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General Self Harm Articles

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True Causes of Self Mutilation and Injury
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CAUSES OF SELF-MUTILATION
TABLE OF CONTENTS
Introduction …………………….........................................1
Review of Literature …………...........................................1
Methodology ………….............................................. .....20
Findings ………………............................................ .......21
Discussion ………………............................................ ...23
Conclusions ……………............................................. .....25
Bibliography………….................................. .....................28
Appendix…..…...................................... ........................29


Introduction

There are two million or more Americans, and countless more around the world, who regularly injure themselves intentionally and compulsively. Over the years, there has been an alarming rise in the number of people who feel compelled to handle life’s frustrations by wounding their bodies. They use razor blades, fire, knives, and countless other items. The creativity of self injurers in finding ways to hurt and deform their bodies is astounding, but more important is the way in which they are all alike: they are struggling with inner conflicts that seem to vast to cope with.

Review of Literature

This study is being conducted to understand the reasons as to why people self mutilate. To reveal the causes of self-mutilation, the study must be broken down into three subtopics; Nature, nurture, and trauma. Self mutilation can be put into 3 types.
The first type is major self-mutilation, which is the most drastic. It is a result of psychosis or acute intoxication, exotic religious or sexual undertones. The subjects feel no pain or regret.
The second type is stereotypical self-mutilation. This is rhythmic and monotonously repetitive behaviors, associated with organic brain disease such as mental retardation, autism, and Tourette’s syndrome. It is believed that some highly repetitive behavior is to induce stimulation or reduce. It is also theorized that head banging may be an attempt to re-experience the comfort of hearing the mothers heartbeat in the womb.
The third type of mutilation is moderate self-mutilation. This is controlled and relatively shallow cuts. Some engage episodically, some repetitive. The injurer feels preoccupied by thoughts of cutting and feeling addicted. Depression, Post Traumatic Stress Disorder, Dissociating, Personality Disorder, and Obsessive Compulsive Disorder are also common.

Nature (Biological Characteristics)

Dissociation
Strong (1998) found that when a child is exposed to a severe trauma in early childhood, they learn to dissociate; to make their mind and body separate. Although dissociation is useful to survive an actual traumatic experience, it can become a chronic, automatic response to minor stressors reminiscent of the past trauma. The sensation of pain and the sight of blood breaks the depersonalization and proves to a self-injurer that they are still human.
Smith, Cox, and Saradjian (1998) explain that a traumatic experience in early childhood causes dissociation. At a later time, triggers associated with the original trauma can unconsciously lead to a dissociative state. Cutting relieves this state.
When people feel dissociated, they cut in attempt to feel the physical sensation of pain, the blood that will prove to them that they are alive, says Conterio and Lader (1998).
A study of self injurers with abuse histories (Conterio and Lader, 1998) shows that the self injurers feel separated from their bodies even when they do not consciously desire to feel that way. A study done by Clarke (1999) shows that self injurers want to relieve their dissociation; feeling pain is better than feeling nothing.

Cutting as a symbol
Strong (1998) shows that blood is used to represent healing and salvation. Cutting and sacrification during adolescent initiation rites are tests of strength, courage, and indurance that help mark the transition into adulthood. Cutting also connects with the Shamonic healing ceremonies and religious values.

Neurotransmitter Serotonin
A study (Smith, et al., 1998) found that when a person has high levels of stress, they have lower levels of the neurotransmitter, Serotonin. Low levels of Serotonin are linked with various kinds of impulse behavior and lack of constraint, making it difficult to resist the urge to self harm.
Strong (1998) shows that Serotonin is a critical neurotransmitter that influences mood and agression. A 1992 study of cutters and non-cutters found decreased serotonin activity in the cutting group.

Body Ego
Strong (1998) shows that on a subconscious level, stimulation of the skin through self-mutilation helps heal the injurers sense of self by reaching the body ego.

Primitive
Strong (1998) found that laboratory monkeys separated from their mothers during the first year of life became excessively fearful and aroused and engaged in self-mutilation; biting themselves, head banging, slapping their own faces, and sometimes attempting to chew off a limb. After self-injuring, the moneys would become calm.
Turner (2002) saw that experimental animals that have been exposed to inescapable stressors develop stress-induced analgesia. Fear activates the secretion of endogenous opioids, which can become highly addictive.

