Sunday, February 02, 2003

Jewish Survivors of Sexual Abuse: Self-Injury, Self-Harm, Self-Inflicted Violence, Self-Injurious Behavior, Self-Mutilation

Jewish Survivors of Sexual Abuse: 
Self-Injury, Self-Harm, Self-Inflicted Violence, Self-Injurious Behavior, Self-Mutilation

(Healing from childhood sexual abuse, incest, sexual assault, rape, clergy sexual abuse)


About Individuals Who Self Harm

We all react in differently to various situations. We all find ways of coping and dealing with the fears, hurt, anger and grief, emotional physical and sexual abuse leaves us to face.

Approximately 1% of the population has, at one time or another, used self-inflicted physical injury as a means of coping with an overwhelming situation or feeling.

This may appear to be a strange question. But some people may not be sure that what they are doing actually is this. So, to clarify what is meant by self harm/injury i have broken it down to a few small paragraphs.

If you cause physical harm to yourself so that you are causing tissue damage. Things like bruising, breaking the skin or leaving marks that last for longer than a couple of hours.

If you cause this harm to yourself when you are trying to deal with unpleasant, difficult or overwhelming emotions, obsessive thoughts, or when you are dissociated.

If you often think about self harm/injury even when you're feeling calm and not upset/angry/emotional even though you may not be physically thinking about doing it right now.

The first two are indications of self harm/injury, and the last indicates that you may be compulsive.

Many psychiatrists and psychologists suggest that this way of dealing with pain and trauma is because that somewhere along the line, you didn't learn good ways of coping with overwhelming feelings. 

Some doctors had a theory that it was mainly people who had been abused as children who did this, but as time has gone on it has been proved that these people make up only a small section of those who cut.

From talking to people who do cut on a regular basis i have come to realize that the reason they do feel the need to harm themselves is because it brings a rapid relief from tension, stress and emotional pain.


Disclaimer: Inclusion in this website does not constitute a recommendation or endorsement. Individuals must decide for themselves if the resources meet their own personal needs.

Table of Contents:  

  1. National Self-Harm Network  Based in London, England - We are a survivor-led organisation, founded in 1994. We are committed to campaigning for the rights and understanding of people who self-harm.
  2. SIARI Self-Injury & Related Issues  Offering hope, support, and enlightenment to those who self-injure, their kith and kin, and those who work alongside people who hurt themselves.

  1. Women Living with Self-Injury  - by Jane Wegscheider Hyman
  2. The Scarred Soul : Understanding & Ending Self-Inflicted Violence - By Tracy Alderman

  1. The Life Healing Center of Santa Fe   A therapeutic residential facility specializing in the treatment of adults who have experienced severe emotional trauma. The specific trauma can range from a single catastrophic event to ongoing physical, sexual, or emotional abuse, whether recent or in the past. The center also provides continuing care for chemical dependency, eating disorders, and relationship difficulties.

  2. SAFE Alternatives (Self Abuse Finally Ends)   A nationally recognized treatment approach, professional network and educational resource base, which is committed to helping you and others achieve an end to self-injurious behavior.

(See Below)
  1. About Self-harm
  2. Bill of Rights for People Who Self-Harm
  3. Common Myths about Self-Injury


About Self-harm

Self-harm, also known as self-injury, self-inflicted violence, self-injurious behavior, or self-mutilation, can be defined as the deliberate, direct injury of one's own body that causes tissue damage or leave marks for more than a few minutes and that is done in order to deal with an overwhelming or distressing situation.

It's important to remember that, even though it may not be apparent to an outside observer, self-injury is serving a function for the person who does it. Figuring out what functions it serves and helping someone learn other ways to get those needs met is essential to helping people who self-harm. Some of the reasons self-injurers have given for their acts include:

  • Affect modulation (distraction from emotional pain, ending feelings of numbness, lessening a desire to suicide, calming overwhelming/intense feelings)

  • Maintaining control and distracting the self from painful thoughts or memories

  • Self-punishment (either because they believe they deserve punishment for either having good feelings or being an "evil" person or because they hope that self-punishment will avert worse punishment from some outside source

  • Expression of things that can't be put into words (displaying anger, showing the depth of emotional pain, shocking others, seeking support and help)

  • Expression of feelings for which they have no label -- this phenomenon, called alexithymia (literally no words feeling), is common in people who self-harm  See Osuch, Noll, & Putnam, Psychiatry 62 (Winter 99), pp: 334-345 Zlotnick et al, Comprehensive Psychiatry 37(1) pp:12-16.

