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Ask the Mental Health Expert Archives 2001-2004

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Wrist Slasher

Q. I first slashed my wrist in 1965 for self punishment and self-disgust. Since then I have fought the urge. When I get that urge, I talk with friends and am okay. However, when my friends mention it to me, I get the urge. When I think about it I want to do it. I have an urge to do it now. It is like a hunger and a thirst. How can I find out more about this disorder?

A. You are hardly alone in your struggle against self-injurious behavior (SIB)--this is a commonly reported issue in most clinical practices. SIB is not a specific disorder, but a type of behavior that has many different causes, including some psychiatric disorders. For example, individuals with autistic disorders may engage in head-banging, while some patients with schizophrenia may injure themselves because of an underlying delusional belief or command hallucinations.

Among those without such severe disorders, SIB can occur in many contexts and for many reasons, ranging from adolescent experimentation (nose piercing, etc.) to intense feelings of self-hatred. Many individuals who engage in SIB describe a need to feel real by cutting or injuring themselves. Others describe a build up of tension that is relieved only by cutting, burning, etc. Your experience of SIB as somehow satisfying a hunger or thirst is yet another underlying feeling.

Some evidence suggests biological abnormalities in some self-injurious persons; e.g., deficiency of the brain chemical, serotonin. This sometimes responds to so-called SSRI medications, such as Prozac or Zoloft. The classic book on this subject is probably Dr. Armando Favazza's text, Bodies Under Siege. A more recent work on this subject is Dr. Tracy Alderman's The Scarred Soul. You can also find helpful information on SIB at several on-line sites, such as www.palace.net/~llama/psych/injury.html.

However, if you continue to be troubled by these urges, or find it increasingly difficult to control them, my strong recommendation is that you seek out professional counseling with someone experienced in treating SIB. Some therapists provide a type of therapy called DBT--Dialectical Behavioral Therapy, pioneered by Dr. Marsha Linehan--which can be quite helpful in managing this difficult problem. Good luck!

November 2002

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