Opiates
Strong (1998) found some biological evidence that cutting and burning may release natural opiates and other brain chemicals, creating and an addiction and withdrawl cycle.
Intrusive thoughts or other reminders of trauma trigger an endorphin response that releases the body’s natural opiates and provides a form of analgesia.
In an unpublished study, Strong (1998) measured the pain response of eight self-injurers when they felt an extreme urge to cut. Six of the eight did not
register pain to any painful stimulus that could be applied within ethics. This condition response may take on the nature of an addiction, with cutters experiencing opiate withdrawl and cravings in the absence of stress or traumatic triggers.
(Smith, et al., 1998) Endogenous opioids are petrochemicals that are released when the body is in danger or injured. They act as pain killers, and people can become addicted to the calming effects of these opioids.

Stress Chemicals
Strong (1998) found that there are chemicals in the brain caused by sexual abuse; Catecholamines. The chemicals Epinephrine, Norepinephrine, and Dopamine are chemicals that are released by stress. Over time, abused girls showed signs that their stress response system was attempting to adapt to a chronic state of anxiety and hyper arousal by becoming under responsive to stress. Putman’s study of abused girls produced higher levels of these chemicals. These chemicals may be the chemicals that trigger the hyper arousal state in which cutters feel agitated and anxious. Reliving the trauma through flashbacks and nightmares releases these hormones and further engrains the traumatic memory.

Brain Chemistry
Strong (1998) found evidence that severe trauma may alter both the structure and chemistry of the brain and other body systems involved in the regulation of stress, making a permanent state of fear and anxiety.
Self Healing and Self Preservation
Strong (1998) argued that self injurers were groping for a means of self-healing and self-preservation. Drawing on the Freudian concepts of two primary opposing human drives (life instinct and death instinct), he believed that self-injury was a kind of compromise in an ongoing war between aggressive impulses and the survival instinct. Self-injury represented a sacrifice of one part of the body for the sake of the whole.
Turner (2002) discovered that self-injurers use their addiction as a way to self-medicate, as alcoholics and other addicts often do. Deliberate self-injury can be either a method of stimulation to escape depression, numbness and feeling “dead inside”, or a method to relieve anxiety and agitation.

Related Disorders
Turner (2002) found that there are many related clinical and personality diagnoses among self-injurers. Diagnoses such as post-traumatic stress disorder; dissociative disorders; mood disorders (depression and bipolar disorder); anxiety disorders; impulse control disorders; and borderline personality disorder.
The self-injurers have problems with interpersonal relationships, such as codependency, adult children of alcoholics, abusive romantic relationships, domestic violence, battered wife syndrome.
There are also Post Traumatic Stress Disorder, Dissociation, Anxiety Disorders, Impulse Control Disorders, Dissociative Disorders, Mood Disorders, and Borderline Personality Disorder.
Schizophrenia is a disorder of thought, a disorder of perception, a disorder of emotion, and a disorder of behavior. Self mutilation is common among schizophrenics because voices inside their heads command them to.
Obsessive Compulsive Disorder has also been linked with low levels of Serotonin.
Turner (2002) found that there are also many organic mental disorders linked with self mutilation, such as mental retardation, Lasch-Nyhon syndrome, Tourette’s syndrome, and temporal lobe dysfunction.
When self injurers have psychotic disorders, they may harm themselves in response to profound disorders of thought and perception, symbolic meanings, and under control of “outside forces”. The self injury may be a response to command hallucinations or delusions, particularly with religious themes.

Neurobiological Abnormalities
Turners (2002) current research on traumatized children has identified a wide range of neurobiological abnormalities in this population, and that children who have been victims of abuse have chronic problems with affect management, which range from extremes in hyperactivity to psychic numbing.

Analgestic or Palliative aims
Self mutilation is physically calming for the injurers. It makes them feel in control, and boosts their morale. The mutilation also makes them feel “cleansed”. (Conterio et al., 1998)
Strong (1998) tells that for someone who is over stimulated, self mutilation can “bring you down”, and for someone who is numb and dissociated, it can stimulate you.
Canterio et al. (1998) found that some self injurers may think that they are bad, have a bad soul, or that their emotions are bad. Bleeding them “out” makes them feel cleansed.

