In her new autobiography, Crazy Days, English actress Sadie Frost, 45, describes her turbulent six-year marriage to English actor Jude Law. The couple had three children together and after each child was born, Ms. Frost suffered from postpartum depression (called postnatal depression or PND by British doctors), a condition that has also affected Gwyneth Paltrow, Lisa Rinna and Brooke Shields.
As her marriage with Jude Law was ending, Sadie suffered what was called a “breakdown” in Los Angeles that apparently caused her to be placed on an involuntary 5150 hold for evaluation and was committed to a psychiatric hospital for 28 days.
In her book (excerpts of which are being published in the London Daily Mail), Ms. Frost describes an incident in 1997, after the birth of her second child, Rafferty (her first child with Jude Law), where she “wanted to press the self-destruct button” and went out partying all night after arranging a babysitter for the children. The next day she was “racked with guilt” and:
“…was sitting at my dressing table, not feeling anything – just numb. I watched my hand slowly pick up a pair of scissors. It was as if I was being sucked down lower into the chair and scissors seemed to be drawn to my arm. I appeared to have cut myself. Blood dripped down my arm. There was no sense of panic within me – I just felt empty.”
This incident of self-injury, apparently without suicidal intent, caused us to remember a lecture we attended last March on “Why People Hurt Themselves” by noted Harvard psychologist Dr. Matthew Nock. Dr. Nock has researched and written extensively on the social functions of self-injury which has puzzled doctors, scientists, and philosophers for thousands of years. Here is his description of some characteristics of self-injury that strike us as an abstracted echo of Ms. Frost's personal account:
The “most commonly used method of self-injury … is cutting or carving oneself with a sharp implement such as a knife or razor, with most self-injury occurring on the arms, legs, and stomach.” Other characteristics of self-injury include “thoughts of engaging in self-injury [that] typically occur when the person is alone and experiencing negative thoughts or feelings …” and the “… widely held belief that self-injury is performed in most cases as a means of self-soothing or of help-seeking … most self-injurers report feeling little or no pain during episodes of this behavior.”
In his 2010 article in the Annual Review of Clinical Psychology, Professor Nock explains the important differences between suicidal and non-suicidal thoughts and behaviors which are summarized in the diagram below:
Although, as Dr. Nock points out, non-suicidal self-injury (NSSI) occurs in the context of a wide variety of different Axis I and II mental disorders it is not in itself a mental disorder but in some cases serves social functions. For example, NSSI can be a form of communication where "actions speak louder than words" as signals of distress, strength and fitness or in the service of social affiliations. On a more theoretical level, these self-injurious behaviors could be maintained through reinforcement or either intrapersonal or interpersonal functions such as affect regulation or help-seeking, respectively.
Dr. Nock also writes about the incidence, risk factors, prevention, assessment, monitoring and treatment of NSSI. Regarding assessment, here are links to three psychometric tools that are identified by Dr. Nock as being useful for clinicians and researchers:
- Deliberate Self-Harm Inventory
- SASII: Suicide Attempt Self Injury Interview
- Behavioral Test for Assessment of Self-Injurious Thoughts
- Bodies under Siege: Self-mutilation and Body Modification in Culture and Psychiatry
- Understanding Nonsuicidal Self-Injury: Origins, Assessment, and Treatment
- A Bright Red Scream: Self-Mutilation and the Language of Pain