People who self-injure often never developed healthy ways to feel and express emotion or to tolerate distress. Studies have shown that self-harm can put a person at a high level of physiological arousal back to a baseline state.

It's natural to want to help people who self-injure develop healthier ways of coping when they feel overwhelmed, but it's important not to let your discomfort with the concept of self-harm cause you to issue ultimatums, punish self-harming behavior, or threaten to leave if the person self-harms again. Ideally, you should set boundaries to keep yourself feeling safe while respecting the person's right to make his or her own decisions about how to deal with stress.


Bill of Rights for People Who Self-Harm

An estimated one percent of Americans use physical self-harm as a way of coping with stress; the rate of self-injury in other industrial nations is probably similar. Still, self-injury remains a taboo subject, a behavior that is considered freakish or outlandish and is highly stigmatized by medical professionals and the lay public alike. Self-harm, also called self-injury, self-inflicted violence, or self-mutilation, can be defined as self-inflicted physical harm severe enough to cause tissue damage or leave visible marks that do not fade within a few hours. Acts done for purposes of suicide or for ritual, sexual, or ornamentation purposes are not considered self-injury. This document refers to what is commonly known as moderate or superficial self-injury, particularly repetitive SI; these guidelines do not hold for cases of major self-mutilation (i.e., castration, eye enucleation, or amputation).

Because of the stigma and lack of readily available information about self-harm, people who resort to this method of coping often receive treatment from physicians (particularly in emergency rooms) and mental-health professionals that can actually make their lives worse instead of better. Based on hundreds of negative experiences reported by people who self-harm, the following Bill of Rights is an attempt to provide information to medical and mental-health personnel. The goal of this project is to enable them to more clearly understand the emotions that underlie self-injury and to respond to self-injurious behavior in a way that protects the patient as well as the practitioner.

The Bill of Rights for Those who Self-Harm
1.  The right to caring, humane medical treatment.

Self-injurers should receive the same level and quality of care that a person presenting with an identical but accidental injury would receive. Procedures should be done as gently as they would be for others. If stitches are required, local anesthesia should be used. Treatment of accidental injury and self-inflicted injury should be identical. 

2.  The right to participate fully in decisions about emergency psychiatric treatment (so long as no one's life is in immediate danger).
When a person presents at the emergency room with a self-inflicted injury, his or her opinion about theneed for a psychological assessment should be considered. If the person is not in obvious distress and is not suicidal, he or she should not be subjected to an arduous psych evaluation. Doctors should be trained to assess suicidality/homicidality and should realize that although referral for outpatient follow-up may be advisable, hospitalization for self-injurious behavior alone is rarely warranted. 

3.  The right to body privacy.
Visual examinations to determine the extent and frequency of self-inflicted injury should be performed only when absolutely necessary and done in a way that maintains the patient's dignity. Many who SI have been abused; the humiliation of a strip-search is likely to increase the amount and intensity of future self-injury while making the person subject to the searches look for better ways to hide the marks. 

4.  The right to have the feelings behind the SI validated.
Self-injury doesn't occur in a vacuum. The person who self-injures usually does so in response to distressing feelings, and those feelings should be recognized and validated. Although the care provider might not understand why a particular situation is extremely upsetting, she or he can at least understand that it *is* distressing and respect the self-injurer's right to be upset about it. 

5.  The right to disclose to whom they choose only what they choose.
No care provider should disclose to others that injuries are self-inflicted without obtaining the permission of the person involved. Exceptions can be made in the case of team-based hospital treatment or other medical care providers when the information that the injuries were self-inflicted is essential knowledge for proper medical care. Patients should be notified when others are told about their SI and as always, gossiping about any patient is unprofessional. 

6.  The right to choose what coping mechanisms they will use.
No person should be forced to choose between self-injury and treatment. Outpatient therapists should never demand that clients sign a no-harm contract; instead, client and provider should develop a plan for dealing with self-injurious impulses and acts during the treatment. No client should feel they must lie about SIor be kicked out of outpatient therapy. Exceptionsto this maybe made in hospital or ER treatment, when a contract may be required by hospital legal policies. 

7.  The right to have care providers who do not allow their feelings about SI to distort the therapy.
Those who work with clients who self-injure should keep their own fear, revulsion, anger, and anxiety out of the therapeutic setting. This is crucial for basic medical care of self-inflicted wounds but holds for therapists as well. A person who is struggling with self-injury has enough baggage without taking on the prejudices and biases of their care providers. 

