Diagnosis: Self-Mutilation

Chances are if you are viewing this page, you know someone who self-injures or perhaps even do it yourself. This topic has been one that has remained quiet for some time. Some psychologists would claim that self-mutilation is an attention-seeking action. Others would call it an act of manipulation. Perhaps it's a cry for help or a way of getting revenge. It is estimated that there are over two million chronic self-injurers in America today. How long will it be before these silent, blood-red cries are heard?

        So just how can someone be brought to the point of cutting? Well first, let's compare self-injury to suicide, keeping in mind that they are two VERY separate issues. Suicide is a last resort, as many call it. It is the only way that someone sees they can escape pain. From experience, I can tell you that suicide is never the answer. However, I am a cutter and for some reason, I have yet to move on from this terribly addictive behavior. Self-injury differs from suicide in that it is seen as a last resort that involves staying alive. The cutter, which will be the name I use to refer to all self-injurers, may feel trapped or lost in their emotions. But not everyone inflicts pain upon themselves to feel better. There is something confusing about all of this.

The problem for many psychologists is that they associate drug use, suicidal behavior, depression, etc., with the past of a particular person's life and cutting is sometimes left out. Now this, of course, is a commonly practiced technique. When someone is doing something, it would make sense to look at that person's past lifestyle and try to find connections. Someone that is an alcoholic, for example, may have started drinking a year or so ago because they felt alone or had an emptiness they wanted to fill. From there, you can trace the path of their addiction to alcohol. However, self-mutilation is commonly put into the present, and discovering the reasons for the action is left hidden. Therein lies one of the big keys; it cannot be finding the "what will stop it?" but rather the "why is he/she doing it?" What factors are involved? Here they are...

We see a closer resemblance of self-mutilation to drug-use, sex, alcohol, etc. as all being "gap fillers," which means they are used to fill an emptiness with something comforting or soothing. There is yet another thing that these behaviors share. Most people who cope by means of such actions blame their outside problems. This does hold some truth-the person is responsible for his actions, but not his feelings. The person is emotionally immature and doesn't know appropriate coping tools. Hypothetically speaking, consider a cutter as being a kindergartener and normal healthy teenagers as being a senior college class-the kindergartener will not know what to do and they will use whatever tools they know, regardless of the consequences. Also, some individuals may have viewed drugs, abuse, alcohol or other negative things in their home and "learned" these as acceptable behaviors to handle problems. Why are some teenagers attacked by psychologists when they are found to be turning out just like their abusive and drug-addicted parents? It's a known fact that about 90% of teenagers grow up to be almost identical to their parents. Suddenly these teenagers become the exception and are isolated from the rest, though they are just the same way.

Abuse is one of the most prevelant factors in self-mutilation. When someone finds himself or herself self-injurying, they must look deep back into their past and think-were they ever abused? But first, let's get our definitions of abuse on the same track. There is physical, mental, sexual and emotional abuse, some of which go hand-in-hand. Physical abuse is beating, hitting, slapping, being hit by objects, etc., or by lack of contact, like neglect. Mental abuse can be neglect, being put down by family and friends, or any number of misinterpreted comments that lead to feeling insufficient. Emotional abuse can be from neglect, being put down, not reaching expectations, etc. And sexual abuse is the forced intrusion upon one's sexual parts by someone else, whether it be rape or molestation. Something I find interesting, is about how important it is for an infant to feel contact when maturing into a child. Notice the two extremes you see with neglect and with abuse: under-stimulation and over-stimulation. It is my belief that this leads to a psychological sense of betrayal by the body. While in the womb, the skin and the brain actually develop from the same tissue-the ectoderm. There is a very close link between the skin and the mind. It is no surprise that mental pain has developed into physical pain by this point. The person has been betrayed by their surroundings and now by their own bodies. This betrayal opens to many reasons for cutting.