Communicative aims
Self mutilation will depict self-injurers emotional state and express their wishes, needs, and desires. It is used to communicate with themselves and others. Self injury can represent an act of vengeance, a reenactment of earlier abuse, or a desperate cry for help and compassion. (Conterio et al., 1998)

Endorphins
Clarke (1999) shows that self-mutilation causes a release of endorphins, the bodies natural pain relievers. Scientists think that endorphins are released when people self mutilate, triggering pleasurable feelings and a strong reinforcement to continue the behavior.

Post Traumatic Stress Disorder
Turner (2002) found that people with severe numbing almost always have PTSD. There is an interrelationship between trauma, particularly childhood trauma, and self injurious behavior.
Clarke (1999) suggests that whenever someone with PTSD feels anxious, they dissociate and hurt themselves.


Nurture

Self-Soothing and Trust
Strong (1998) shows that emotional attachments makes a child feel connected and supported, not alone and helpless. Abused and neglected children never learn from their parents how to soothe themselves and cannot trust others to
help them do so. They may turn to cutting and other forms of self-injury as a means of self-soothing and reestablishing, at least temporarily, biological and psychological equilibrium.

Body Language
Strong (1998) viewed her patients cutting as a form of physical communication dating back to maternal deprivation at a preverbal stage of life.

Body Image
More girls than boys are likely to self injure. Strong (1998) shows a contributing factor to be that girls have to pull away from their mothers to become an individual when their bodies start to resemble their mothers. Boys do this at a younger age, giving them more time to adjust.

Boundaries
Strong (1998) found that some people cut to mark the bodies boundaries. It allows abuse survivors to reclaim their bodies so the abuser will no longer desire them. Wounds may also serve as a badge of proof, a marker to punish an abusing parent, and makes them take notice. It is a symbolic cry for help or a manifesto resistance.

Love
Some children may associate pain with love. They may hurt themselves to feel close to their abuser. Pain and self punishment, comforting is its familiarity, maintains the psychic relationship. Cutting can recreate a childhood drama, but also control the outcome. The only physical contact some children had was abuse, so they recreate that to feel loved. The injurers can play the part of the abuser, the victim, and the loving caretaker. Some also try to get therapists and emergency room doctors to care for them, to prove that they are loveable. (Strong, 1998)
Children are dependent on their parents for survival, and sometimes they
can’t believe that their parents are malevolent. Instead, they internalize their parents “badness” as part of themselves.
Clarke (1999) describes that children may connect violence with love. When an adolescent feels alone and unloved, they may self mutilate to revive the
memories of their earlier abuse. Survivors of abuse hurt themselves because it conjures up memories of connection.

Reality vs. Fantasy
Strong (1998) found that some self mutilators punish themselves for pleasure felt by sexual molestation. When adults tell children that something did not happen, the children don’t trust their sense of reality, but believe that cutting is real.
When abuse is denied, and the family lacks empathy for the child’s suffering it is much more difficult for the child to give appropriate meaning to the experience.

Familiar roles
Strong (1998) conducted a study of 53 self injurers and 52 non self injurers. Walsh found that through the action of self mutilation, cutters have acted out all the familiar roles of childhood: the abandoned child, the physically damaged patient, the abusive victim, the dissociated witness to violence and the self-destructiveness, and the aggressive attacker.

Common Characteristics
Strong (1998) shows that cutters were more likely to have lost a parent of been placed outside the home, suffered a childhood illness or had surgery, had been the victim of sexual or physical abuse, and witnessed impulsive and destructive behavior in their homes, such as domestic violence and alcoholism. Problems in adolescence that seemed to spark episodes of self injury were recent loss, isolation from peers, and conflict.
Conterio et al. (1998) found that most self injurers were abused by their families emotionally, physically, sexually, or through neglect. Chaotic events such as a divorce, dramatic geographical move, or the death/ life threatening illness of a relative are common. Most self injurers have emotionally fragile parents and suffered from lack of touch, comfort and affection.
Many self injurers report that their absent or emotionally unavailable caregivers made them feel continuously endangered and profoundly vulnerable.
Families of self injurers enforced strict and rigid codes of morality and behavior, and also taught their children to not express anger.
Strong (1998) of the American Journal of Psychiatry found patients suffered great instability in their early lives and family relationships.

