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Section 1. Medical psychology
Ding Shaojie, Ph.D., Karazin University V. N. Karazin Kharkiv National University E-mail: din256@ukr.net Zhao Xin, Ph.D., Karazin University V. N. Karazin Kharkiv National University E-mail: zhao262@ukr.net Wen Hong, Karazin University V. N. Karazin Kharkiv National University E-mail: ven_@ukr.net
THE SPECIAL FEATURES OF CHILD-PARENT RELATIONSHIPS OF ADOLESCENTS WITH SELF-MUTILATING BEHAVIOR
Abstract. Summary. The article is devoted to the study of the special features of child-parent relationships of adolescents with self-mutilating behavior. It shows that highly intensive emotional reactions of self-mutilating character are consolidated involuntarily in family atmosphere. The self-harm act, on the one hand, lowers the intensity of painful emotions, and on the other hand, negatively consolidates self-harm which is seen as an effective means of avoiding emotional pain.
Keywords: self-mutilating behavior, adolescents, child-parent relationships.
Problem statement. The problem of self-muti- appearance and course of this or that behavior form.
lating behavior among adolescents has been faced Self-mutilating behavior can be determined as a wide
in the psychologists' practical activities quite often range of actions, connected with intentional physical
recently [1; 2; 3; 4]. For a long time self-mutilating harm of one's own body. Such actions can appear in
behavior was narrowed down to suicide attempts, the result of both pathological and non-pathological
it was considered to be the symptom of borderline mechanisms. They can be a symptom or a conse-
personality disorder, was misinterpreted in mass quence, a part of cultural or social ceremonies. Such
media and misapprehended in society. This led to actions can also take part in identification processes,
the appearance of a great number of myths, misin- connected to age, gender, social or cultural environ-
terpretations, and, as the result, ineffective forms of ment [2; 5; 6].
treatment when faced with such behavior. Today there are different kinds and forms of beTo adequately determine the work targets the havior aimed at body harm. To these refer the fol-specialists need to understand the mechanisms of lowing: eating behavior disorders (anorexia and
bulimia), tattooing, piercing, performing obtrusive actions: onychotillomania (destruction of nails and periungual skin), onychophagy (biting nails and periungual skin), onychocheilophagia (biting nails, periungual skin and lips), autoepilation - trichotillomania (pulling out hair) with possible further trichophagy (eating hair) and dermatotillomania (skin pinching), cutting oneself with sharp objects, scratching the skin and wounds, ulcers, stitches and nevi. Obtrusive actions also include the following: body parts perforation with inserting foreign objects in the holes; banging fists and head against objects and self-hitting; pricking (with pins, nails, wires, stylus, etc.); self-burning, partial self-suffocation (without a wish to intensify sexual arousal or to reach sexual satisfaction); finger joints displacement, biting hands and other body parts; alcohol, drug and medication abuse (with intoxication and overdose without suicidal intentions); swallowing corrosion chemicals, batteries, pins [4; 5].
The most wide-spread type of self-mutilation spread around the world is superficial/ moderate self-mutilations. They usually appear in adolescent age and include such actions as pulling hair, scratching skin and biting nails, which refer to compulsive subtype, as well as cutting skin, excision, searing, sticking the needles in, breaking bones and preventing wound healing, which refer to the episodic and repetitive subtype. Skin cutting and searing which appear periodically are the most widespread types of self-mutilating behavior. They can be symptoms or epiphenomena of a range of mental disorders such as borderline, histrionic and antisocial personality disorders, posttraumatic syndrome, dissociative disorder and eating behavior disorders [1; 4; 6; 9].
So, to answer the question "Why do patients intentionally harm themselves?" Armando Favazza writes: "Because it brings temporary relief to a great deal of symptoms such as, for instance, anxiety, depersonalization and despair... Those who cut themselves perform in essence a certain kind of primitive surgery on themselves which ends in material
proof of healing" [9]. A. Favazza sees self-mutilating behavior as "morbid forms of self-help, which give quick but temporary relief to states causing sufferings such as growing anxiety, depersonalization, obsessive thoughts and strong but unstable emotions".
When it is impossible to get distracted from these episodic behavior models and they repeat again and again, they acquire their own life and begin to constitute what is called a syndrome of repetitive self-mutilation. Those, who do repetitive self-mutilations do not want to die, but they can develop a depression and be on the verge of suicide due to inability to control their self-mutilating behavior. They feel that nobody really understands what they are going through [8]. Thus, self-mutilating behavior as a rule is not connected to suicide attempts, although among suicidents there are often people with preceding self-mutilation.
The most common forms of self-mutilating behavior among adolescents are self-cutting, scratching and doubling fists to bleeding, scratching skin to bleeding, picking off the sores, self-hitting against hard surfaces, intoxication, skin searing (more common among boys).
