinct subgroups of self-injurers among young adults: a latent class analysis. Journal of Consulting and Clinical Psychology, 76, (1), 22–27.
Maltsberger, J. T., & Lovett, C. G. (1992). Suicide in borderline personality disorder. In D. Silver & M. Rosenbluth, (Eds.), Handbook of borderline disorders (pp.335-387). Madison: IUP.
Millon, T., & Davis, R. (2001). Transtornos de la personalidad em la vida moderna. Barcelona: Masson.
Simeon, D., & Favazza, A. (2001). Self-injurious behaviors: Phenomenology and assessment. In D.Simeon & E. Hollander (Eds.), Self-injurious behaviours, assessment and treatment (pp. 1–28). Washington, DC: American Psychiatric Publishing.
Simeon, D., & Hollander, E. (2001). Self-injurious behaviours, assessment and treatment. American Psychiatric Publishing, Inc.
Scharbach, H. (1986). Auto-mutilations et auto-offenses. Paris : Presses Universitaires de France.
Stanley, B., Gameroff, M. J., Michalsen, V., & Mann, J. J. (2001). Are suicide attempters who self-mutilate a unique population? American Journal of Psychiatry, 158 (3), 427-432.
Walsh, B. W. (2006). Treating self-injury: A practical guide. New York: Guilford Press.