Childhood Experiences
Strong (1998) concluded that most self injurers had painful childhood
experiences, such as emotional deprivation, physical neglect, emotional abuse, physical abuse, sexual abuse, and childhood loss.
In 1979, it was speculated that early emotional deprivation was a major cause of self harm. (Strong, 1998)
Also, Turner (2002) concluded that disruptions in early care giving may have long-term consequences for biological self-regulating systems, leading to self mutilation.

Unhealthy Environment
Strong (1998) found in a 1989 study of adolescents in the United Kingdom that those who had come from an unhealthy or inadequate environment and were lacking self esteem were more likely to develop behaviors that were dangerous to their health.

Contributing factors
Among patients who injure themselves moderately, Strong (1998) found their reasons to be tension release, establishing control, feeling secure and unique, returning to reality, venting anger, irresistible urges, relief from alienation, and conforming negative self-perception.
Strong (1998) shows that self injurers where were abused as children have a damaged sense of control over their bodies. Self injury permits control over the rapture of skin/environment boundaries.

Religious
Turner (2002) shows the many connections of self mutilation and the bible. The Gospel of Mark 5:5 describes a man who “night and day would cry aloud among the tombs and cut himself with stones”.
Matthew 5:29, 30 says “And if thy right eye offend thee, pluck it out. And if they right hand offend thee, cut if off”. In Matthew 19:12, eunuchs castrate themselves “for the sake of the Kingdom of Heaven”. (Strong, 1998)
Strong (1998) found that patients with major mutilation had their motives drawn form religious beliefs (Catholics). Strong also found people mutilated to identify with religious sufferings; to atone for sins; obey a “heavenly command”; rid themselves of demons; or to make a sacrifice to god.

Contagious
Clarke (1999) shows that young people who are sent to detention centers or hospitalized in psychiatric wards will be exposed to others who already practice self mutilation and will mock their behavior.

Self Direction
Smith et al. (1998) says that when children do not have their needs met or are actively abused, they develop a very powerful anger as protest. Children are often punished for any exposed anger, and therefore if children cannot hold angry
feeling “in”, and have been socialized not to express them outwardly, the anger
becomes directed inwards onto themselves. Women often justify directing anger at themselves because of perceived feelings of failure and inadequacy; often related to relationship difficulties. Some survivors of childhood abuse take on the beliefs of those the perpetrated the abuse against them (that they deserved the abuse). Anger then becomes directed inwards.
Canterio et al. (1998) shows that self injurers who grew up in violent and angry homes feel that when you become angry, you must be violent, but that it is safer to direct the violence onto yourself.
Clarke (1999) explains that people who are trying to live up to other peoples expectations (and fail) can make an adolescent feel anger, anxiety, disappointment, and self-disgust. Also, when children are encouraged to not discuss their feelings, they develop unhealthy coping behaviors.

Self Punishment
Smith et al. (1998) say that some use self harm as a punishment for experiencing emotions they feel they should not have, it relieves guilt.
Clarke (1999) show that feelings of shame and a sense of being responsible for the abuse can lead to self harm. Also, abuse victims can feel responsible for abuse.

Expression
Smith et al. (1998) show that self injury can be a means of showing others that the injurer is hurting.
Conterio et al. (1998) show that self injurers have difficulties identifying and communicating emotional states, wishes, and needs. The injurers grow up feeling misunderstood and neglected.

Coping
Conterio et al. (1998) found that injurers use self injury to continue to cope in circumstances that seem to be oppressive.

Caring Response
Conterio et al. (1998) say that self injury is used as an attempt to engage in the caring response of others. Clarke (1999) also found that self injury is a way of getting attention from neglective parents.

Others
Conterio et al. (1998) concludes that some self injurers harm themselves to test family and friends of their trust and concern.
Conterio et al. (1998) shows that sufferers are unable to put into words their feelings of anger and maltreatment. They self injure to show how much they hurt.

Differentiating
Conterio et al. (1998) say patients whose families intruded on their bodies often describe self injury as a way of differentiating themselves from others.

