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Article Excerpt
In this exploratory study we used qualitative methods to examine possible relations between young women's self-injurious behaviors, sexual self-concept, and a conservative Christian upbringing. Structured interviews were conducted with three young women fitting these characteristics from a private Christian university in the Northeastern United States. Phenomological data analysis revealed themes for these women that support a relation between their SIB and the development and expression of both their spirituality and sexuality. Implications for counseling practice include the need for a thorough assessment of past and present spirituality and the inclusion of sexual self-concept into counseling discussions.
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The body of literature regarding deliberate self-injury has burgeoned since Favazza and Conterio's (1989) seminal article profiling the typical self-injurer as a female in her late 20s who started self-injuring as an adolescent. Self-injurious behavior (SIB) is best described as, "the deliberate, direct destruction, or alteration of body tissue without conscious suicidal intent, that results in injury severe enough for tissue damage to occur" (Gratz, 2006, p. 241). While reliable statistics are difficult to collect and vary widely, recent studies estimate that between 1-15% of the U.S. population (2-8 million individuals) engage in SIB (Deiter, Nicholls, & Pearlman, 2000; Ross & Health, 2002; Purington & Whitlock, 2004).
Several studies have examined root causes for SIB, particularly among adolescents, finding invalidating environments, attention seeking, past trauma, depression, substance abuse, violence, and sexual abuse as precursors (Crouch & Wright, 2004; Denov, 2004; Nicholson, 2004; Nixon, Cloutier, & Aggarwal, 2002; Olfson, Gameroff, & Marcus, 2005; Strong, 1998). Of these causes, researchers have noted that the leading indicator of deliberate SIB appears to be an invalidating environment that also involves a history of sexual abuse (Linehan, 1993; Saxe, Chawla, & van der Kolk, 2002). Young people who continue SIB into late adolescence or college often replace the impulsivity of the act with a chronic need for emotional regulation (White Kress, 2003). Specific risk factors for college students include insecure attachment, childhood separation, emotional neglect, sexual abuse, and dissociation (Gratz, Dukes, Conrad, & Roemer, 2002). In addition, research suggests a correlation between the level of a women's self-objectification and her negative body image, which then often leads to both increased symptoms of depression and incidents of self-injury (Muehlenkamp, Swanson, & Brausch, 2005). Despite significant increases in the understanding of SIB, self-injury currently remains a "burgeoning area of research with many questions yet to be answered" (Purington & Whitlock, 2004, p. 3).
One area of study that is just beginning to be explored is the possible relation between female sexuality and SIB. The few studies conducted in this area seem to suggest that a woman's sexual self-concept (or schema) may play a role in SIB (Alexander & Clare, 2004; McKay, Gavigan, & Kulchycky, 2004; Skegg & Nada-Raja, 2003; Whitlock, et al., 2006a). A large online study found that people with a history of SIB were more likely to be female and bisexual or questioning their sexual orientation (Whitlock, Powers, & Eckenrode, 2006b). A specific study of females diagnosed with Borderline Personality Disorder (BPD) who self-injured found these women to have undifferentiated sex roles (i.e., less likely to identify with either masculine or feminine sex roles) while the women with BPD who did not engage in SIB primarily identified with more masculine sex roles (McKay, Gavigan, & Kulchycky, 2004). The relation between SIB and sexuality was further supported by a study that found that one quarter of deliberate self-injury among men and one sixth among women was potentially attributable to same sex attraction (Skegg & Nada-Raja, 2003). The authors suggested that one reason for this correlation was the belief that same sex attraction may be viewed as troubling, stigmatizing or thought of as "wrong" by some women as a result of environments that fail to validate the sexual identity of these women. This lack of sexual validation and its subsequent effect on SIB in some women was also supported by a qualitative study of 16 lesbian or bisexual women who self-injured. These women reported that they had not felt validated and were not allowed to express their emotions about their sexuality or about other personal things. The investigators also noted that when these women continued to feel unaccepted or different, they continued to self-injure (Alexander & Clare, 2004). These few studies seem to suggest that for some women self-injury may be related to unaccepted or invalidated sexual feelings and/or sexual identity.
Some women raised within a conservative Christian religious environment may have similar experiences related to sexual identity and sexual expression because several studies have indicated that views of sexuality within this culture tend to be restrictive when compared to majority culture (Bassett, Smith, Newell, & Richards, 1999; Bassett et al., 2002). Religious and spiritual support in general, however, has been found to have moderating effects upon both physical and psychological health, as well as enhancing the coping abilities and social support of individuals (Koenig, McCullough, & Larson, 2001; Lingren & Coursey, 1995; Pargament, 1997). The influence, therefore, of a conservative Christian upbringing on SIB is not clear but a relation may exist for some individuals.
The research reviewed indicates that there may be a relation for some women between SIB, sexual self-concept, and a conservative Christian upbringing. In order to explore if this relation exists, a small qualitative study was designed to begin to tentatively examine these concepts. The purpose of the research was to gain a better understanding of how these three aspects of the person and the environment might impact one another and influence the beliefs, behaviors, and experiences of a small sample of women.
METHOD
Participants
Participants for this study included three Caucasian Christian women ranging in age from 18 to 25, who attended a small, private, Christian university in the Northeast. Each of these women had sought counseling at the university's counseling center previously for issues relating to SIB and were recruited based on their fitting the criteria of the study (i.e,. history of self-injury, college-aged, female) as part of a purposeful sampling seeking to better understand the reasons behind their SIB (Groenewald, 2004). The women's names and any identifying personal information have been changed to protect their identities. The first woman (Holly, age 18) had been treated for depression and at...
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