Working in the field of self-injury is like scuba diving without a mask. You get glimpses of what might be under the surface, but it’s difficult to know if what you’re seeing is real. There is little quality research within the field of self-injury. When I first began studying this area more than fifteen years ago, there were less than a thousand articles, books, and dissertations in total, and many of these centered on self-mutilation in those with developmental or neurological issues. Today, there are roughly two thousand journal articles with self-injury as its focus. As a comparison, a recent search of the literature on schizophrenia lists over seventy thousand journal articles.
Several years ago I was asked an excellent question about the relationship between self-injury and sexual orientation. At that time, there was no research in this area and I had no good answer to this question beyond some speculation. Now, revisiting the same question, I have found only slightly more information. To date, there have been two research studies directly exploring this area, one qualitative in nature (Alexander & Clare, 2004; Skegg, Nada-Raja, Dickson, Paul, & Williams, 2003). However, there has been a decent amount of anecdotal information collected over the years. Thus, the ways in which self-injury relates to sexual orientation are still little more than speculation at this point in time. I am still scuba diving without a mask.
I will present a very brief overview of self-injury and then postulate a connection between self-injury and the LGBT population and why prevalence of self-injury might be higher among this group.
Self-injury, best defined as an act done to one’s self, by one’s self, not for the purpose of suicide, is a highly prevalent behavior within our society. The most recent research suggests that approximately four percent of adults within the general population and somewhere between 14% to 38% of adolescents and college-aged individuals engage in self-injurious behaviors (Prinstein, 2008; Walsh, 2007). Cutting is the most common type of self-injury, with other behaviors including burning, skin picking, interfering with healing of wounds, self-hitting, and hair pulling, among others. Escaping intolerable emotions, producing pleasant feelings, communicating with others, nurturing one’s self, establishing control, and self-punishment are all reasons given for self-injury (Alderman, 1997). The common theme of all of these reasons is that self-injury serves as a method of coping.
Anecdotal evidence suggests that self-injury is more common within the LGBT community than within the heterosexual community. There are several reasons why a higher prevalence of self-injury within the LGBT community actually makes some sense. Self-injury typically begins in adolescence, a time when sexuality and sexual orientation are being explored. LGBT youth, particularly those who have not yet come out and/or formed close relationships with others like them, seem particularly susceptible to many of the factors that may contribute to self-injurious behaviors. These individuals often lack a solid support system, struggle to fit in, hide their sexual orientation, and are at a point in life when they have limited functional coping skills. Research has demonstrated that LGBT youth have higher rates of suicide and other types of self-damaging behaviors such as alcohol and drug use (Garofalo, Wolf, Wissow, Woods & Goodman, 1999; DuRant, Krowchuck & Sinal, 1998). Thus, it makes sense that this particular population is likely confronted with numerous overwhelming emotions and limited resources for coping, placing them at greater risk to self-injure than those without the pressures associated with being LGBT.
Many of the people who self-injure report a history that includes physical, sexual or emotional abuse (Alderman, 1997). Several studies indicate that LGBT youth may be victimized by family members or others due to their perceived or true sexual orientation (Balsam, Rothblum & Beauchaine, 2005; Pilkington & D’Augelli, 1995). Even though there has been an improvement in the understanding of LGBT issues, there are many youth who have been the victims bullying, hate crimes, and various types of emotional abuse such as being the target of derogatory name calling.
Few would argue that there continues to be a great deal of negative stigma attached to being LGBT in this society. Although LGBT visibility and rights have certainly improved over the past twenty years, it’s only been sixteen years since the first same-sexed kiss appeared on national television (L.A. Law, 1992). The possibility that California would be the second state to adopt same-sex marriage is certainly a step toward equality, but it’s only a step. Many people continue to view LGBT individuals as unacceptable and in quite a negative manner. And some of these people are more than willing to share their negative opinions of LGBT people without regard for the psychological ramifications of doing so. Unfortunately, this negativity, inequality of basic rights and laws, and consistent implication of difference would lead many LGBT people to feel shame, lowered self-esteem, and self-hatred -- all factors associated with self-injury.
Self-injurers typically report feeling different and isolated. Similarly, many LGB youth report feeling different and isolated (Crowley, Harre & Lunt, 2007) and have few with whom they can confide. In a 2004 study by Alexander and Clare, a group of self-injuring lesbian and bisexual women directly attributed the sense of feeling different they experienced to their sexual orientation and this sense of feeling different as a causative factor of their self-injurious behaviors.
Similarly, those LGBT individuals who have not yet accepted their own identity are likely to experience a great deal of shame and want to keep their LGBT identity a secret. Many LGBT youth live in areas in which they feel it may be too dangerous to come out. Twenty percent of surveyed college students living on campus feared for their physical safety due to their perceived sexual orientation, according to a 2003 study (Rankin). It’s not uncommon for youths, just realizing their sexual orientation, to hide or lie about their true identities. These factors, secrecy, isolation, and inadequate ability to communicate with others, are all associated with self-injury.
Finally, in clinical samples, self-injuring individuals have presented with negative body image attitudes (Walsh, 2006). Many self-injurers describe hating their bodies. Likewise, numerous studies have identified body image as a concern for individuals within the LGBT community (Kraemer, Delsignore, & Schnyder, 2008, Gil, 2007, Kelly, 2007). Thus, poor body image is just another factor that may be a link between members of the LGBT community and self-injury.
What is the relationship between self-injury and sexual orientation? The answer is not so clear. Certainly, being LGBT does not mean that one is going to self-injure, nor does being a self-injurer mean that someone is LGBT. However, it does appear that there may be good reason for the anecdotal evidence that there may be a higher proportion of self-injurers within the LGBT community. Shame, secrecy, isolation, feeling different, poor body image, low self-esteem, abuse history, poor support system, and limited coping outlets are all possible factors associated with being a member of the LGBT community. These same factors have also been shown to be linked with self-injury. So while there does seem to be a salient relationship between self-injury and sexual orientation, there definitely needs to be research conducted in this area.