The professional literature provides abundant evidence that individual with autism exhibits a myriad of uncommon form of social interaction, communication, and behavioral pattern that often present major challenges to their families and professional providers. However, there is a noticeable shortage of quality research targeting self-injurious behavior in respect to people with learning difficulties.
One of the reasons that self-harming behavior remains largely an enigma is that when useful studies are done or appropriate theories developed they, too often, remain within a single domain such as mental health; and their broader application is not investigated. Therefore, a separate bodies of literature that consider the causes of self-harm for a particular group like people with learning difficulties are over due.
The term learning disability is used to refer to sociobiological conditions that affect a persons communicative capacities and potential to learn.
Someone with a learning disability does not necessarily have low or high intelligence, it just means this individual is working far below their ability due to a processing disorder, such as auditory processing or visual processing.
After three decades of active research interest a clear and useful definition for self-harm remains elusive. In fact, the search for understanding is the foundation of this complex phenomena that has been so absorbing to both researchers and practitioners. A wide definition would include the following: an intentional, self-directed act to destroy, disfigure or impair the appearance or function of some body part while inflicting pain; the act does not include suicidal ideation.
The language of self-harm presents a profound insight into how it is understood in society. For example, individuals who self-harm are, too often, called “self-cutters" The problem is that people become defined by their self-harming behavior, perhaps eclipsing other more validating defining labels, such as communication, oppression and abuse as the driving force behind self-harming activities; especially among individuals with learning difficulties.
According to recent research, self-harming is the most self-destructive behavior exhibited by people with learning difficulties. The most common these activities are head-banging, hand-biting, excessive self-rubbing, and scratching. Both individuals in general and individuals with learning difficulties engage in self-harming activities for many different reasons. However, the contributing factor for self-destructive behavior is often physiological, sociological, environmental, and psychological.
The negative effect of many of the labels used to describe self-harming behavior indicates that self-harming is perceived in our culture as socially unacceptable. Therefore, it is not always treated with compassion and understanding; and it may also be a source of guilt and shame to the individual who use this form of expression.
Studies had shown that the type of self-harming behavior engaged in act to reduced or relieved a specific form of anxiety. For example, hand-biting may be a reaction to frustration, excessive scratching could be a means of self-stimulation, and head-banging or ear-hitting may be the result of middle ear infection. Some self-injurious behavior may be the result of heightened-arousal, such behavior acts as a release that lowers the arousal state. Self-injury could be a form of self-stimulatory behavior that is repetitive, ritualistic that provide the individual with some type of sensory stimulation.
From a sociological perspective, an with learning difficulties may engage in self-harming activities to obtain attention from the environment. Often people with learning difficulties may engage in self-harming behaviors to avoid or escape unpleasant task. Research literature also suggests the possibility that self-harming activities may be related to hypersensitivity to sounds in the environment. If, for instance, a disturbing sound bothers an individual with learning difficulties he/she my communicates the discomfort by hitting one's head or ears.
The role of professional educators and caretakers is to conduct functional analysis to develop a complete description of the individual's self-harming activities and determine a possible cause and effect relationship between the activity and the environment; including social, physical, and psychological.
The two major sets of theories set forth to explain why people engage in self-injury are physiological and sociological. However, I strongly support the inclusion of a psychological theory to the mix.
The psychological connection is especially relevant to some individuals with autism or learning disabilities. It is widely recognized that this population is often limited in means of verbal communication. Therefore, individuals with autism or learning disabilities may rely on non-verbal means of expressing their emotions. This means of expression is very important if the emotional pain represents a re-stimulation of past hurts; such as physical, sexual, or psychological abuse. In such case, self-harm may represent the best attempt to assuage the of past abuse, neglect, and other trauma.
The psychological approach call our attention to many common themes that are the driving force behind many individuals who used self-injurious behavior as a means of expression. It cannot be purely coincidental that many of the same themes are reported by people who had been abused by someone in authority. These themes can be understood as “messages" that the individual either reinforces internally or wishes to share with caregivers and professionals
In a service-based environment, for example, individuals may feel that they have is very little control over what happens to them. Self-injurious activities may provide the only opportunity of self-control in a very personal manner; this can be very attractive when there is limited option for verbal expression. Also it is quite normal that as tension and stress mount people will seek ways to release the pressure. Individuals who use self-harm, to express emotions, find this method very effective, especially if it results in the flow of blood. For instance, if the psychological, physical, or emotional pain is too difficult to bear . . . or the origin of the abuse is unclear. . . it may be desirable to focus on deliberate self-inflicted pain that is controlled by the individual.
It is broadly accepted that people with low self-esteem tends to engage in self-injurious behavior more often than the general public. For example, if the internalized person is worthless there may be a desire “damage" the external image so that it mirrors worthlessness felt inside. Individuals with autism or learning disabilities who are often devalued, by society, and experience prejudice and personal rejections from the environment this would be a likely consequences of internalized oppression.
It is true for most individuals with developmental disabilities a variety of functions are served simultaneously by self-harm in a manner that is described as self-help. Viewed in this manner, self-harming behavior can be seen both as communicative and functionally adaptive as well. This, however, raises the possibility that is self-harm represents an intended message than accurate reading of the message will diminish the need for self-injurious behavior, which is the goal of treatment.
Clearly, self-harm would not be the communication medium of choice for all individuals with autism or developmental disabilities, but this approach may represent a last effort to focus attention on some past or present unmet needs.
The relationship between communication and self-harming behavior suggest that self-harm can be a “scream" without sound. Many individuals with developmental disabilities have limited means of self-expression, in which case, self-harm is a convenient language.
Finally, the exact relationship between self-injurious behavior and abuse is individualized and complex. However, to explicitly ignore or implicitly dismiss self-harming activities as just part of the syndrome is to ignore the true “message" of self-injurious behavior which may, in fact, become the ultimate abuse.
Dr. Smith is a psychotherapist and personal consultant with over 30 years experience working with individuals and groups. Dr. Smith specializes in working with Adult Children of Alcoholics, Survivors of Incest, Childhood *** Trauma, Survivors of Rape, and individuals experiencing symptoms of Depression, Anxiety, Relationship Concerns, and Symptoms related to Cigarette Addiction. Dr. Smith can be reached at: insightconsultant.com E-mail: firstname.lastname@example.org