Until my last stint in residential treatment, I never though of self-injury as being contagious. Maybe this is because when I was younger, I couldn’t imagine hurting yourself. I hated getting a shot, letting alone the thought of self-harm. In my mind, it was something that crazy people did.
Now, unfortunately, it’s something that I struggle with (although I’m doing much better than a year ago). However, I noticed in residential treatment that when one or two people would self-injure, suddenly there would be a flare-up of self-harm… including individuals who had never done such a thing before.
I did a little research on this, and found some interesting information:
From Self-Injurious Behavior in Adolescents:
“It is widely assumed that NSSI is contagious, although lack of empirical data necessarily limits our capacity to test this assumption. Nevertheless, studies of contagion among adolescents in clinical settings demonstrate the tendency for NSSI to spread in a population [37]–[39] and the presence of self-injury in media, such as in music, movies, and newspapers, has increased dramatically in the past several years.”
The study gives several reasons for this:
- the shaping of norms
- providing social reinforcement of behaviors
- providing (or limiting) opportunities to engage in the behavior
- facilitating or inhibiting the antecedents for the behavior
Personally, I think that self-injury has become more socially acceptable than it was 10 years ago. It’s still not looked upon in a positive light, but it’s more common and easily recognizable. There’s a huge stigma attached to it, but maybe a little less judgment. As far as “providing social reinforcement of behaviors,” I think of that as showing the pain that someone is going through. A lot of the time people don’t know about emotional pain… but self-injury makes it more real an communicates “Hey, I’m not okay. Something is wrong.”
There’s also a great PDF (free full text) on The Influence of Social Contagion and Technology of Non-Suicidal Self-Injury, which I highly recommend that you take a few minutes to read.
Self-Injury and Subculture Status:
“Two patients in this study stated that cutting did not relieve any anxiety or anger, but rather were influenced by the self-injury of others because they themselves did not want to feel like outsiders. There was also an instance wherein a patient was treated by others with contempt and accused of being a fake. Two of the four patents who acted accusatory toward the “faking” patient had co-occurrences with this patient’s one instance of self-harm. This may indicate that there are social rules that must be abided by during instances of contagion, which may bring meaning or value to these events.”
In conclusion:
“…because of the nature of psychopathology and individual (developmental) differences in psychological functioning, it is likely that only some portion of the population would be susceptible to instances of self-injury contagion under normal circumstances.”
Like with everything, not everyone is predisposed to self-injurious behavior… but with the first point, I think it’s interesting (and unfortunate) that even individuals who weren’t inherently driven to self-harm engaged in the behavior anyway, because it was a sign of sickness. As competitive as eating disorders are, self-injury (kind of like the existence of trauma) someone makes you “sicker” than the rest.
My final thoughts:
There is a lot more research out there, but my big question is — does the learned self-injury continue after discharge? Or, is it limited to that residential / inpatient subculture? Many individuals learn to purge during treatment, and end up swinging to bulimia or purging anorexia, but I have no idea if that is the same situation with self-injury. I’d love to hear your thoughts.
In Finland, we have public healthcare and there’s only one clinic for ED treatment (adults). It’s kind of hospital ward, not a fancy treatment centre. There’s zero tolerance for self injury – you will be get kicked out, no matter how sick you are. It’s voluntary treatment and if you’re danger to yourself they can’t really prevent it. Of course shavers, scissors etc are banned, but still. If you’re acutely suicidal you’ll be kicked behind closed doors, “normal” SI patients are just sent home.. to gather motivation? I kind of understand that, but not really. It’s kind of childish punishment “go-home-and-think-what-you’ve-done”.
Last time I was allowed to stay after cutting because my discharge was scheduled within a couple of days. But one girl I met had been there at least 10 times within a year or two, since she always gave in and cut herself. Badly. Of course they’ll search her stuff, but she told me how she’ll take blade out of a pencil sharpener. She’s in very bad shape and I pray she won’t cut (or get caught) this time.. there’s little life left in her emaciated, badly injured and torment body.
I found the article is really helpfully, but it is so hard to stay on track to stop self injury.
When I was in an adolescent unit, I was getting CRAVINGS to self harm, which is crazy, because I’d never done it before! It was all over the place, and if you didn’t do it, you were really left out and you did seem “less ill” than the others- and the BIGGEST, most horrific insult you can say to someone in hospital is that they’re an “attention-seeker”. Everyone thought they were at some point, and everyone was accused of being one by someone.
