Self-Harm as a Process Addiction

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Definition of Self-Harm

• Hurting oneself on purpose by cutting, burning, pulling hair, bruising/hitting oneself, ingestion of toxic substances and picking at wounds (NAMI, 2018).
• The most common form of self-harm is cutting (NAMI, 2018).
• There are two types of self-injury: Non-suicidal self-injury and suicidal behavior. (Blasco-Fontecilla, H. et al., 2016).
• Both types of self-harm are process addictions. (Blasco-Fontecilla, H. et al., 2016).

Why Do People Self-Harm?

• Mental illnesses commonly associated with self-harm: Borderline Personality Disorder, Depression, PTSD, Anxiety, and Eating Disorders (NAMI, 2018).
• Someone who does not know how to deal with their emotions or hides them, use self-harm as a release (NAMI, 2018).
• Injuring oneself can raise endorphin levels and other pain killing hormones, which increases mood (NAMI, 2018).

Statistics

• Girls aged 14-17 are hospitalized for self-harm, four times more often than boys (CIHI, 2014; Klonsky, et al., 2011).
• Most self-harming begins between the ages of 12-15 (CIHI, 2014; Klonsky, et al., 2011).
• Self-harm often occurs in adolescence and young adulthood (NAMI, 2018).
• In 2010, The WHO estimated that, 880,000 deaths occur as a result of self-harm. (“Self-harm,” 2018)

Non-Suicidal Self-Injury as a Process Addiction

• Faye (1995) suggested that the increase in negative emotions prior to non-suicidal self-injury is comparable to the aversive withdrawal symptoms experienced by drug users.
• Nixon et al. (2002) found consistency with an addiction model of non-suicidal self-injury, by finding that all participants reported having urges to self-injure after a stressful event.
• 79% reported almost daily urges to self-harm. 98% of participants endorsed at least three of the addictive criteria. 81% endorsed more than five criteria (Nixon et al., 2002).
• Both positive and negative reinforcement sustain substance use, only negative reinforcement preserves non-suicidal self-injury (McCarthy et al., 2010)
• The largest change in emotions from before to after engaging in non-suicidal self-injury involved the removal of negative emotions. (Klonsky, 2009).
• The most common motivation for non-suicidal self-injury reported by participants was “to cope with feelings of depression” (Nixon et al., 2002).

Suicidal Behavior as a Process Addiction

• Stanley et al. (2010) have suggested that suicide attempters with a history of self-mutilation use self-injury to deal with emotional/psychological pain.
• Suicide attempts might replace self-injury to regulate negative emotions in suicide attempters (Esposito et al., 2003).
• Non-suicidal self- injury is a negative reinforcer while suicidal behavior is a positive reinforcer. It is a positive reinforcer because it relieves the feeling of emptiness and creates a higher level of support from others. (Esposito et al., 2003).

Treatment

• Counseling: Dialectal Behavioral Therapy, Cognitive Behavioral Therapy, Psychodynamic Therapies, Mindfulness-Based Therapies (Mayo Clinic, 2017; NAMI, 2018).
• Pharmacotherapy (Mayo Clinic, 2017; NAMI, 2018; “Self-harm,” 2018).
• Psychiatric Hospitalization (Mayo Clinic, 2017; NAMI, 2018).
• Removal of harmful objects (“Self-harm,” 2018).
• Connect with others for support (Mayo Clinic, 2017)
• Recognizing triggers (Mayo Clinic, 2017).

References

• Blasco-Fontecilla, H., Fernández-Fernández, R., Colino, L., Fajardo, L., Perteguer-Barrio, R., & Leon, J. D. (2016). The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior. Frontiers in Psychiatry, 7. doi:10.3389/fpsyt.2016.00008
• Canadian Institute for Health Information. (2014). Intentional self-harm among youth in Canada. Retrieved from https://www.cihi.ca/web/resource/en/info_child_harm_en.pdf
• Esposito, C., Spirito, A., Boergers, J., & Donaldson, D. (2003) Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Suicide and Life Threatening Behavior, 33:389–99.
• Faye P. (1995). Addictive characteristics of the behavior of self-mutilation. Journal of Psychosocial Nursing and Mental Health Services, 33, 36–39.
• Klonsky, E. D., Glenn, C. R. (2009). Assessing the functions of non-suicidal self-injury: Psychometric properties of the Inventory of Statements About Self-Injury (ISAS) Journal of Psychopathology and Behavioral Assessment, 31, 215–219.
• Klonsky, E., May, A. & Glenn, C. (2014). The relationship between nonsuicidal self-injury and attempted suicide: Converging evidence from four samples. Journal of Abnormal Psychology, 122(1), 231-237.
• Mayo Clinic. (2017). Self-injury/cutting. Retrieved from https://www.mayoclinic.org/ diseases-conditions/self-injury/diagnosis-treatment/drc-20350956
• McCarthy, D. E., Curtin, J. J., Piper, M. E., & Baker, T. B. (2010). Negative reinforcement: Possible clinical implications of an integrative model. Substance abuse and emotion. American Psychological Association; Washington, D.C. pp. 15–42.
• NAMI. (2018). Self Harm. Retrieved December 6, 2018, from https://www.nami.org/Learn- More/Mental-Health-Conditions/Related-Conditions/Self-harm
• Nixon, M. K., Cloutier, P. F., 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, 1333–1341.
• Self-harm. (2018). Retrieved December 6, 2018, from https://en.wikipedia.org/wiki/Self-harm
• Stanley B., Sher L., Wilson, S., Ekman, R., Huang, Y. Y., Mann, J. J. (2010). Non-suicidal self- injurious behavior, endogenous opioids and monoamine neurotransmitters. Journal of Affective Disorders, 124, 134–140.
• Victor, S. E., Glenn, C. R., & Klonsky, E. D. (2012). Is non-suicidal self-injury an “addiction”? A comparison of craving in substance use and non-suicidal self-injury. Psychiatry Research, 197(0), 73-77. doi: 10.1016/j.psychres.2011.12.011