REASONS:
Self-punishment: This is a common reason and suggests severe abuse as a child. Whether it was from family, friends, or people at school, the cutter has acquired a self-hating mind-set and they see themselves as worthless, fat, ugly, stupid, unloveable, and anything else they can conjure up. 99.99% of the time, these are all untrue assumptions.
Inablity to express emotions: "Expressing" pain or some other emotions by deliberately injuring one's self; these emotions are described as being too painful or too confusing to put into words.
Inablity to cope: This usually results from a traumatic childhood, involving some sort of abuse, neglect, or major trauma, such as a death in the family.
Regaining self-control: This is another common reason people cut. Again, the sense of betrayal comes back into play. The cutter feels lost and abandoned. Many cutters describe feeling like they are in a big black hole, or lost in a maze of emotions. They may feel everyone is out to hurt them. Cutting becomes a way of saying "Look. I am in control now." They are, in short, turning mental and emotional pain into physical and tangible pain. It is true to say that it is much easier to care for a physical wound, than an emotional one.
Revenge: This is the reason that is often confused as being attention-seeking and/or manipulation. By revenge, I simply mean using one's own flesh as a way of showing anger or resentment towards someone. The cutter doesn't wish to confront the person and so they use their own bodies. This is another reason suggested by cutters who were abused as children. Because the parent(s) is often out of the picture at that point, the cutter's body becomes their only way of "comunicating" with them. It is almost like a secret language that only the cutter and the abuser(s) understands.
Obsessive Compulsive Self-Injurous Behavior(OCSIB): This is usually applied to obsessive compulsive disorders in which self-mutilation is involved. An example would be trichotillomania, which is an obsessive compuslive disorder where the person habitually pulls their hair out.
To show mortality or regain a sense of living: As discussed earlier, a cutter often describes feeling numb or "not alive." Not unrealistically, the pain from the self-injury or the sight of blood, serves as visible evidence to the cutter that they are, in fact, alive.
Relief of tension or to release anger: This reason is very substantial when cutting is compared to another physical coping mechanism-crying. Both commonly result from negative feelings of hurt or anger; both involve the shedding of bodily fluid; both are often described as uncontrollable; and both leave the person feeling tired, relieved, and calm afterwards. Coincidence? I don't think so.
Expression: Body piercings or tattoos have been around since the first recordings of history. Often they are used to show rank, connection to a certain group, or any number of things.
Symbolism: Some persons may carve symbols, words, or messages into their flesh. The scars serve as a way of remembering something that the cutter may feel they cannot remember in their mind or something they want to always retain. Tattoos have been known to show a reminder of some important event, such as a relationship, a death, or something else.

NON-REASONS:
Suicide Attempt/Wanting to Die: It must be made aware to everyone that Self-Mutilation is NOT suicidal behavior. Suicidal people want to die to end the pain; cutters want to live but they feel the only way to remain in control, sane, intact, etc., is to self-injure.
Attention-Seeking: Self-Mutilation is rarely used as an attention-seeking device as there are many, MANY, other alternatives one could take to seek attention. Breaking one's own bones, slicing one's own skin or burning one's own flesh just could not be as simple as "wanting to get attention."
Manipulation: The same as attention-seeking, there are many other ways that one could manipulate others as opposed to self-injury.
Masochism (Sexual Pleasure from abuse and/or physical pain): Self-Mutilation serves other purposes, as discussed above, and the types of self-inflicted injury discussed on this site are not about a person getting sexual pleasure from being abused-masochism and self-mutilation are two different psychological issues. These are all simple excuses to blame the cutter for being weak and pathetic and to avoid solving the real problem.

Beneath the scars and bruises of every cutter, lies a very dark and hidden secret. For some, it may be the sexual abuse they went through as a child. For another, it could be how her drunken father beat her and her mother every night. And even for others, the secret could be as simple as not feeling loved. But every single one of them has the same problem-the inability to verbalize their emotions. It is more than likely a lack of coping skills that causes this self-injurious behavior. The cutter is raised in a very negative, or perhaps even an overly positive, environment. As a child, they grow up without learning methods of dealing with frustrating or painful emotions. Shy children may also have this problem. To the parents, they may appear successful, happy and positive. However, they may truly be very quiet, socially rejected loners who feel no outlet to a constant emptiness within. At the other end of the scale, growing up in a violent home with abuse, neglect, rejection and other forms of pain, no proper coping tools are developed here, either. The cutter is introduced to violence, drugs/alcohol, sex, and other destructive behaviors. These become their only known ways of coping. As they mature, they often will become drug abusers, alcoholics and may abuse spouses, or their own children, also. However, if the pain remains inside, and the victim feels they must remain very secretive, they could turn to self-abuse. Interestingly enough, cutting is not advertised like drugs and sex, nor is it as "socially-acceptable" as eating disorders. More often than not, it is "discovered" by accident or as an impulsive and almost instinctive response to some form of hurtful stimuli. In one example, a girl got into a fight with her mother and went upstairs to take a shower. While she was shaving her legs, she suddenly sliced her wrists with her shaving razor and as the blood started to trickle out, she discovered a new kind of relief; thus began her 13 years of habitual self-mutilation.

