Friday, January 16, 2009

Thoughts on the Course of Self-Injury

by Tara Deliberto

Non-Suicidal Self-Injury (NSSI) refers to the direct and delibertate destruction of one's own body tissue without intent to die. Most people who engage in NSSI use razor blades or knifes to break the skin in an attempt to regulate their emotions. I usually describe NSSI in this way to my friends: Did you ever see a movie where someone was losing control, a friend slapped them in the face, and then the person suddenly regained control? Well, NSSI is like that only it is the person who hurts themselves. To the shock of most of my friends, less often, people report engaging in NSSI for social gain- i.e. getting attention or eliciting sympathy.

Nock & Prinstien outline the four reasons/functions people report for engaging in NSSI; however, not only can one person be engaging in NSSI for two or more reasons in one instance, I think there is a more dynamic process of development and maintenance of NSSI through various functions at different times.

At first I thought social reinforcement ("doing it for attention") could certainly be a secondary gain of engaging in NSSI (exactly like social support being a "secondary gain" in treatment of medical illnesses) and therefore, help maintain the behavior after the first episode. Then I started thinking... well, for that matter, one could also initially engage in NSSI primarily for social approval and also feel a decrease in physiological arousal, right?. That lead me down the path of wondering what functions maintain the behavior over time.

Surely, one can start engaging in NSSI solely for social reinforcement, which then elicits a positive emotion. But then, after a while, perhaps engaging in NSSI in the absence of reinforcement from other people can decreases negative emotions without necessitating actually receiving support (Pavlov's dog style!!!). Again... for that matter... the reverse is probably true too! For example, some people could engage in NSSI for the first time in the total absence of social support and receive an automatic decrease in physiological arousal. Over time, after eventually sharing this information and gaining social support, the behavior that was once used as a tool for automatic physiological arousal decreases can be used to solicit social support.

I would certainly expect an even more complex and dynamic system of functions maintaining the behavior to develop over time, with each relevant function contributing a varying amount. Additionally, I would expect the range of situations prompting the usage of NSSI to range anywhere from narrow to broad/generalized over time (meaning that it can go from broad to narrow to broad... or narrow to broad to stopping completely... or any combination over time, NOT just narrow to broad!).

In short: NSSI is a multipurpose tool that is automatically picked out of the toolbox in response to a wide array of situations and can fix the problems in different ways over time.
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