Self-Injurious Behaviors in State Prisons

• DOI: 10.1177/0093854810385886
• Author: Hayden P. Smith,Robert J. Kaminski
• Date: 01 January 2011
• Published date: 01 January 2011
• Subject Matter: Articles

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CRIMINAL JUSTICE AND BEHAVIOR, Vol. 38 No. 1, January 2011 26-41

DOI: 10.1177/0093854810385886

© 2011 International Association for Correctional and Forensic Psychology

AUTHORS’ NOTE: Correspondence concerning this article should be addressed to Hayden P. Smith,

Department of Criminology & Criminal Justice, University of South Carolina, Columbia, SC 29201; email:

SmithHP@mailbox.sc.edu. The authors wish to thank Dr. Dana DeHart for her assistance in obtaining

Institutional Review Board approval. We also wish to thank the three anonymous reviewers at Criminal Justice

and Behavior for their valuable and insightful comments.

SELF-INJURIOUS BEHAVIORS

IN STATE PRISONS

Findings From a National Survey

HAYDEN P. SMITH

ROBERT J. KAMINSKI

University of South Carolina, Columbia

Self-injurious behaviors in correctional facilities have been reported as a significant threat to inmates, staff, and institutional

operations. This study is the first national survey to inquire about self-injurious behavior in incarcerated prison populations.

Surveys were mailed to mental health professionals working in state facilities that provided mental health services and housed

100 plus inmates. Data were received from 230 respondents representing 473 prison facilities. The average prevalence of

inmate self-injury was 2.4%, and it was 0.7% for serious self-injury. Cutting was reported as the most frequent act of self-

injury, with considerable concern for the importation of self-injury tools reported. Treatment responses were typically thera-

peutic or punitive, with a significant portion of facilities employing suicide protocols to address self-injurious behaviors.

Results from negative binomial regressions suggest institutional characteristics associated with the prevalence of inmate self-

injury include female-only institutions, specialized maximum-security units, and elevated staffing ratios.

Keywords: self-injury; national survey; prison; inmates; standards of care

Self-injurious behavior (SIB) is defined as “the deliberate destruction or alteration of

body tissue without conscious suicidal intent” (Favazza, 1989b, p. 137). SIB includes

moderate acts such as cutting, scratching, or burning the skin; hitting oneself; pulling one’s

hair; reopening one’s wounds; and breaking one’s bones as well as severe acts such as eye

enucleation, face mutilation, and amputation of limbs, breasts, and genitals. Excluded from

this definition of self-injury are culturally acceptable forms of body modification such as

tattooing and piercing (Favazza, 1989b). A review of national studies of emergency room

admissions documents a decrease in rates of suicide coupled with an increase in rates of

self-injury (Brickman & Mintz, 2003). Reasons for this increase in self-injury include,

although are not limited to, the following: SIB is a more commonplace and openly dis-

cussed phenomenon within diverse media, younger persons receive more education on the

topic, more boys are engaging in SIB, and medical personnel are now more likely to rec-

ognize and diagnose acts of self-injury (see Cornell Research Program, 2009). In the cor-

rectional context, there is also evidence that suicide rates have decreased in state prisons

(Mumola, 2005), but there has been a lack of comparable studies that document rates of

Smith, Kaminski / Self-Injurious Behaviors 27

SIB. As such, we know little about the prevalence and manifestation of SIB as well as the

associated institutional responses and characteristics of the prison that influence rates of

self-injury.

LITERATURE REVIEW

Previous research estimates the prevalence of self-injury in noncorrectional populations

to range from 4% to 38%, with a lifetime prevalence estimate of 17% among college stu-

dents (Cornell Research Program, 2009). By comparison, incarcerated populations are

predicted to experience greater risk of self-injury due to exposure to early trauma, psychi-

atric comorbidity (i.e., higher risk of borderline and antisocial personality disorders), and

the presence of institutional stressors associated with confinement. At present, the correc-

tional literature features disparate estimates of the prevalence of SIBs in prison, and a

national-level study is needed. To date, prevalence estimates reveal that 2% to 4% of the

general prison population and 15% of prisoners receiving psychiatric treatment routinely

engage in SIBs, making these samples comparable to nonincarcerated samples (Toch,

1975; Young, Justice, & Erdberg, 2006). Other studies estimate the rate as ranging from

2,200 to 3,760 per 100,000 inmates, which is considerably higher than mainstream popula-

tion estimates of 130 to 149 per 100,000 persons (Sloan, 1973; Young et al., 2006).

However, recidivist self-injurers are also segregated into specialized treatment units in

which self-injuring behavior is much more pervasive. For example, one study of mentally

disordered inmates housed within a maximum-security hospital found that 52.9% of these

inmates had engaged in self-injury during their incarceration (Gray et al., 2003). Likewise,

self-injury rates have been documented at 40% among violent institutionalized youth

(Pattison & Khan, 1983) and 86% in a study of adjudicated females (Ross, McKay, Palmer,

& Kenny, 1978). Taken as a whole, these estimates of self-injury in prison are assumed to

be conservative. This is because they are based on self-injury events of ample severity to

warrant institutional responses and therefore typically do not include SIBs of low to moder-

ate severity. Moreover, many of these studies are outdated, from non-U.S. settings, or

based on limited samples. The high degree of variability in these estimates requires further

investigation.

Another issue concerning self-injury involves the manifestation of the behavior within

the correctional milieu and the associated response by institutional staff. Among nonincar-

cerated populations, the most common manifestation of episodic low to moderate SIB is

skin cutting and burning (Favazza, 1989a). Typically, a vulnerable individual experiences

emotional distress that either overstimulates or understimulates the senses, with the result-

ing cutting behavior serving to regulate one’s psychological constitution. Over time, this

stress response can become addictive, with repetitive self-injuring often including a ritual-

istic approach to favored cutting procedures and paraphernalia. Ritualism as part of self-

injury enables the individual to develop a sense of control that he or she feels is lacking.

Yet this process may manifest differently within the correctional milieu for several reasons.

Foremost, correctional facilities are highly controlled systems wherein negligible privacy

is afforded. Custodial and security requirements are designed to maximize the observation

and control of inmate behavior while minimizing the importation and use of dangerous objects.