Saturday, October 24, 2009

Self-injury and affect regulation.

I am currently obsessing on self-injury---especially among studies that doen't neccessarily include autism or intellectual disabilities.  Abfh is right.  There's a lot out there.  It is a very common phenomena.  I thought the following gave a logical reason for it--to ease bad feelings (negative affect).  With a synopsis of 18 other studies, the author concludes that it helps them feel better (aka affect regulation function). 

1: Clin Psychol Rev. 2007 Mar;27(2):226-39. Epub 2006 Oct 2. Links

The functions of deliberate self-injury: a review of the evidence.Klonsky ED.

Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, United States.

Deliberate self-injury is defined as the intentional, direct injuring of body tissue without suicidal intent. The present article reviews the empirical research on the functions of self-injury. This literature includes self-reports of reasons for self-injuring, descriptions of the phenomenology of self-injury, and laboratory studies examining the effects of self-injury proxies on affect and physiological arousal. Results from 18 studies provide converging evidence for an affect-regulation function. Research indicates that: (a) acute negative affect precedes self-injury, (b) decreased negative affect and relief are present after self-injury, (c) self-injury is most often performed with intent to alleviate negative affect, and (d) negative affect and arousal are reduced by the performance of self-injury proxies in laboratory settings. Studies also provide strong support for a self-punishment function, and modest evidence for anti-dissociation, interpersonal-influence, anti-suicide, sensation-seeking, and interpersonal boundaries functions. The conceptual and empirical relationships among the different functions remain unclear. Future research should address the measurement, co-variation, clinical correlates, and treatment implications of different functions.

The picture?  I remember Bettleheim and his comparison of autistic children and Holocaust survivors.  I came across info that children who survived the Holocaust were referred to as "Les Enfants Terribles" , which was also a title of a book written in the 30's, that was made into a movie and  a play...but that has nothing to do with what was said.  Following is an excerpt from a website teaching children about the Holocaust from the memories of adults who were finally able to give their stories, the stories of survival, from when they were children and prisoners of Nazi camps.

They tried to resume normal lives, but they were very angry children and were called "les enfants terrible." Once they destroyed all their furniture in their dormitory. A doctor told them that it would be best for them to try and forget all that they had seen and to move on with their lives. Robbie thinks in retrospect that this was the right advice at the time. No one wanted to listen to their stories, and in any case, he felt it was too difficult to explain. Those who continued to dwell on their experiences and the fate of their families ended up in psychiatric hospitals.

One day, the survivors of the present day "bedlams", present day "death camps" may no longer be able to tell their stories. There has to be a better way.  When I was raising my son, praying over him in a hope that he would change....the heavens spoke to me that it wasn't him who had to change...IT WAS ME!  The kids being "treated" (little different from any other type of selfish prayer or shamanism, in some ways....) today do not need to change.  We have to change how we see them.

It doesn't just happen.  It's work...soul work.

I just go on and on and on, don't I?

Okay, here's the last tangent.  Remember "Spit Boy", who I hope I lovingly introduced the last tome...or tomb, I'm not sure.  They all seem to run together...

The one time nana-nana-nana-nana-nana-nana-nana-nana SPIT BOY! came to school without medication, he screamed almost the entire time. And I remembered this morning that on that day he kept biting himself constantly and crying. It was as if he was in a war zone, being constantly bombarded! We were used to ornery smiles. His medication was ritalin, I'm not sure what that means, but I'm pretty sure it was. How it kept him out of the war zone, I can't imagine.

You know, it is so hard to keep a focus.  I hope you'll forgive me.


abfh said...

Ritalin is an amphetamine, and what you're describing sounds like withdrawal symptoms.

r.b. said...

Oh my God...that could put a whole NEW spin to drug know, as in being abused by drugs. All I remember is he was suffering.

Jannalou said...

Withdrawal symptoms like that are uncommon if the medication is being used appropriately - amphetamines have an incredibly short half-life, unlike antidepressants and SNRIs (Strattera). Having been on amphetamines, an SSRI, and an SNRI, I can confidently state that amphetamines don't cause any kind of withdrawal symptoms if you happen to miss just one day.

What's interesting is that if the medication is unnecessary or the wrong one, it often increases anxiety. But if it's needed (as in ADHD), it lessens anxiety. I know when I was on the right medication (for me, Dexedrine) my anxiety levels were way down.

If the Ritalin was helping with ADHD symptoms, the behaviour could have been an attempt to cope with the disorganization of the brain without the medication. That's not really withdrawal, if you think about it.

