Superficial Self-Harm: Perceptions of Young Women Who Hurt Themselves

By Ryan, Katherine; Heath, Melissa Allen et al. | Journal of Mental Health Counseling, July 2008 | Go to article overview

Superficial Self-Harm: Perceptions of Young Women Who Hurt Themselves


Ryan, Katherine, Heath, Melissa Allen, Fischer, Lane, Young, Ellie L., Journal of Mental Health Counseling


Although only 1% to 4% of the U.S. population engages in superficial self-harm (SSH), this behavior is much more prevalent in adolescents, with estimates ranging from 14% to 39%. While current studies primarily focus on clinical interventions, few have investigated SSH from an individual's perspective, and there is little guidance for family, friends, and others who desire to provide assistance. In particular, those in close contact with youth, particularly in schools, need basic information on SSH and suggestions for responding to students at risk. One-on-one, day-to-day, practical and effective intervention is needed. This study investigated the perspectives of 96 young women with a history of SSH. Based on their responses' to an Internet survey, friends and mental health professionals were perceived as most helpful in acknowledging the individual's emotional pain and distress. Participants also wanted others to be nonjudgmental, to permit emotional expression, and to acknowledge their availability to offer help. Translated into practice, young women who engage in SSH consider an accepting supportive relationship to be a critical element in their recovery.

Self-Harming Behaviors

Individuals are hardwired to survive, to automatically seek protection, and to avoid danger and injury. However, Favazza (1996) provides examples of rituals involving self-harm and physical deprivation that are perceived to serve a purpose in certain cultures, benefiting both individual and community. For example, in Morocco one group drinks boiling water and eats spiny cacti in an attempt to produce a psychic state and create unity with a higher spiritual force. During the New Year's festival of the Ivory Coast Abidji tribe, members participate in self-harm rituals to drive away evil spirits that threaten their community; following tradition, participants go into a deep trance-like state and, in an effort to rid their bodies of evil sprits, plunge knives into their abdomen.

Though it is against the natural instinct to protect oneself, avoid pain, and ensure self-preservation, in these situations self-harm is not only viewed as socially acceptable, it is condoned. These incidents of self-harm, woven into established spiritual rituals, are not considered pathological but are perceived as expressions of personal growth, sacrifice, and enlightenment (Favazza, 1996). However, in other situations, counter to societal norms, individuals may engage in self-harm ranging from minor scratching or cutting to extremely life-threatening behaviors (Nock & Prinstein, 2005). Typically, in mainstream American culture self-harming behaviors are seen as maladaptive and indicative of underlying emotional difficulties (Muehlenkamp, 2006, 2007).

In 1987 Favazza's classic book, Bodies Under Siege: Self-Mutilation in Culture and Psychiatry, expanded research interest and promoted professional conversation. Then, in a 1995 television interview, Princess Diana discussed her private struggle in coping with emotional pain, revealing that she was a "cutter" (Purington & Whitlock, 2004; Strong, 1998). Her admission challenged the longstanding stereotype of superficial self-harm (SSH). Previously perceived as an extreme behavior of the seriously mentally ill, SSH was redefined as a problem occurring in mainstream society. However, although public awareness of SSH has increased dramatically over the past several years, evidence informing effective research-based interventions is limited, particularly for adolescents (Bums, Dudley, Hazell, & Patton, 2005; Nock & Prinstein, 2005; Nursing Standard, 2005; Ross & Heath, 2002; Whitlock, Powers, & Eckenrode, 2006).

Overview of Self-Harming Behaviors

The current Diagnostic and Statistical Manual of Mental Disorders (DSM) does not list diagnostic criteria for self-harm (American Psychiatric Association, 2000). Rather, self-harm, referred to as self-mutilation in the DSM, is listed as commonly occurring with specific disorders, such as borderline personality disorder (BPD) and eating disorders (see also Favazza, 1996; Levitt, Sansone, & Cohn, 2004; Linehan, 1993, 2000). …

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