Puberty
Conterio et al. (1998) found that self injurers report a nightmarish experience of puberty and their first period.
Strong (1998) found that when a child has been sexually abused, they feel disgusted by their bodies and fear that becoming more sexually desirable will only put them at greater risk of victimization. Many cutters are discomfited by the sense of a loss of control over the body and its functions with the onset of menstruation and other physical changes at puberty. Some psychoanalysts theorize that cutting is a way of identifying with the mother by simulating menstrual bleeding. Whether or not that symbolism is apt, the girl can control the bleeding she produces by cutting, unlike the out of control bleeding of menstruation.

Nurture
Clarke (1999) says that by creating a wound, self injurers externalize the emotional pain. Nurturing the pain and making it heal makes the injurer feel loved and “better”.

Trauma

Sexual Abuse
In many studies of self injurers, Strong (1998) found that 50-90% report being sexually victimized as children.
Smith et al. (1998) shows that if an abused fetished any part of a persons body, they may particularly attack that part because they feel it is responsible for their abuse.
Some people who experienced sexual abuse in their childhood feel intense anger and guilt because their bodies reacted normally to sexual stimulation and they became sexually aroused during the abusive interaction. This may cause difficulties later when sexual arousal during consensual experiences becomes a trigger to aversive memories including traumatic flashbacks. This can lead to self harm.
Conterio et al. (1998) found that the body is an object both desired and despised by the abuser, and viewed with loathing by the victim as the cause of their pain and suffering.
Many self injurers want to make themselves unattractive, usually because of their mistaken belief that rape and incest are brought on by irresistible physical beauty or provocative clothing.
Turner (2002) found childhood sexual abuse and emotional neglect were significantly associated to adolescent self mutilation. Emotional neglect was more strongly associated.

Reenactment of Trauma
Strong (1998) found that victims may dissociate, so the body reenacts to understand and remember the trauma.
Smith et al. (1998) suggest that acts of self harm may be a reenactment of
violations in attempt to understand and resolve the experience. Also, Conterio et al. (1998) says that injurers may reenact previous abuse in a way that leads to their command over the previously overwhelming trauma.
Clarke (1999) shows that the self mutilator has incorporated the role of the abuser and the victim.

Dissociation
Turner (2002) suggests that by picking up subconscious cues in the environment, a physically abused child may subconsciously learn that when someone inflicts pain on their body, that they can “go away”, or escape. Therefore, when they inflict pain on themselves, they can escape again.
Hostile Caregivers
Turner (2002) found that 41% of a group of physically and sexually abused children engaged in head banging, biting, burning, or cutting. Research concluded that self injurious behavior, which is often enhanced by the ego deficits and impaired impulse control of the abused children, seemed to represent a learned pattern originating from early, painful traumatic experiences with hostile primary persons.

Release tension

Smith et al. (1998) found that self injurers harm to release tension that arises form the experience of trauma in early life.

Survivor guilt
Smith et al. (1998) suggest that witnessing violence in the home leads to powerless feelings of hopelessness and guilt that you were not the one who was hurt, leading to punishment.
The causes of self mutilation seem to be greater from nature and nurture, than from trauma. Although the causes are greater in nature then that of trauma, the basis of the biological and psychological abnormalities are usually present because of childhood trauma. All three causes of self mutilation are interlinked, and most problems cause more problems in other areas.

Methodology

Research Instrument
Three interviews were conducted to find the causes of self mutilation. The interviews consisted of 24 main questions, with other questions based on the interviewees responses. The questions in the interview were about the respondents childhood, psychological state, and personal views on self mutilation. The questions that were closed ended usually had one or more open ended follow up questions.

Sample

Three people took part in the interviews. Two of the respondents were female (15 and 18 years of age), and one male (17 years of age). Kim and Karmen began to self injure during their adolescence, having done so for 3 years, while Sean began when he was a child (7 years old), and has mutilated for 10 years. Karmen and Sean began to injure because of instincts, while the other began when she heard about it from friends, and all have friends who also injure. All those interviewed cut, while Karmen and Sean burn, Karmen scratches, and Sean pierces.