8.  The right to have the role SI has played as a coping mechanism validated.
No one should be shamed, admonished, or chastised for having self-injured. Self-injury works as a coping mechanism, sometimes for people who have no other way to cope. They may use SI as a last-ditch effort to avoid suicide. The self-injurer should be taught to honor the positive things that self-injury has done for him/her as well as to recognize that the negatives of SI far outweigh those positives and that it is possible to learn methods of coping that aren't as destructive and life-interfering. 

9.  The right not to be automatically considered a dangerous person simply because of self-inflicted injury.
No one should be put in restraints or locked in a treatment room in an emergency room solely because his or her injuries are self-inflicted. No one should ever be involuntarily committed simply because of SI; physicians should make the decision to commit based on the presence of psychosis, suicidality, or homicidality. 

10. The right to have self-injury regarded as an attempt to communicate, not manipulate.
Most people who hurt themselves are trying to express things they can say in no other way. Although sometimes these attempts to communicate seem manipulative, treating them as manipulation only makes the situation worse. Providers should respect the communicative function of SI and assume it is not manipulative behavior until there is clear evidence to the contrary.


Common Myths about Self-Injury

Self-harm is usually a failed suicide attempt.
This myth persists despite a wealth of studies showing that, although people who self-injure may be at a higher risk of suicide than others, they distinguish between acts of self-harm and attempted suicide. Many, if not most, self-injuring people who make a suicide attempt use means that are completely different to their preferred methods of self-inflicted violence.

People who self-injure are crazy and should be locked up.
Tracy Alderman, Ph.D., author of The Scarred Soul, addressed this:

"Fear can lead to dangerous overreactions. In dealing with clients who hurt themselves, you will probably feel fear. . . . Hospitalizing clients for self-inflicted violence is one such form of overreaction. Many therapists, because they do not possess an adequate understanding of SIV, will use extreme measures to assure (they think) their clients' best interests. However, few people who self-injure need to be hospitalized or institutionalized. 

The vast majority of self-inflicted wounds are neither life threatening nor require medical treatment. Hospitalizing a client involuntarily for these issues can be damaging in several ways. Because SIV is closely related to feelings of lack of control and overwhelming emotional states, placing someone in a setting that by its nature evokes these feelings is very likely to make matters worse, and may lead to an incident of SIV. In addition, involuntary hospitalization often affects the therapeutic relationship in negative ways, eroding trust, communication, rapport, and honesty. Caution should be used when assessing a client's level of threat to self or others. In most cases, SIV is not life threatening. . . . Because SIV is so misunderstood, clinicians often overreact and provide treatment that is contraindicated.

People who self-harm are just trying to get attention.
A wise friend once emailed me a list of attention-seeking behaviors: wearing nice clothing, smiling at people, saying "hi", going to the check-out counter at a store, and so on. We all seek attention all the time; wanting attention is not bad or sick. If someone is in so much distress and feel so ignored that the only way he can think of to express his pain is by hurting his body, something is definitely wrong in his life and this isn't the time to be making moral judgments about his behavior.

That said, most poeple who self-injure go to great lengths to hide their wounds and scars. Many consider their self-harm to be a deeply shameful secret and dread the consequences of discovery.

Self-inflicted violence is just an attempt to manipulate others.
Some people use self-inflicted injuries as an attempt to cause others to behave in certain ways, it's true. Most don't, though. If you feel as though someone is trying to manipulate you with SI, it may be more important to focus on what it is they want and how you can communicate about it while maintaining appropriate boundaries. Look for the deeper issues and work on those.

Only people with Borderline Personality Disorder self-harm.
Self-harm is a criterion for diagnosing BPD, but there are 8 other equally-important criteria. Not everyone with BPD self-harms, and not all people who self-harm have BPD (regardless of practitioners who automatically diagnose anyone who self-injures with BPD).

If the wounds aren't "bad enough," self-harm isn't serious.
The severity of the self-inflicted wounds has very little to do with the level of emotional distress present. Different people have different methods of SI and different pain tolerances. The only way to figure out how much distress someone is in is to ask. Never assume; check it oput with the person.

Only teen-aged girls self-injure.
In five years of existence, the bodies-under-siege email list has had members of both genders, from six continents, and ranging in age from 14-60+. It's a person-who-has-no-other-way-to-cope thing, not a teenage (or female or American or whatever) thing.



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