Self harm or self-injurious behaviour (SIB) is any behaviour initiated by an individual that results in physical harm to themselves (Murray, 2003). People are particularly at risk of developing self-harm behaviours if they have limited verbal communication ability, have vision or hearing impairments, experience social disadvantage, or have a dual diagnosis of mental illness and intellectual disability. People with intellectual disability who misuse alcohol or other drugs are at greater risk of self harm and suicide than others (Murray, 2003).
The research reports widely varying prevalence rates of self-harming behaviour among adult populations with intellectual disability – ranging between 1.7 percent and 41 percent (Cooper et al., 2009). Paley (2008) reports that, amongst community-based populations, 17.4 percent of adults with intellectual disability engage in self-harming practices and, in 1.7 percent of this group, the behaviour is both frequent and severe.
Self-harming behaviour can be a particularly difficult issue for caregivers and professionals to deal with in supporting people with intellectual disability. Vicarious traumatisation of caregivers is a serious issue. Paley (2008) outlines some of the common self-harm behaviours exhibited by people with intellectual disability:
- Face slapping or striking face and chest with knees
- Head slapping, rubbing or banging against surfaces
- Trichillotomania (pulling out your own hair)
- Self-induced vomiting or vomiting and re-ingesting
- Hand biting
- Eating inedible substances (pica), eating faeces (corprophagia)
- Skin-picking/picking at wounds
- Gouging of ears, mouth, nose, eyes, rectum and sexual organs
- Kicking or hitting body parts against hard surfaces.
Self harm is a serious issue for many people with intellectual disability and their caregivers. Although it is a difficult and complex condition to understand, self harm is often considered to be a way for people to cope with or express difficult emotions, when alternative means of communication are limited (DADHC, 2009).
Some reasons why people self harm include to:
- Communicate needs and wants
- Communicate that something is wrong
- Release emotions and feelings
- Produce feelings that sooth anxiety and tension (repetitive movement)
- Produce feelings of euphoria
- Punish self (relieve feelings of self-loathing or shame), or punish others
- Produce physical pain as a substitute for psychological pain, and feel the effects of opiate release in response to physical pain
- Self stimulate, or as a response to over-stimulation
- Generate a myriad of particularly-desired social or sensory responses.
Sometimes people with intellectual disability who develop early repetitive behaviours (such as rocking), which are initially beneficial for development (such as improving motor function), can later develop these behaviours to serve different purposes (such as to communicate the desire for assistance to walk). In some instances, these repetitive behaviours change over time from appropriate communication behaviours to inappropriate and self-injurious behaviour (for example, from rocking to banging head).
Understanding the reasons why a person self harms is important in any practice context, and comprehensive exploration of the issues and a commitment to helping the person communicate their needs is crucial to preventing an escalation of the behaviour. An increase in intensity and frequency of self harm is often a sign that the person is not being heard or understood. It is important to not minimise or ignore a person’s self-harm behaviour.