The aims and motives of self-mutilating behavior can be different. Among them are the following:
- getting rid of the sense of inner emptiness, depression, the sense of unrealism of the events;
- stress removal;
- desire to ease emotional pain;
- a way to relieve aggression, anger, annoyance;
- a need to feel the reality of events (a struggle against the sense of depersonalization, multiple personality and dissociation);
- a need to feel euphoria;
- an effort to avoid suicide attempt;
- a way to express pain, strong emotions which are impossible to cope with;
- a way to influence other people's behavior;
- a way to demonstrate to others what is going on inside the personality and how hard it is;
- a request/ cry for help;
- expression or suppression of sexuality;
- a way to express or struggle with the sense of alienation, detachment and loneliness;
- to confirm the reality of pain (wounds, cuts are seen as proof that emotions are real);
- biochemical stress relief
- an attempt to distract oneself from something that is too painful (thoughts, memories, emotions);
- a way to influence the control of one's own body;
- a prevention of something worse.
Research methods and sampling. The work uses
projective drawing method which allows to evaluate inner family relationships, emotional climate and position of adolescent in the family. In the course of study we have analyzed the following: the drawing structure, the special features of family members graphic representation, the drawing process, the adolescents' answers during post-drawing conversation.
The conversation and questioning allowed to ascertain the presence of repetitive self-mutilating behavior acts.
The research involved two groups of people under study. Group 1 (experimental group, hereinafter referred to as Gr. 1) consisted of 34 adolescents aged 13-15, who showed repetitive cases of self-mutilating behavior. Group 2 (control group) included 40 adolescents aged 13-15, where the acts of self-mutilating behavior were absent.
Adolescents from both groups were brought up in two-parent families with average level of income. Adolescents from both groups did not have mental and significant somatic diseases.
Adolescents from group 1 in 15% of cases practiced self-cutting, 20% scratched skin, 20% scratched skin to bleeding, 10% picked off the sores, 10% practiced self-hitting against hard surfaces, 10% seared skin, 10% pulled hair and 20% of them showed combined forms of self-mutilating behavior.
The research results. The adolescents in group 1 drew incomplete families (82%, 9 = 4.78, p < 0.000) (The text in parentheses shows reliable differences
between experimental and control groups), which indicates dissatisfaction with family situation. Adolescents under study omitted those family members who were less emotionally appealing or those relationships with whom were tense. In 47% (9 = 1.99, p < 0.005) of cases the drawings lacked the authors themselves, which indicates self-expression difficulties during communication with relatives, absence of community sense with the family: "nobody notices me", "it is hard for me to find my place". Post-drawing survey allowed to determine that in 35% (9 = 2.04, p < 0.005) of cases the author could have omitted himself in protest thinking that he'd been forgotten: "everything has already been distributed in this structure, I have nothing to do with that, there is no place for me" or "I am not striving to find a place or way of self-expression here".
In 10% of cases (9 = 2.53, p < 0.005) on request to draw their family adolescents drew only themselves. The only figure of the author in the picture was shown to be small, negatively colored in the dark background. In this way the authors emphasized their being outcast and abandoned.
In 32% (9 = 2.08, p < 0.005) of cases the author's figure was drawn to be smaller than the others', which did not correspond to reality. This indicates that adolescents suffer from being insignificant for their parents. Also in 24% (9 = 2.40, p < 0.001) of cases adolescents showed themselves small next to the well-portrayed sibling's figure, which may indicate the privileged position of the latter in comparison to the author's.
The presence of conflicts is seen in the pictures with scattered spaces and broken integrity in family members' portrayal (41%, 9 = 4.04, p < 0.000): parents' figures are divided with big gaps or with one more figure. Due to disconnection of family members in space they are less focused on common actions. Besides, family members' figures, including the child, are static and tense.
In the course of conversation we have established that in the families of adolescents who practice self-
mutilating behavior acts parents do not let a child experience feelings, especially negative ones - fear, confusion, anger. Besides, it has been established that the parents of adolescents practice such upbringing measures as: punishment, shaming, imputing to the child the feelings which he does not experience.
Conclusions. We have established that adolescents with self-mutilating behavior have emotional dysregulation, inability to endure negative emotions which is the result of upbringing in a specific environment, which depreciates the child's emotional
reactions: ignoring, humiliating, shaming and punishment for demonstration of negative emotions, ignoring or disapproval of child's interests, imputing the feelings which the child does not experience. Such a family atmosphere consolidates involuntarily highly intensive emotional reactions of self-mutilating character as the only way for emotional release. The self-mutilating act leads, on the one hand, to reduced intensity ofpainful emotions, and on the other, to negatively consolidated self-mutilation which is seen as an effective means to avoid emotional pain.
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