Self cutting and other forms of non-suicidal self harm are incredibly prevalent, not just among clinical populations, but in the larger population as well. Epidemiological studies, which are crude at best, reveal that at least 4-5% of the US population engages in self harm. While self-harm is often associated with borderline personality disorder, Post Traumatic Stress, depression and anxiety, a surprising number of people without known diagnoses engage in self cutting and other self harm behaviors. One of my former graduate students, conducted research to investigate the prevalence of self harm in Binghamton University college students. BU is a very competitive college and is represented by extremely bright and capable students. Nonetheless, even in this population, the results were quite staggering (sorry, I don’t have specific percentages to report). Other research showed that with college students, 10 – 30% reported cutting or self-harming at least once.
self-cutting: giving expression to pain
Sadly, these behaviors are not restricted to adults, but are increasingly being seen in adolescents and even children. We need much more research to better understand the prevalence, nature and causes of such behavior. Even in non-austistic populations, self-harm has been documented in kids as young as 5 years old. It does, however appear to be on the rise and may correlate with a number of social stressors resulting from family stress, alienation, abuse, lack of stable parental attachments etc.
Self harm is probably most represented by self cutting, usually light cuts with a knife, razor, finger nail etc. This is often done on the forearms, thighs, chest, or pretty much anywhere. It can also take myriad other forms such as burning, scratching, pinching, gauging and so on.
A number of theories have been advanced to explain self harm. Certainly, the issues are complex and variable. However, in my own clinical experience with this, which sadly is rather considereable over the last 25 or so years, a couple of factors account for a majority of cases. Simply stated, people cut because of what they are otherwise not allowing themselves to feel. So in a sense, people are bleeding to feel, but they are not feeling the emotional pain that is really at the core of their feelings. As is the central thrust of the book and blog, the primary source of suffering is based on people’s avoidance of emotional pain, or the so called “dark emotions”. So, in the case of cutting for example, individuals are giving expression to pain, whether it be anger, frustration, loss, shame, helplesness, hopelesness, etc., that is not otherwise being consciously experienced or expressed. Many people often feel a resultant sense of pervasive numbness and dissociation, and they want to feel something in a manner that they perceive they can control. So they cut, and thus release their pain and feel something. Cutting is often followed by a temporary sense of release and relief, even a bit of a “high” is occasionally reported, thus reinforcing the cycle. However, this relief lasts only a short time and can then be followed by guilt and shame, thus leading one to cut again and again. This can lead to very disfiguring scarring, infection and occasionally unintentional death.
So, a question arises;What causes people to cut rather than feel? Clearly, we can conclude that the physical pain of cutting is preferred over the alternative; actually feeling the painful emotions. So what could have happened to make feeling so difficult and therefore avoided? In my experience, the answer is often clear: Such individuals had childhood histories where the no feel rule was very much in effect. What this means is that through a variety of mechanisms, feelings were discouraged whether by overt punishment, guilt, shame, non-validation etc. Another factor is that the child experienced in some manner a lack of stable attachment to primary caregivers and the home situation was viewed as precarious. Thus, one perceives themselves to be floating on a large ocean in only a little raft or dinghy, they will hold on very tightly and thus not do anything that might capsize the little craft, such as expressing their feelings or needs. So for a variety of reasons, people learn to hold things in. But emotions do not go away. There is no such thing as “away” psychologically speaking. We are dynamic creatures. Emotions are energy. Energy cannot be created or destroyed…it can only change form. Cutting and self-harm are one such form.
So therefore, the antidote is clear: Learning to feel and express. But to do this, one needs to mindfully expose and face the anxiety, shame, guilt and other perceived threats that have conditioned one to avoid themselves. In the context of a safe, trusting, therapeutic environment, this is possible. I will attempt to show how the utilization of mindful emotional exposure can facilitate healing. More coming! Stay tuned.
