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From Susan's Place Transgender Wiki

Self-mutilation is the action of a person removing their own limbs or bodily organs, or maiming or mangling themselves.

Self-surgery often ends in self-mutilation. Excluded are the arts of scarification, tattooing and other forms of body art.

Self-harm, a related topic, most frequently connotes assorted sharp implements being used to inflict light, usually superficial cuts, as a way to produce a pain the person feels they can control. Unfortunately, this way to gain control can become addictive. Psychotherapy with a compassionate psychologist may identify the root cause of the desire to cut before serious harm results.

Contents 1 Self-Castrations and Self-Penectomies 2 Alternatives 3 Definition of Self-injury 4 Risk factors 4.1 Gender differences 5 Psychology 6 Motives 7 See Also 7.1 References 7.2 Sources 8 Discuss

[edit] Self-Castrations and Self-Penectomies

Some transsexuals have felt that cutting off the testes or penis would force the doctors to finish the job. More often than not, a skin graft is likely to be placed over the severed penis and the testes re implanted. A lengthy stay in a mental ward is likely for even otherwise sane men who castrate themselves. Since these injuries will reduce the tissue available for SRS, cutting the penile or testicle areas is not advisable for anyone who is considering SRS.

A possible complication to a self-inflicted penectomy includes regular need for urethral dilation under general anesthesia. The main hazard after genital surgery is infection. At the very least, DIY procedures remove skin that could be used in SRS, thus reducing vaginal depth. The hospital stays can run upwards of $12,000 USD.

[edit] Alternatives

• Identify and confront the root cause in psychotherapy
• Seek out a licensed body modification artist for cutting, tattooing, etc.
• Visit Thailand for low cost, few questions asked treatment (must be HIV-)

[edit] Definition of Self-injury

Self-injury (SI), also referred to as self-harm (SH), self-inflicted violence (SIV) or self-injurious behavior (SIB), refers to a spectrum of behaviors where demonstrable injury is self-inflicted.^[1] The term self-mutilation is also sometimes used, although this phrase evokes connotations that some find worrisome, inaccurate, or offensive.^[1] Self-inflicted wounds is a specific term associated with soldiers to describe non-lethal injuries inflicted in order to obtain early dismissal from combat.^[2][3] This differs from the common definition of self-injury, as damage is inflicted for a specific secondary purpose. A broader definition of self-injury might also include those who inflict harm on their bodies by means of disordered eating.

A common belief regarding self-injury is that it is an attention-seeking behavior; however, in most cases, this is inaccurate. Many of those who self-injure are very self-conscious of their wounds and scars and feel guilty about their behavior. This guilt often motivates them into going to great lengths to conceal their self harm from others. ^[4] They may offer alternative explanations for their injuries, or conceal their scars with clothing.^[5][6] Self-injury in such individuals is not associated with suicidal or para-suicidal behavior. The person who self-injures is not usually seeking to end his or her own life; it has been suggested instead that he or she is using self-injury as a coping mechanism to relieve emotional pain or discomfort. Studies of individuals with developmental disabilities (such as mental retardation) have shown self-injury being dependent on environmental factors such as obtaining attention or escape from demands.^[7] Though this is not always the case, some individuals suffer from disassociation and they harbor a desire to feel real and/or to fit in to society's rules. A common form of self-injury involves making cuts in the skin of the arms, legs, abdomen, inner thighs, etc. However, the number of self-injury methods are only limited by an individual's creativity and include, but are not limited to, compulsive skin picking (dermatillomania), hair pulling (trichotillomania), burning, stabbing, poisoning, alcohol abuse and forms of self harm related to anorexia and bulimia. The locations of self-injury are often areas of the body that are easily hidden and concealed from the detection of others.^[8] As well as defining self-harm in terms of the act of damaging one's own body, it may be more accurate to define self-harm in terms of the intent, and the emotional distress that the person is attempting to deal with.^[9] Neither the DSM-IV-TR nor the ICD-10 provide diagnostic criteria for self-injury. It is often seen as only a symptom of an underlying disorder, though many people who self-injure would like this to be addressed.^[6]

[edit] Risk factors

Although some people who self-injure do not suffer from any forms of recognised mental illness,^[5] many people experiencing various forms of mental ill-health do have a higher risk of self-injury. The key areas of illness which exhibit an increased risk include depression,^[10][11] phobias,^[10] and conduct disorders.^[12] Substance abuse is also considered a risk factor as are some personal characteristics such as poor problem solving skills and impulsivity. Emotionally invalidating environments where parents punish children for expressing sadness or hurt can attribute to a lack of trust in oneself and difficulty experiencing intense emotions.^[13] Abuse during childhood is accepted as a primary social factor,^[14] as is bereavement, and troubled parental or partner relationships. Factors such as war, poverty, and unemployment may also contribute.^[10][15][16] In addition, some individuals with pervasive developmental disabilities such as autism engage in self-injury, although whether this is a form of self-stimulation or for the purpose of harming one's self is a matter of debate.^[17]

[edit] Gender differences

The best available evidence to date indicates that four times as many females than males have direct experience of self-harm. Caution is however needed in seeing self-harm as a greater problem for females, since males may well engage in different forms of self-harm which may be easier to hide or explained as the result of different circumstances.^[4] The WHO/EURO Multicentre Study of Suicide, established in 1989 demonstrated that, for each age group, the female rate of self-injury exceeded that of the males, with the highest rate among females in the 13–24 age group and the highest rate among males in the 12–34 age group. However, this discrepancy has been known to vary significantly depending upon population and methodological criteria, consistent with wide-ranging uncertainties in gathering and interpreting data regarding rates of self-harm in general.^[18] Such problems have sometimes been the focus of criticism in the context of broader psychosocial interpretation. For example, feminist author Barbara Brickman has speculated that reported gender differences in rates of self-harm are due to deliberate socially-biased methodological and sampling errors, directly blaming medical discourse for pathologising the female.^[19]