Data Collection

The respondents were two females, and one male, whom I previously knew. Kim is 18 and lives in Port Alberni, B.C., Karmen is 15 and lives in Thunder Bay, Ontario, and Sean is 17 and lives in Ottawa, Ontario. Two interviews (Sean and Kim) were done on the phone, and Karmen in person. All interviews were completed within a few days of each other.

Findings

Kim described her childhood as average with some emotional abuse, and the others interviewed described their childhood as broken. Karmen had an alcoholic and neglective mother, and absent father and older brother. Sean had abusive and neglective parents, and he also grew up around large amounts of illegal drugs and violence. Kim did not experience any trauma or neglect, while the other respondents did. Karmen had family loss, abuse (sexual abuse) and a neglective mother, while Sean experienced loss of friends, severe abuse (physical and sexual abuse), and neglective parents.
All the respondent’s parents have been addicted to a substance, and also all the respondents have been addicted to a substance themselves. Kim’s parents are addicted to cigarettes, and her to alcohol; Karmen’s mother is addicted to alcohol, and her to marijuana, speed, pain killers, and alcohol (although she had overcome most of these addictions); and Sean’s parents were addicted to cocaine, heroine, glue, and LSD, and he to cocaine and heroine (although he has not partaken in the drugs for 3 years).
All the interviewees have manic depression, and Karmen and Sean have dissociation. None have been hospitalized because of their injuring, and none feel that they partake in harming themselves for attention.
All have used drugs while self injuring, and it has increased the urge for Kim and Karmen, but not been a factor for Sean.
Karmen and Sean feel numb before self injuring, while they all feel angry. None feel much pain while self injuring, and all feel ’alive’ afterwards, but Kim
and Karmen feel guilty after. All respondents harm to relieve anger, Karmen and Sean to relieve dissociation, punishment, and Karmen for sexual reasons, and Sean for lack of reason to live, art, and religion.
All enjoy self mutilation, but Karmen only enjoys it during the act itself. All are discouraged to harm by friends, but Kim and Karmen feel that they are addicted to injuring themselves.
Karmen has sought help for mutilation (it did not help), but the others have not.
Sean has stopped self mutilating within the past four months because of emotional support and love, while the rest have yet to find a reason to stop.

Discussion

From the comparison of interviews, it was shown that a primary reason that a person self injures is to exit from a dissociated state. When Sean was abused as a child, he would dissociate during the acts of violence or molestation. It was shown that after a small event reminiscent of the previous abuse, Sean would dissociate and harm himself to relieve these symptoms. This was also present with Karmen, who injured herself to relieve depersonalization.
It was also shown with Karmen and Sean that they had primitive instincts to harm themselves. When they were young and were separated from their families, or mothers, they reacted by harming themselves. This was also present in laboratory monkeys who were separated from their mothers (Strong, 1998).
All three respondents felt little or no pain when they injured themselves, which is an effect of endogenous opioids (which are petrochemicals), which act as a pain killer when the person is in danger or harmed (Smith et al., 1998). People can become addicted to the calming effects of these opioids, which is the case with most.
It was found that manic depression is very common amongst those who self injure, and this disorder was present with all respondents.
It was found that if a child has emotional deprivation, physical neglect, emotional/physical/sexual abuse, and childhood loss, they are likely to self injure (Strong, 1998), which is present with all three subjects.
Strong (1998) also found that if a child had a unhealthy environment while growing up, they were likely to have low self esteem and develop behaviors that were dangerous to their health, which is true for Karmen, but more prominent in Sean.
Stong (1998) found that some children may associate pain with love, especially if the child was abused while growing up. This may be present with Karmen and Sean who were both sexually abused, and mainly Sean who was also physically abused.
Smith et al. (1998) said that some self injurers may do so to punish themselves because they feel guilty for any abuse experienced as a child. This is true with Sean, who feels guilty for his abuse.
In many studies (Strong, 1998), self injurers reported being sexually abused (90%), which is the case with Karmen and Sean. It was also found (Strong,
1998) that self injurers harm to release tension that arises form the experience of trauma in early life. This is true for all respondents.
The subjects that were interviewed had only depression and dissociation, but no other psychological disorders that are usually related with self harming. Also, they did not cut to communicate with other people (Smith et al., 1998), or to cleanse (Clarke, 1999). They did not cut to sooth themselves (Strong, 1998), or because of a traumatic puberty or body image (Conterio et al., 1998). None of the people cut because of the Catholic religion, or to show vengeance or test the caring response of others (Conterio et al., 1998). Also, the studies did not harm as a reenactment of trauma that they have experienced in their childhood, which was expressed as a reason for self injuring in the secondary source (Strong, 1998). Some things that were found in the study but not in the review of literature is that Sean cut for a different religion (demonism), and also for artistic reasons (scarification).
The study could not relate some of the scientific reasons with the interview subjects (such as the Neurotransmitter Serotonin, stress chemicals, brain chemistry, and neurobiological abnormalities), because it is difficult to find from only interviews. To research these causes, the respondents would have to go through intense psychological test, as well as scientific tests.
Also, the respondents may have withheld some information because of embarrassment or loss of the memories.