For many cutters, their pain is described as a random mess of hurt that has no past and no future. Some will be able to link their self-injury to a past event, but most will not. It is this darkest secret that will eat away at the cutter's consciousness until there is nothing left. Digging deep into the past is the only way to find it and free it from their mind. It may be easier for a cutter to talk to a friend or a teacher or a therapist, as opposed to a family member. Sometimes, the pain or secrets they hold can be related to the concerned parent, and trying to pry into them and find out what the problem is will only irritate the problem more. Sexual abuse is the top-most found factor in cutting, and the most common gender of cutters-female. It seems that out of all of the horrible things a young girl can experience, cutting chooses the most painful. Being molested or raped is an embarrassing and shameful experience, leaving the victim hurt, alienated, and exposed to the world. What they must understand is that they are not alone and that keeping it inside will make it worse. Telling someone they trust will get them in the direction of being happy again.

Many people do not know how to approach someone who self-injures. Criticism, ridicule, threats and strict contracts, however, are certainly not the appropriate ways. It must be understood that someone who self-injures feels trapped and alone and incapable of expressing his or her emotions. They have resorted to a coping mechanism that keeps them in secret, secure and alone. Exploiting them and/or attacking them for their actions will worsen the problem and may lead to worse injuries or even a suicide attempt. Instead, gaining a strong and unbreakable trust is the key to helping a cutter. Betrayal is one of the many blocks that make up the foundation of a cutter's pain. When a cutter feels they can trust you, that is a very big step. Once this is accomplished, care, love, and respect are necessary, along with assuring the cutter that they will not be left alone and that better solutions will be found. Once a secure connection is established, it is time to let the dark and painful past spill out. Remember that painful experiences that a cutter holds on to and keeps trapped inside, will always come back and will get worse as time goes on. It is proven that getting out these bad memories and painful pasts do a great bit of good in moving forward from self-mutilation. Keep in mind that you are becoming this person's "emotion journal." They are turning to you to pour out everything they have kept inside for so long. Encouragement and support are necessary to move out from the shadowed abyss of self-mutilation.

Many psychologists and psychiatrists will argue over self-mutilation in every way possible. Some will say it is not truly a psychological problem; others will say it is a psychological problem, but one of a more psychotic type. However, before someone can determine which, if either, of these is true, every bit and piece of psychology must be examined first. It's all simply perspective! And because each person's perspective is different, that leads to a very broad look on any one thing that a person does. But one thing can be certain; self-mutilation, defined as the deliberate and direct modification and/or destruction of one's body, is used for expression and/or a coping tool. Now I know you may have just given a funny face when you saw "expression." Well, by this definition, body piercings and tattoos are also self-mutilation. In a religious environment, we see self-injury everywhere. In some indian cultures, body piercings, ritualistic practices, and other actions are often done to protect or save their people from some sort of evil. Is this a coincidence? Even in Christianity, did Jesus Christ not allow his body to be tortured to free mankind from a future of suffering? Suddenly, self-injury does not appear to be as wicked of a behavior as once-thought.

Examining self-mutilation from a psychological standpoint, you suddenly enter a never-ending world of questions and possibilites. Because this is such a complex and scattered subject, I have broken everything down into specific sections and have them listed below. They are in no particular order and the content of each has no medical or psychological value, whatsoever. I am not a doctor and the ideas mentioned in each are my own views and opinions.