This gender discrepancy is often distorted in specific populations where rates of self-injury are inordinately high, which may have implications on the significance and interpretation of psychosocial factors other than gender. A study in 2003 found an extremely high prevalence of self-injury among 428 homeless and runaway youth (age 16 to 19) with 72% of males and 66% of females reporting a past history of self-mutilation.^[20]

There does not appear to be a difference in motivation for self-harm in adolescent males and females. For example, for both genders there is an incremental increase in deliberate self-harm associated with an increase in consumption of cigarettes, drugs and alcohol. Triggering factors such as low self-esteem and having friends and family members who self-harm are also common between both males and females. One limited study found that, among those young individuals who do self-harm, both genders are just as equally likely to use the method of skin-cutting.^[21] However, females who self-cut are more likely than males to explain their self-harm episode by saying that they had wanted to punish themselves. In New Zealand, more females are hospitalised for intentional self-harm than males. Females more commonly choose methods such as self-poisoning that generally are not fatal, but still serious enough to require hospitalisation.^[22]

[edit] Psychology

Attempts to understand self-injury fall broadly into either attempts to interpret motives, or application of psychological models.

Motives for self-injury are often personal, often do not fit into medicalised models of behavior and may seem incomprehensible to others, as demonstrated by this example:

“

My motivations for self-harming were diverse, but included examining the interior of my arms for hydraulic lines. This may sound strange.[6]

”

Motives for self-injury can be different. Some feel as if they are not good enough and they might not want to take it out on the person who harmed them. It's often difficult for them to open up and tell about their "secret shame". Often when the sufferer does tell somebody there is a lack of understanding or knowledge of how to help.

Assessment of motives in a medical setting is usually based on precursors to the incident, circumstances and information from the patient however the limited studies comparing professional and personal assessments show that these differ with professionals suggesting more manipulative or punitive motives.^[23]

The UK ONS study reported only two motives: "to draw attention" and "because of anger".^[10] Many people who self-injure state that it allows them to "go away" or dissociate, separating the mind from feelings that are causing anguish. This may be achieved by tricking the mind into believing the suffering felt at the time is caused by self-injury instead of the issues they were facing before: the physical pain therefore acts as a distraction from emotional pain.^[5] To complement this theory, one can consider the need to 'stop' feeling emotional pain and mental agitation. "A person may be hyper-sensitive and overwhelmed; a great many thoughts may be revolving within their mind, and they may either become triggered or could make a decision to stop the overwhelming feelings."^[1] The sexual organs may be deliberately hurt as a way to deal with unwanted feelings of sexuality, or as a means of punishing sexual organs that may be perceived as having responded in contravention to the person's wellbeing. (e.g., responses to childhood sexual abuse).

Alternatively self-injury may be a means of feeling something, even if the sensation is unpleasant and painful. Those who self-injure sometimes describe feelings of emptiness or numbness (anhedonia), and physical pain may be a relief from these feelings. "A person may be detached from himself or herself, detached from life, numb and unfeeling. They may then recognise the need to function more, or have a desire to feel real again, and a decision is made to create sensation and 'wake up'."

It is also important to note that many self-injurers report feeling very little to no pain while self-harming.^[14] Those who engage in self-injury face the contradictory reality of harming themselves whilst at the same time obtaining relief from this act. It may even be hard for some to actually initiate cutting, but they often do because they know the relief that will follow. For some self-injurers this relief is primarily psychological whilst for others this feeling of relief comes from the beta endorphins released in the brain^[24] (the same chemicals that are thought to be responsible for the "runner's high" and are similar to morphine). Endorphins are endogenous opioids that are released in response to physical injury, act as natural painkillers, and induce pleasant feelings and would act to reduce tension and emotional distress.^[25]

As a coping mechanism, self-injury can become psychologically addictive because, to the self-injurer, it works; it enables him/her to deal with intense stress in the current moment. The patterns sometimes created by it, such as specific time intervals between acts of self-injury, can also create a behavioral pattern that can result in a wanting or craving to fulfill thoughts of self-injury. ^[26]

[edit] Motives

Self-injury is not typically suicidal behavior, although there is the possibility that a self-inflicted injury may result in life-threatening damage.^[27] Although the person may not recognise the connection, self-injury often becomes a response to profound and overwhelming emotional pain that cannot be resolved in a more functional way ^[4]. The motivations for self-injury vary as it may be used to fulfill a number of different functions.^[24] These functions include self-injury being used as a coping mechanism which provides temporary relief of intense feelings such as anxiety, depression, stress, emotional numbness and a sense of failure or self-loathing. There is a positive statistical correlation between self-injury and emotional abuse.^[10][28] Intense pain can lead to the release of endorphins^[24] and so deliberate self-harm may become a means of seeking pleasure, although in many cases self-injury becomes a means to manage pain, in contrast to the pain that may have been experienced through abuse earlier in the sufferer's life over which they had no control.^[27] For some people harming oneself can be a way to draw attention to the need for help and to ask for assistance in an indirect way but may also be an attempt to affect others and to manipulate them in some way emotionally.^[27][24] However, those with chronic, repetitive self-injury often do not want attention and hide their scars carefully.^[29]

[edit] See Also

[edit] References

[edit] Sources

• Misticals. Theoretically Beautiful http://www.bmezine.com/scar/A40310/scrtheor.html (1/2/2005).
• Wikipedia

[edit] Discuss

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This page was originally authored by members of Susan's Place Wiki Staff.