Evidence of deliberate self injurious behavior exists in literature from as far back as the Middle Ages (11), and possibly occurred even before then. Self injurers usually begin their masochistic practices during a period of depression or anxiety. Many self injurers describe physically harming themselves as a means of controlling or transforming their emotional pain (7); however, the compulsive and habitual characteristics which manifest in the actions of many self injurers (9) as well as the prevalence of self injurious behavior among non-clinically depressed, severely mentally retarded patients has led neurobiologists to hypothesize that there is a physically addictive element to self injury which contributes to its continuance (4).
Normally, when a person is injured, the brain releases a neurotransmitter called ‘beta-endorphin’ to combat the sensation of pain (1). Beta-endorphin, classified as an ‘endogenous opiate (4)’ is secreted in humans from the pituitary gland in the cerebral cortex and binds to the mu-opioid receptors (6). It functions similarly to morphine, a powerful organic, plant-based painkiller derived from the poppy papaver somniferum, which is usually administered intravenously in hospitals to patients with severe injuries (8). In addition to relieving pain, these chemicals also provide euphoric effects (10). Both synthetic opiates, such as morphine, and naturally occurring opiate agonists, such as beta-endorphin, function by inhibiting transmission of pain signals within the brain, and breaking down the proteins responsible for pain perception (4). They also promote the excess release of another neurotransmitter, dopamine, which causes the euphoria (3).
Synthetic opiates, of which the Schedule I substance ‘heroin’ is included, are notoriously physically addictive. Physical addiction occurs after frequent, repeated use, and results from brain tissue adapting to the drug and becoming dependant upon it for the release of certain chemicals; in the case of opiates, that chemical is dopamine (8). Because beta-endorphins bind to the same receptors and function similarly to addictive opiates, it is plausible that they are also physically addictive (12); however, just as a person is not physically addicted to morphine after receiving one dose in a hospital, a single injury will not cause beta-endorphin addiction. But people who self injure usually do so repeatedly, and hospital studies have confirmed that beta-endorphin levels rise after self inflicted injuries (5). Some studies have shown that only certain points in the body stimulate beta-endorphin release, and people who self injure in these areas tend to be compulsive and habitual with their masochism (12). The addiction hypothesis suggests that after time, the repetition causes their bodies not only to build a tolerance against, but also to become dependant upon the release of beta-endorphins to produce dopamine (2). Several clinical trials have been done in support of this theory, using hospitalized self injurers (5), as well as some studies using mentally retarded self injurers (12). In these studies, patients were treated with ‘naltrexone,’ which blocks beta-endorphins from binding to the mu-opioid receptors, thus disabling the effects (5). The results of these studies showed that naltrexone was effective in reducing the incidence of self-injurious episodes (12, 5). While there is almost always a psychological epidemiology for masochistic behavior, since the person was probably not previously physically addicted to his or her own beta-endorphins, understanding the neurobiological functions involved with this dangerous, compulsive behavior, can assist mental health practitioners in providing comprehensive, effective treatment for self injurious patients.
The addiction hypothesis also provides compelling implications for similar repetitive behaviors. Tattoos and body piercings, for example, are often jokingly described by people who get them as addictive. It may be possible to extend the addiction hypothesis of self injury to these activities and suggest that some of the people who participate in them in fact are addicted! This is especially noticeable when considering people who get ‘play piercings,’ piercings in which only needles or impermanent jewelry are inserted in the body. Though expensive and considered crass in some social circles, getting pierced or tattooed does not bear the same stigma or risks as self injuring, but it is interesting to contemplate whether the desire to repeatedly get pierced and/or tattooed could similarly be culled by a substance liked naltrexone.
Another populace which should be considered in relation to the addiction hypothesis of self injury are physical abuse victims. Battered lovers are especially prone to remaining with their abusers, even after sustaining severe and sometimes life threatening injuries (2). Again, it would be fallacious to believe that the reason for this phenomenon is purely physiological, but it would be useful to determine whether physical addiction to beta-endorphins plays a role in the desire to stay in a physically abusive relationship.
Though self-injury is a complex disorder, and the extent to which beta-endorphins affect a self injurer’s habituation of the dangerous behaviors is still unknown, understanding the neurobiological, as well as the psychological, components involved will assist mental health practitioners in providing effective outpatient rehab in Los Angeles. Furthermore, it may be possible for the theory to be extended toward other vulnerable populaces, such as abuse victims, and were studies to be conducted confirming this hypothesis, the rates of prolonged domestic violence could possibly lower. It is also a useful and thought-provoking hypothesis that can possibly be applied toward understanding the behaviors of people involved in fringe social groups, such as those who choose to get multiple piercings and/or tattoos.
1. author unknown. Beta Endorphin. http://medical-dictionary.thefreedictionary.
com/beta+endorphin , copyright 2009
2. author unknown. http://www.domesticviolence.org, 2009
3. author unknown. Human Beta Endorphin Receptor, β-EPRELISA kit. www.uscnlife.cn/UploadFile/file55812.doc
4. author unknown. Meet the Family: Endogenous Opioids. http://www.opioids.com/
5. Azar, Beth. The Body Can Become Addicted to Self Injury. http://self-injury.net/resources/articles/article/the-body-can-become-addicted-to-self-injury/43/ 1999-2008
6. Bergal, S, Dalayeu, JS, Nores, JM. Physiology of beta-endorphins. A close-up view and a review of the literature. http://www.ncbi.nlm.nih.gov/pubmed/7520295 , 1993
7. Brody, Jane E. The Growing Wave of Teenage Self Injury In: The New York Times (online) http://www.nytimes.com/2008/05/06/health/06brod.html?_r=2 scp;=1 sq;=
self%20mutilation st;=cse , published May 6, 2008
8. Cohen, William E, Holstein, Michael E, Inaba, Darryl.(2007) Uppers Downers and All Arounders: Physical and Mental Effects of Psychoactive Drugs. CNS Productions, Inc, Medford, Oregon
9. Cutter, Deborah, Jaffe, Jaelline, Segal, Jeanne. Self Injury: Types, Causes and Treatment. http://www.helpguide.org/mental/self_injury.htm , last modified February 2008
10. Dzung, Ahn Le, Gianoulakis, Christina. ‘Feel Good’ Endorphins in the Brain Released by Low to Moderate But Not Heavy Drinking, http://www.medicalnewstoday.com/
articles/143153.php, published March 21, 2009
11. Greenblatt, Stephen (editor). (2006) The Norton Anthology of English Literature 8th Edition: Volume B WW Norton amp; Company London
12. Shaw, Peggy. New Hope for Self-Injury Sufferers In: Bio-Medicine (online) http://news.bio-medicine.org/biology-news-2/New-hope-for-self-injury-sufferers-12572-1/ published September 8, 1999