NOTE: The content of this section is explicit and graphic in nature. If you are a self-injurer make sure to prepare yourself, this article may distress you or trigger you. Have a list of substitute strategies available and soothe yourself. I am not a medical doctor, I am a self-injurer and this is what I’ve learned from my research and experience.
Self-injury is the deliberate act of inflicting serious and immediate harm on the self, most commonly the skin. Examples of self-injury (superficial self-mutilation) include cutting, burning, scratching, head banging, and hitting yourself with a hammer. In the extreme, self-injury may result in major self-mutilation. Take note, these are not suicide attempts. Self-injury can be further classified as compulsive, such as hair pulling (trichotillomania), and skin picking when it is done to remove perceive faults. Compulsive SI is repetitive and may even have multiple occurrences in one day. Compulsive SI seems to have different roots in that the behavior involves obsessive thoughts and is or can be done to avoid a perceived or imagined bad outcome. As such it is more closely linked to OCD (obsessive-compulsive disorder) behaviors, thus it will not be addressed at any length here.
Impulsive SI can be episodic or repetitive, mainly due to the degree of the illness. The episodic self-injurer does not identify him/herself as a self-injurer, however this behavior may eventually become repetitive. Repetitive SI is much like an addiction, an illness which consumes the person even when not involved in the self-injurious behavior. The repetitive self-injurer will self-injure, on a regular basis, when he/she becomes overwhelmed. Repetitive SI is very difficult to overcome because of its addictive nature. According to the DSM IV, repetitive self-injury is a symptom of borderline personality disorder, however experts cannot agree if it is a symptom or a diagnosis in its own right.
Since the most common act of SI is by far cutting; I will for the purpose of this document use the expressions “cutting” and “self-injury” interchangeably. Moreover, I differentiate between self-injury and self-mutilation, whereas in diagnostic terms self-injury is a level of self-mutilation.
The reasons why people engage in SI vary somewhat but all describe an attempt to deal with overwhelming emotional pain, a realization that physical pain will end when psychological pain seems to have be endless. For survivors of abuse, SI can serve the role of reenactment, allowing one to play out roles of victim (being injured), perpetrator (as the injurer) and caretaker after the fact, creating a happier ending to a painful memory, or perhaps promoting continuity between past and present, or simply creating a situation of physical pain all too familiar when unable to deal with the overwhelming emotional pain. Self-injurers experience a “rage” that they cannot express, as such SI can serve as a substitute for anger, viewed as bad, or serve as punishment, a way to deal with guilt which may or may not be justified. SI can be used to repress feelings or avoid more terrifying feelings, such as the incest survivor who cuts whenever a memory threatens to surface.
Self-injurers engage in this behavior for a number of reasons but by in large it is a self-prescribed treatment, a coping technique used to reclaim control. SI allows for a release of tension pent up when overwhelming emotions occurs. The self-injurer is ill equipped to deal with such emotions and must “expel” this pain to the surface. Cutting enables the self-injurer to put an end to a tremendous psychological pain, a feeling of being dead or unreal, being drawn out of a disassociative state through physical pain. Feelings of relaxation even gratification and numbness are experienced simultaneously with the pain. Self-injurers experience a feeling of mental disintegration. SI promotes reintegration and reinvolvement in life, proof of being alive and in control. The behavior is inevitably followed by a calming effect and then feelings of shame first from the act of cutting, the stigma and the scars, then to a general sense of oneself.
According to research most self-injurers are bright and intelligent, prone to alcohol and/or drug addiction, have low self-esteem and have great difficulty in relationships. They grew up in homes where they were possibly exposed to alcoholism and domestic abuse. They experienced instability in their early lives and family relationships including physical and sexual abuse or abandonment, where subjected to distant and/or overly critical parents. Trauma seems to be a constant in the self-injurer’s early life. As a result, the self-injurer is unable to trust and develop healthy dependencies, and hence, does not have any healthy personal attachments. Healthy attachments allow us to be restored and supported when we become emotionally depleted, without them we are at risk of developing a variety of psychological or behavioral disorders namely OCD, depression, anxiety, phobias, eating disorders, and SI. While self-injurers cannot form healthy attachments to others, finding an appropriate balance of trust and distance, he/she can be a gifted listener and nurturer, encouraging others to form attachments to him/her. Those with low self-esteem are likely to form attachments with abusive or needier partners unconsciously inviting this behavior he/she believes is deserved. Moreover, a self-injurer “feels at home” with pain since it is likely reminiscent of childhood experiences. Hence the cutter will not turn to others when in need but rather turn to SI.
The relationship between the self-injurer and the therapist is very paramount to the success of the therapy. The shame which inevitably accompanies SI is detrimental to developing attachments, even one to a therapist. The cutter experiences a general sense of shame about oneself, avoids attachments for fear that if others knew him/her they would reject him/her. This characteristic of self-injurers is particularly dangerous since it isolates the cutter from successful therapy. Ultimately, forming healthy attachments will be necessary to overcome self-injury.
Self-injury is a coping mechanism and as such it is leaned in much the same way that healthy behaviors are learned, thus the behavior is engrained in the self-injurers personality and will require a reparenting of sorts to reverse and stop the damage. Overcoming SI is not simply a question of abstinence, rather it requires adapting and learning healthy coping mechanism, developing better communication skills, learning to care for the self, and making peace with the past. As such, therapy and patience are needed to overcome this disorder; and medications may be prescribed.
If you know a self-injurer and want to help, a non-judgmental stance is of the utmost importance. To be an effective support to the self-injurer you need to be empathetic and understanding of his/her pain, adopt a nurturing posture without forgetting to care for yourself, remain confident and optimistic, and become knowledgeable about the illness. Encourage him/her to seek out professional help and information about this illness.
Levenkron, Steven, Cutting – Understanding and Overcoming Self-Mutilation, 1998, W.W. Norton & Company Inc., 269 pp.
Moskovitz M.D., Richard A., Lost in the Mirror – An Inside Look at Borderline Personality Disorder, 1996, Taylor Publishing Company, 190 pp.
Santoro, J., Cohen, R., The Angry Heart – Overcoming Borderline and Addictive Disorders, 1977, New Harbinger Publications, Inc., 253pp.
Strong, Marilee, A Bright Red Scream – Self-Mutilation and the Language of Pain, 1998, Penguin Books Ltd, 234 pp.
For more information on Self-Injury please refer to our References link.
Published April 2005
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