conversations on the fringe

One of the ironies of surviving abuse is that victims might further harm themselves.  Self-mutilation includes; burning, hitting, cutting, excessive scratching, using harsh abrasives on skin or scalp, poking sharp objects into flesh, head banging, pulling out hair or eyebrows for noncosmetic purposes, inserting objects into body orifices, excessive fasting, self-surgery, excessive tattooing or piercing, or refusing needed medication.  This seems like such a paradox.  Why in the world would those who are already in intense pain further injure themselves?  It seems to make no sense, yet it does.  Most often, it follows a history of protracted childhood trauma (such as physical and/or sexual abuse), not a single exposure.  The person harms himself/herself in response to overwhelming, dissociated pain.  At least sixteen reasons account for this complex behavior.  Self-mutilation:

1. Expresses pain that can’t be verbalized.  It can be expected when the abused child was told to keep the offense a secret, or when the abuse happened before the child learned to talk.  The nonverbal outcry says, “Something terrible has happened.”  It may be a plea for help.
2. Attempts to convert emotional pain to physical pain.  Physical pain can be localized, displaced, and released, providing temporary distraction from psychic pain.
3. Paradoxically relieves pain.  Stress triggers natural pain killers in the brain, temporarily easing psychic and physical pain.  This so-called stress-induced analgesia might also help explain victims become addicted to trauma-related stimuli.
4. Is a way to feel alive.  Numbing and dissociation feel dead.  Perhaps feeling pain is better than feeling nothing.  Physical pain grounds one in reality and counters dissociation.  It returns focus to the present, providing relief from intrusion.  Some people report that blood provides a soothing, warm sensation that relieves stress and reminds them they are still alive.
5. Provides an illusory sense of power, a sense of mastery and control of pain.  Reversing roles and assuming the role of offender, the person might think, “This time when I am hurt, I am on the controlling end.  I can determine when the pain begins and ends.”
6. attempts to complete the incompleted.  The idea of repetition compulsion states that we repeat what we’ve experienced until we’ve completed old business – processing it and learning it and learning a better way.  Unfortunately, simply reenacting the abuse doesn’t change the trauma material.  Complete processing of the material does.
7. Is a way to contain aggressive tendencies and pain.  The person thinks, “If I discharge my anger and hurt on myself, then I won’t hurt anybody else.”  Maybe it is the only way to stop anger, at least for a time.  Learning constructive ways to express emotions is the antidote for this approach.
8. Vents powerful emotions that cannot be venter directly.  (e.g., I can’t rage at the powerful perpetrator, so I vent on myself instead).
9. Makes the body unattractive to spare further abuse.  This harmful defense makes sense to a child who was powerless to stop sexual abuse.  Excessive thinness or weight might accomplish a similar purpose.
10. Might become associated with pleasant moments.  Following abuse, some abusers become remorseful, attentive, and loving for a time.  Thus, the victims might be conditioned to think that pain signals the beginning of good times.
11. Imitates what the child has seen.  Children naturally imitate behavior that is modeled by adults.  They learn to abuse if their parents are abusing, just as they will learn kindness if the parents model that.
12. Can be an attempt to attach to parents.  Children have a deep need to attach to parents, even if they are rejecting.  In order to gain the abusive parent’s approval, the child might internalize his or her punishing attitudes.  The child’s thinking might be, “I’ll show I’m good and devoted to Mom by doing what she does to me.”  This makes more sense when we realize that abusers often isolate the victims, making them more dependent on them for approval.  Need for approval causes the victim to identify with the aggressor.  A child might confuse abuse with emotional closeness, especially if abuse was the only form of attention the parent showed.  The child might think, “If I keep hurting myself, eventually they will love me.”
13. Can mark a return to the familiar, understandable past.  The child thinks, “I don’t understand loving, soothing behavior, but I do understand pain.  It doe not always feel good, but at least it is predictable.”
14. Is consistent with one’s view of self.  People treat themselves consistent with their self image.  Abuse teaches the victim, “I’m worthless, bad, no good, an object – so it makes sense to treat myself like an object.”  Self-punishment consistently follows from feeling blameworthy, bad, or inadequate.
15. Is consistent with one’s view of a maimed world and a nonexistent future.
16. May ensure safety if it results in hospitalization. 

The fact that a young person hurts themself does not mean they are insane.  They are simply repeating what they learned to cope with intolerable pain.  As they learn productive ways to meet their needs they will no longer need to do this.