What behaviours does self-injury encompass?

The main focus of this book is on direct acts of self-injury. In particular, the spotlight is placed on two of the most common types identified through research, namely, cutting and burning. However, as you will see from Figure 1.1 (Direct Self-Injury) a wide range of other behaviours are grouped in the same category, some of which to a lesser degree will be mentioned throughout the text.

Unfamiliar behaviours

While most of the behaviours shown in Figure 1.1 are probably self-explanatory, there are two that you may not be familiar with and perhaps need further clarification.

Compulsive skin-picking (CSP)

Compulsive skin-picking, also referred to as neurotic excoriation and dermatillomania is the practice of consistently picking, squeezing or scratching the skin causing abrasions. One respondent referred to it as ‘skin gouging’ – this is how she described the practice:

DSM-IV-TR lists skin-picking as an Impulse-Control Disorder Not Otherwise Specified (p. 677).

Trichotillomania

According to DSM-IV-TR, one of the essential features of trichotillomania (also referred to as ‘TTM’ or ‘trich’) is the ‘Recurrent pulling out of one’s own hair resulting in noticeable hair loss’ (p. 677). Typically, hair is pulled from the scalp, eyebrows and eyelashes, but it may also be pulled from other areas of the body where hair grows. Trichotillomania is also listed in the DSM as an Impulse-Control Disorder Not Otherwise Specified.

What behaviours are not being discussed?

In Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry (1996: 233) Armando Favazza, a psychiatrist and leading researcher on self-injury classifies the behaviour into three types:

• 1.Major self-mutilation.
• 2.Stereotypic self-mutilation.
• 3.Superficial or moderate self-mutilation.

Our interest is with the latter, thus major and stereotypic self-mutilation will not be addressed. Nevertheless, for those of you who are wondering what behaviours major and stereotypic self-mutilation comprises a brief description is now given.

Major self-mutilation

Favazza uses the term major self-mutilation to describe the least common forms of self-injury that result in significant damage to body tissue or permanent disfigurement. Examples of this type include removal of an eye, castration, and limb amputation. These acts, which are relatively rare, are frequently linked with psychotic states or severe alcohol misuse.

Stereotypic self-mutilation

Favazza uses the term stereotypic self-mutilation to describe repetitive self-injurious behaviours often observed in institutionalised individuals with mental impairments, for instance, autism, Lesch-Nyhan syndrome and Tourette’s syndrome. Examples of this type include rhythmic head-banging, eyeball pressing, and finger, lip, tongue or arm biting.

In addition to the aforementioned, other high risk self-injurious acts such as jumping from bridges or high buildings are not addressed.

Culturally accepted self-injury

Deeply embedded culturally permitted practices such as piercing, tattooing, scarification, and cutting of the skin connected with healing, spiritual enlightenment, social order, or as a rite of passage into adulthood is another area not addressed, because the purposes behind these acts hold different meanings to self-injurious practices as discussed in this book.

Note: For those wishing to learn more about culturally sanctioned, major and stereotypic self-injury, Favazza’s book Bodies Under Siege (1996) comes highly recommended.

Non-direct self-harm (NDSH)

As seen from the above respondent’s testimony, self-injury does not always come alone. Research has consistently shown that self-injury and eating disorders, and self-injury and alcohol misuse are frequent companions. Thus, bearing in mind the close relationship between direct forms of self-injury and some indirect forms of self-harm it is inevitable that a few behaviours shown in Figure 1.2 (Non-direct self-harm) will present themselves during discussion.