The Chemical Purpose
When a person cuts, something is going on inside their mind. Up to this point, we have seen the factors and reasons behind cutting, but we still do not know why self-injury, specifically, is the coping tool cutters resort to. Because the once mental/emotional pain is now being made physical, many other factors come into play. First of all, when the body is injured or stressed or put into an "adrenaline-like" state, the brain releases natural opiates and other chemicals. These chemicals trigger an actual reaction in the body, similar to those of synthetic narcotics. Although not proven, it is suggested that when a person cuts, the body releases these chemicals and a "euphoria" takes over. This is still all speculation, but there is good reason to suspect something chemical is occurring.

The Physical Reaction
When a healthy human being is confronted with an enemy, the instant reaction is what is called a "fight or flight" response. The body has released chemicals to stimulate movement, the heart has sped up, the arteries in the vital organs have dilated, the arteries around the body have constricted, and blood pressure rises. This response prepares the body to either run to safety or stand and fight. It is possible that this very same reaction occurs before people hurt themselves. Set off by any number of stimuli, whether it is a fight, an abuse incident, or something else, the body has gone into a "fight or flight" response. Runaways may also experience this. However, because the painful experience is then brought directly inward, the emotions become the culprit, as opposed to an outside conflict. The cutter feels they must run away from their emotions or fight them, and perhaps cutting is their way of doing both. But it doesn't stop there. While they are cutting, their body is doing something also. When a person's blood pressure rises and they are in this "superman-like" state, they may get a small cut or injury and not notice it. This is due to the constricted blood vessels and the increased heart rate-their nerves are actually deadened so that they may do more. Then, once they have calmed down, they may feel the sting and notice it. This is also seen with cutters. Many describe themselves as "numb" and how they enter an extreme dissociation when they cut. Afterwards, once the relief has arrived, they feel the pain, and often have regret and guilt. It is my belief, that it is this same "fight or flight" response that occurs before someone cuts that results in the numbness and then resulting in relief afterward.

The Mental Reaction
When a person is put into a stressful situation, they must find some way to get relief. For a healthy person, this may be exercise, writing, drawing, singing, etc. For cutters, physical pain is the only way to find relief. Inside their mind, there is a very out-of-sequence reaction to the stress. Prior to cutting, they are overwhelmed with emotions and thoughts. Living in a "here and now" world, they cannot see past problems or current troubles. When something bad happens, all good of the past, and all possible good in the future, is ignored and they dwell on the negative. Immediately, they feel compelled to hurt themselves in order to escape. They cannot think clearly and cutting is seen as the only option. Always remember though; it is not a suicide attempt-self-mutilation is a last resort to pain and suffering, but it is one in which the victim wishes to remain alive. Also before the cutting, the person may enter what is known as a "dissociative" state. This psychological phenomenon is actually not that uncommon. You may experience it on a ride to work or to school-you know where you are going but you "dissociate" from what is around you. To a cutter, this may be frightening. They may feel dead or non-existent, like a wandering soul on the face of the earth. By the time they are cutting, which is usually a very impulsive reaction, they are entirely unaware of what is going on around them. The cutting commences and a vague, foggy world surrounds the cutter as they try to stop the pain. After maybe several minutes, the pain begins to become too much and the cutter returns to reality. After the "blackout," they may have regret and guilt over their cutting. Some have even been known to pass out and awaken hours later, covered in blood.

The Addiction
It was discussed earlier how the body releases its own natural opiates and chemicals when put under extreme stress or into a "fight or flight" mode. Interestingly enough, these chemicals can also become addicting to the body. When cutters first discover the relief self-injury brings, they often do it sparingly, only when things are very bad. Soon after, however, it can take minute things to set off their cutting frenzy. It is actually possible that a person can become addicted to cutting. Some persons in mental health hospitals have confessed that their self-mutilation was more difficult to overcome than smoking cigarettes or even overcoming a heroin addiction. Self-mutilation may in fact have a legitimate addictive sequence: dependency, tolerance, and withdrawal. As the person cuts more, they soon discover it is all they must use and they turn to nothing else. Also, cutters rarely go from worse to better when it comes to hurting themselves. Usually, they start with nicks and scratches, working up to cuts and then to gashes. This is similar to drug users having to move up their usage as they become tolerant to the drug's effects. And when a cutter stops cutting, they even show a period of seclusion, restlessness, and anger, similar to that of an alcoholic or chain smoker who has quit using.