二、自我傷害的誘惑及相關探討

(一) Definition

非自殺性的自傷行為(Non-suicidal self-inflicted Injury)，英文縮寫NSSI。當事人故意以某種方式造成自己身體上的傷害，但其目的並不再於造成不可逆的死亡。常見的NSSI有以下方式(資料來源:Walsh, 2006)，大致依照其發生頻率及普及性來做排序:

1. Carve or cut their skin(割、刮、切傷)

2. Bang or punch objects or themselves(撞擊傷)

3. Burn themselves(燙傷)

4. Embed objects under their skin(穿刺傷、自己施加的紋身)

5. 吞食廢棄物、扯頭髮

(二) Statistical

(資料來源: American Psychological Association, APA)

百分之十七的青少年承認其在過去至少執行過一次自我傷害行為。

“About a third of students reporting NSSI in two college studies said they had hurt themselves so badly that they should have been seen by a medical professional, but only 5 percent sought treatment, according to a random sample of students in eight colleges and universities reported in a 2011 article by Whitlock and colleagues in theJournal of American College Health.”

“As for adolescents, about 17 percent had engaged in NSSI at least once, according to an international meta-analysis of 52 studies, conducted by psychologist Jennifer Muehlenkamp, PhD, of the University of Wisconsin–Eau Claire and colleagues (Child and Adolescent Psychiatry and Mental Health).”

(三) Association

(資料來源: American Psychological Association, APA)

研究顯示NSSI預告了相對提高的自殺可能性，在一份關於美國五所大學學生的研究中，有NSSI行為但沒有自殺意念的學生，相對於對照組有高達3.4倍的機率在學期結束前從事自殺行為，因此雖然被稱為”非自殺性”的自我傷害行為，其仍反映著當事人背後需要陪伴及向外界求助的訊號，必須非常重視！

“Research also finds that NSSI is a strong predictor of later suicide attempts. In a 2013 study reported in theJournal of Adolescent Health, Whitlock, Muehlenkamp and colleagues followed 1,466 students at five American colleges over three years. Students who self-injured at the beginning and did not report suicidal thoughts, plans or actions at the time, but who went on to engage in 20 or more self-injuring behaviors, were 3.4 times more likely to have attempted suicide by the study's end.”

(四) Classification

(資料來源: Nixon& Heath, 2009)

Based on motivation, NSSI can roughly be divided into four categories

1. Automatic Positive Reinforcement(自我正/負增強)

2. Automatic Negative Reinforcement

3. Social Positive Reinforcement(社會正/負增強)

4. Social Negative Reinforcement

(五) Investigation

(資料來源: American Psychological Association, APA)

1. 關於身體的物化、自我貶低以及自我意識的消失

“Other risk factors are under the microscope as well. These include self-injurers' ability to endure pain, low feelings of self-worth (see article, page 59), tendency to objectify the body, and risk factors that overlap with those of other conditions like eating disorders.

Muehlenkamp is examining body objectification as an important potential factor in the development and maintenance of NSSI. The notion holds that when people see their own body as an object — the result of internalized cultural and familial pressures — it's easier to distance themselves psychologically from their bodies and hence to harm themselves.

A 2013 study by Muehlenkamp and colleagues inSuicide and Life-Threatening Behaviorsupports this hypothesis. Males and females with poor body regard who also scored high on emotion dysregulation were more likely to self-injure than people with poor emotion regulation but normal body regard.The findings suggest a potentially significant commonality between NSSI and eating disorders, which are present in as many as 55 percent of those who self-injure, Muehlenkamp adds."Body objectification, body devaluation and a lack of internal bodily awareness are also prevalent in that population," she says.”

2. 哈佛大學相關研究

Also known as non-suicidal self-injury, or NSSI, the condition is classified in the fifth edition of theDiagnostic and Statistical Manual of Mental Disorders(2013) as a "new disorder in need of further study," as well as a symptom of borderline personality disorder. Two researchers at Harvard University are taking a different tack on this inquiry. Although researchers generally accepted that NSSI helped people deal with strong negative emotions,Joseph Franklin was focused on the possible emotional benefits of NSSI and Jill Hooley was looking at the motivations behind it.

Professor Joseph Franklin

(1) 關鍵在於”後痛苦釋放”(pain offset relief)

That is, healthy controls showed exactly the same degree of physiological defensiveness and subsequent physiological relief as those who engaged in self-injury. Removing the stimulus does not return the individual to their pre-stimulus state, however. Rather, it leads them into a short but intense state of euphoria. The first time they hurt themselves, they experience unpleasant pain. But when they keep doing it and experience pain relief, they begin to associate cutting or other forms of self-injury with relief, and they return for more.

Professor Jill Hooley

(2) 自我貶低及自信心缺乏是主因

To ask the question a different way, why do self-injurers harm themselves instead of opting for healthier or more pleasant ways of relieving emotional pain, such as watching a movie, meeting a friend or going to a yoga class? Was this increased pain endurance linked to some of the psychological factors that are commonly associated with self-injury — depression, hopelessness or dissociation, for instance? How often they spontaneously described themselves as being "bad,""defective" or "deserving of punishment."

"It was as if harming themselves or experiencing pain was somehow congruent with their highly negative self-image,"she explains. The higher a person's score on negative self-beliefs, the longer they were willing or able to endure pain.

(3) 血、傷口、銳利物的連結作用

“Likewise, Franklin reasoned that most people would not be overly fond of stimuli that depict blood, wounds, knives or equivalent images. But he surmised that people who self-injure might feel differently, partly because his findings suggested they would associate such images with pain relief. "We're predicting that images of self-injury will activate reward-processing areas in the brains of people who engage in NSSI.”