I say this because people often hear "amphetamine" and immediately think "meth" or "addiction" or "danger," and if people are using amphetamines appropriately, they are neither addictive nor dangerous.

Anyway, I actually wanted to say that I perseverated on BPD for a while and looked at reasons for self-injurious behaviour because it struck me that sometimes behaviour isn't actually an attempt to communication anything. Sometimes people hurt themselves because they're trying to ease a different kind of pain (I recall pulling my hair to stop a headache when I was a child - it does work for a little while). Sometimes they do it to regulate their sensory systems. Sometimes they so it to let someone else know something is going on. Sometimes I think we hurt ourselves because it's become a habit. I hurt myself sometimes because I'm bored. (I recently took up knitting so I'd have something to do with my hands while watching TV. It's saving my feet from getting the skin peeled off them.)

r.b. said...


HI! Thanks for your input. Are your "perseverations" on your blog? I'd like to look it over, if so.

I still wonder, though, about the supposed safety of ritalin. It was schizophrenia in a patch form for my son a few years back. When he got too much, he had "visions", if you know what I mean. I took him off it, and he got suspended twice. Now we homeschool. But it was helpful in low doses for 9 years. It really did calm him.

Having said that, I use lexapro to settle my nerves. I've never gone off it, so I don't know what it is like. Better living through chemistry, my neighbor used to say.

Because it didn't seem necessary for the post, I neglected to say Bubba (spitboy) also suffered from Muscular Dystrophy. One of the aides read up on it, and it is supposed to be painful. Maybe the ritalin lowered his arousal level.

I don't know. I wish I had the answers. It seems so complicated.
But something tells me it shouldn't it is made complicated by failing to see what is right before our eyes. Like the blind men and the elephant.

I do digress...

Jannalou said...

No, I perseverated on that long before I ever got a blog. I do have the paper I wrote on the topic floating around somewhere, though; if I ever find it, I'll put it up on my web site and link to it from my blog. :)

At the wrong dose, Ritalin (and other amphetamines) can increase anxiety to a horrible level. When I was on too high a dose of Concerta, I had a week-long anxiety attack. (Not fun.) I've known two kids now who, when on Ritalin, began acting out and behaving completely out of character (one complained of being sick all the time; the other was non-verbal and PECS wasn't helpful enough so he started hurting others). Having lived through it myself, I was able to tell what was wrong. (Not that the professionals know this - the psychologist's remark was that Ritalin doesn't cause violence. I blogged about that a few years ago.)

I went off my meds last spring, and when I was going off the Cipralex (equivalent of Lexapro), I had the best brain zaps ever. Like, I felt like I was sideways while driving down the road, but I could tell that I was upright because of what I was seeing. Talk about weird! Going off Dexedrine was nothing like that - it was SO easy, and I took it easily as long as I took the Cipralex. Strattera was like Cipralex, but it didn't take as long for the zaps to fade; mostly I just got dizzy for a few days and then I was fine.

r.b. said...

When you say brain zaps...Like it's literally shorting out? I had that on paxil. I was in my room for a week or two, sleeping most the time, until it stopped.

It's weird, I had NO reaction to quitting Lexapro, except I became very, very passive, probably my natural state. How depressing!

Jannalou said...

Moments of dizziness and vertigo for me. I don't know if it's different for everyone or not. If you Google the term (with quotes around it) you'll find descriptions.

I actually just had a look at my mood tracking information, and my mood has evened out a lot. Last year I was very up and down, even during the summer, but this year I seem to have gotten to and stayed at baseline. If that changes, it's usually up. In fact, this month is nearly over and I've only had one downward blip. Quite amazing, really. :) I didn't start tracking until I was starting to taper the Cipralex, but I think it's interesting to see the changes, all the same.

Tanisha Eileen said...

It is very wonderful and beautiful to have come across this blog posting :)
I am 26 years old and have been dealing with self injury since I was 12. I can admit now that admitting to myself its still a problem has been hard to admit!
Since I have started to face this issue, and try to understand it and read about it the more I can see how common it is, and I can see how misunderstood it is.
What you said about changing how we view and deal with issues, its so so important and it made me happy to read because its so true.
Self injurers can be treated extremely poorly because it is just so misunderstood, by not just friends and family but even health professionals and definitely online strangers.
I can see the place that a self injurer can find themselves in not just facing their mind but such discrimination from the world and I feel a need to inform people of the seriousness of it!
Since trying to find research, its surprised me how little there is! so anyway I think it is awesome that you have said something about it!

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