I am sitting in front of one of my bulimic clients taking her Detailed Personal History. In answering a question that I asked regarding her ever having felt so depressed that she wanted to take her life she answers, “no” and then tells me that she has something else to show me. She places her arm in front of me showing me the old wounds she had from a decade before when she was “cutting” herself. She explained that in her case she did it because it helped her to know that she was alive.
I have had many other clients over the years who have cut themselves because it brought a sense of peace and calm to themselves. So, this is an important subject to better understand.
Because self-injury frequently occurs in private it is very difficult to determine the rates of it. Estimates vary from 3% to 38% in adolescents and young adults. Onset can occur in children as young as seven years old, but the usual age of onset is between 12 and 15 years old. Sadly, 30% to 40% of college students report in engaging in self-harm after the age of 17.
There are many co-occurring mental health disorders with that of self-harm. Some of them include: mood disorders, anxiety disorders, eating disorders, conduct disorder, substance abuse and experiencing trauma.
As with other addictive behaviors, cutting or self-harm can give the illusion of getting needs met by avoiding uncomfortable emotions and staying safe. While cutting my clients have told me that they are in a trance-like state totally absorbed in the cutting. They feel a great release and wonderful feelings. This as a result of the dopamine rush they experience as they cut themselves.
There are a few theories to explain why people self-harm according to the research that has been done.
Learning: When the self-injurious behavior is either positively or negatively reinforced. When the person feels calm leading to improved mood or a decrease in negative feelings the self-injury becomes a learned behavior.
Coping Strategy: While coping with negative life events, the self-injury provides a feeling of calm.
Emotional Regulation: Self-harming takes the individual’s mind off the distressing thoughts and feelings they are experiencing temporarily.
Create a Sensation: Individuals who have experienced great trauma disallow them from feeling emotions. The self-injuring allows them to produce pain which they feel as pleasurable.
Control: Some people feel they have no control over their lives, where the decision to self-harm is a decision that they are in control of, giving them some sense of control in their lives.
Emotional Expression: Some individuals may have never been able to develop normal emotional expression and others may have learned that expressing their negative emotions was wrong. In both these cases self-harm allows them to express their negative emotions.
Punishment: For some individuals who were raised in homes where they were told that they were no good and useless people, they feel they deserve punishment for these perceived transgressions.
Signs and Symptoms of Self-Harm would include:
– Scarring from cuts and burns on their bodies that can be hidden with clothing.
– Recurring injuries such as lacerations and bruises.
– Broken bones with an insufficient explanation.
– Chronic interpersonal challenges leading to withdrawal from interpersonal interactions.
– Having a sharp instrument with them all the time.
– Feelings of helplessness, futility and worthlessness.
– Internal hostility.
– Obsessing about harming themselves.
These symptoms can lead to infections and in some cases death due to complications. Many of these people become substance abusers as well. So it is very important that these people receive the help they need. Usually self-injurers will not commit suicide, the self-injuring being their method to cope. It is also not a manipulative act, because these activities of self-injury are done in private.
If You Find Someone Close to You May Be Self-Injuring:
– It is important that they know that you care about them and are not judging them.
– Model appropriate coping mechanisms.
– Be a positive role model and avoid any violent or destructive behaviors.
– Help them understand that you understand that they have a right to have normal feelings and that there are professional people out there that can help them to do that so they no longer need to put themselves at risk by continuing the self-injuring.
It is very important that the communication is done in a loving and compassionate manner because those who self-injure already feel alone and hopeless. Help your loved one to get the help required so they can be released from this self-destructive and sometimes deadly behavior.
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