Conclusion

Most of the research results were previously discussed in the review of literature. None of the respondents were exactly the same, but all had similar characteristics. A more complete and scientific study would be helpful to understand the biological, chemical, and psychological brain aspects of the interview subjects, which would help connect them to more of nature and scientific aspect of the study.
The study would be valuable to self injurers and family of self injurers because it would help to show the root of the problem. Self injury cannot be stopped unless the injurer understands and tries to fix the initial problem. It would help to show families that self injury is a coping mechanism, and that there are healthier coping mechanisms.
The hypothesis was supported by the interview results,. Almost all of the reasons given by the interviewees was stated in the review of literature, which was based on the hypothesis that there are three main reasons as to why people self injure: nature; nurture; and trauma.
Although it may be inevitable for a person to begin to self injure, society must have an overall desire to help people who self injure, and not isolate or look down upon them. People must realize that self mutilation is a coping mechanism, and that self injurers harm because of the emotional turmoil that they feel inside. It is impossible to generalize all self mutilators into the same category, because all harm themselves for very different reasons, ranging from punishment to love. Society must dispel all the myths surrounding self mutilation, or sufferers will continue to keep quiet or refuse help from others. Because every 4 in 100 teenagers self injure, it is important for the public to become educated about the issue and its reasons before it gets worse.

Bibliography
Clarke, Alicia. (1999). Coping with Self Mutilation.
New York: The Rosen Publishing Group, Inc.
Conterio, Karen and Lader, Wendy. (1998). Bodily Harm.
New York: Hyperion.
Cox, Dee, Saradjia, Jacqui, and Smith, Gerrilyn. (1998). Women and Self Harm.
New York: Routledge.
Strong, Marilee. (1998). A Bright Red Scream.
New York: Penguin Group, Inc.
Turner, V.J. (2002). Secret Scars.
Center City: Hazelden.

Appendix
Self Mutilation Interview
1. How old were you when you started to self mutilate?
2. How long have you been self mutilating for?
3. How did you find out about self mutilating?
4. Do you know anyone else who self injures?
5. How do you injure yourself?
6. How would you describe your childhood?
7. Did you experience any trauma as a child?
8. Were you physically/sexually abused as a child?
9. Were you neglected as a child?
10. Did you have a traumatic time while going through puberty?
11. Have your parents/caregivers ever been openly addicted to anything?
12. Do you have any psychotic disorders?
13. Have you ever/are you addicted to anything?
14. Have you ever been hospitalized for mutilating?
15. Do you self mutilate to get attention from parents, therapists, or hospital personnel?
16. Do you use drugs before, after, or during self mutilation?
17. How do you feel before and after you self injure?
18. Do you feel ashamed afterward?
19. What reasons do you have for self injuring?
20. Do you enjoy self mutilation?
21. Do you feel pressured by peers to self injure?
22. Do you feel that you are addicted to self mutilation?
23. Have you ever sought help for mutilating?
24. Do you plan on stopping self mutilation? How?

StatCan Statistics
-4 in every 100 teenagers self injure
-1 in every 10 people are connected directly to self harm - either they have done it themselves, or are close to someone who does.
- Fewer than one third of people who hurt themselves have ever tried street drugs.

Samaritans (UK) Statistics
1 in 10 children Self-Harm at some stage during their teenage years
43% of people know somebody who self-harms, or who did...but just might not know it.

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