As soon as I left I had no urges. It was just.. it seemed really appealing in a social and emotional sense. Everyone else was addicted, and I felt weak and attention-seeking for being hospital and not even having as much of a problem, and it gave them a reason to support each other and include each other in discussions. When you’re not a self-harmer in an adolescent unit, you can be shut out of most of the conversations!
Whilst I was there, since I wasn’t addicted to self-harm, I didn’t see the opportunities the others did- like how to make plastic really sharp and how to sneak in blades and what to use and such- so I didn’t have anything to cut with. The others were desperate and used anything. I did scratch at my hands and wrists enough to cause bleeding several times when I was anxious, and many months later I have marks from it still on my hands. However, I’ve only done it once since I left, and it feels like all my urges are “my own” again. Such as, wanting to purge/restrict- see, I know that’s me. Surprisingly, it was actually more difficult not to start self harming in hospital than it was to just keep on not having a self harm problem, despite all the “support”. So it must have been trigger central for the recovering self-harmers.
I felt really, really inferior in hospital and everyone there was paranoid about not deserving to be there, and if they weren’t, then they were in denial in a different, and were angry about being there for no reason. I think self-harm can really give you some physical proof that you’re struggling. You can look at the marks and say “there. look what I did. I’m so fucked up”.
I think it would have been similar if I’d been in somewhere like rehab- even if I’d never had a drug addiction, it would have started to look attractive.
And that could be because you’re totally cooped up in like.. two rooms all day in hospital, and there’s no connection to the outside unless you go on leave on the weekends, and waaaay more than we realise or admit, what we do is socially motivated. Which isn’t something to be ashamed of, we’re social animals and so society and community is crucial to our survival. You can tell how important it is by how people would rather DIE than be socially isolated- take the cases of bullying that lead to suicide. And we are constantly copying people around us, gauging what we’re doing by comparison, and it’s not always disordered, it’s how we function and learn. But when all you’re experiencing all day every day is people talking about and thinking about and engaging in self-harm, it becomes something that seems.. sensible, normal, your brain starts to take it as something relevant to surviving, because all you can see is how it’s so prevalent in life. It gets twisted, connected.
When not self-harming leads to social isolation, you will eventually self-harm. It’s different out in the world because you have different groups of people to emulate and fit with, but… in there, there’s ONE place and ONE population you’re stuck with. Almost every functioning human brain is strongly drawn to social conformity. It’s kind of considered a mental illness if it ISN’T. So, it’s to be expected. But I really think this issue should be addressed, or acknowledged by the units.
This got garbled because I didn’t plan it out before I said it.
Interesting…(I’m not a good speller). I agree about it being socially contagus especially in the adolescent & teenage years. I am 54, I starting cutting, (it did not have a name when I first did it 40 years ago) I don’t believe it was very common then, however I was 14, how would I know! I managed to not cut after the first 5 cuts at 14, for 39 years. Last year, was my breaking point. What is interesting to me is, and this has Nothing at all to do with your article, is it took my husband until 2 days ago to notice the 8″ scare on my upper arm! But back to what you were talking about, I can’t offer anything for residential treatment. But know of several teenagers whom have cut recently, because thier friend had done it and Recieved lots of attention at school. I never did it for attention, but rather a release of pent up emotion and self punishment, and the alleviation of internal hurt, and emotional pain. When these times hit me, just thinking about it, is joyous, and the thought of letting out internal pain is almost like having a candy bar sitting in front of me, that I can’t resist.
Just my personal thoughts on the subject. Yes, I’m under psych care and have been for 38 years, and take my fair share of meds a day. Have PTSD, depression, and last cutting was almost admitted to SilverHill treatment Ctr, was then told i had borderline personality disorder.
Thanks for listening and letting me put my 2 cents in. However arbitrary and disjointed my comments were.
I’ve never been in IP or residential, but after reflection upon my own experiences with self harm I realized that I didn’t start until there were people in my life doing it. I had though of harming myself, but never acted on those thoughts until I knew a few other people that were doing it too. And it’s something I’ve struggled with for many years now.
This is off topic, but: I check your blog regularly (even though I never comment!). Your insight amazes me. Thank you.