Sally has been quite sad lately. She has many issues which she avoids discussing with her family and friends. Some problems have been around for a long time while others are caused by daily interactions. Sally tends to be overwhelmed by most of life’s situations. When she feels that her life is spinning out of control, she has started to do something that she hasn’t told anybody. Sally cuts herself. She is not suicidal nor does she want to end her life. Now, whenever she feels stressed, she has begun to turn to taking a sharp razor and making small, slight cuts on her inner thigh. She found the physical pain was more manageable than the out-of-control emotional pain. She was aware of how unhealthy this choice was for her. She covered it up, didn’t tell anyone, and one time the area she cuts got infected. Even in light of the consequences, she would find herself returning to this behavior. It seemed to provide her with short-term relief but never provider her with long-term resolution.
Though Sally’s behavior might be foreign to you, her behavior is not as uncommon as you might expect. All too often young adults (predominantly female) have developed this unhealthy method to cope with their perceived stress. Just like any other compulsive behaviors or ritualistic patterns, whenever the individual perceives some personal level of stress, they begin to have intrusive negative thoughts, which invariably lead to any previous behavior that decreased their stress; hence the compulsive behavior. This four stage process has been referred to as the “Motivated Cycle” of compulsive behaviors (Dr. Paul McHugh, Director of Psychiatry the Johns Hopkins University Bloomberg School of Public Health). 1. Perceived stress, 2. Intrusive thought, 3. Compulsive behavior, and 4. Short-term relief. People tend to go a period of time in which they are not engaging in the unhealthy behavior. Upon experiencing some form of stress (real or imagined) the individual initiates a pattern of negativistic internal thoughts and feelings. Due to the lack of functionally productive coping skills, the individual returns to contemplating any option that provided some control, escape or avoidance. Though, they have not actually engaged in the unhealthy behavior during this cycle, they have begun the process of internally convincing themselves that this option is acceptable. Finally, the act or behavior, in this case, cutting is used to fend off the unpleasant emotions or perceived stress. Since it decreased the perceived stress, it is reinforcing and therefore is likely to reoccur. As Gordon Allport coined the phrase, Functional Autonomy, the unhealthy behavior develops a life of its own even in light of her awareness of the dangers, her embarrassment and the infection. Unfortunately, no long-term resolution to the perceived stress has been developed. No functional coping skills have evolved which could either help manage her perceived stress or more importantly, alter her perception.
Young adults that choose to cut may not be able to express how or why they began. There is usually a long history of emotional stress experienced by the individual. They oftentimes refer to their stress as overwhelming and too painful for others to comprehend. This belief tends to lead these children to isolation. This lack of open communication with loved ones or friends prevents them from receiving support or suggestions on how to better handle their perceived life stress. All too often youngsters with this issue also experience co-morbid or dual diagnoses; Depression, Anxiety Disorders, Substance Abuse, as well as other behavioral problems. They perceive life as presenting with unrelenting drama, pain, and trauma. I have often found that individuals who were sexually abused during their childhood engage in this practice.
Most cutters are not suicidal. Their behavior is self-destructive but not usually with the intent to inflict permanent harm. There can be injuries sustained from this repeated behavior; the scar tissue that develops, the potential for infections (based upon unclean items used for cutting by razors, knives, scissors, needles, and glass), embarrassment and the unintended consequences of accidental fatal outcomes.
Many people were shocked when they heard that Princess Diana reported self-inflicting harm to her arms and legs.
The usual time from for the onset of this behavior is preteen to middle teen.
Usually there are events in the youth’s life which are perceived as overwhelming.
Self-loathing statements are common.
They feel incredible moods of anger, hurt, rejection, etc and feeling out of control. They use the physical pain to stop their emotional pain. They feel that they now control the amount of time they experience the physical pain (both start and finish) rather than the ongoing out-of-control emotional pain.
A different reason expressed by some youth is they find that the physical pain is the only feeling they experience.
They report feeling numb all of the time. Many individuals have told me that they feel numb, or a black hole, or empty inside, and that feeling pain is better than feeling nothing at all.
Some use this behavior as their method of communicating with others (both peers and family).
Unfortunately, some use this behavior as a form of manipulation.
Some use this behavior to reveal to the world how serious some event is in their life and draw attention to the situation.
Most people who cut realize the public reaction and they determine that it would be best to cover up the self-inflicted scars. Hence, they oftentimes wear clothes that cover up their wounds. Even in warm or hot weather, they insist on choosing items that cover up.
Sometimes self-injurious people make up stories to explain away the injuries yet they also make themselves sound like they are incredibly clumsy and accident prone.
Changing your behavior requires several steps. Insight must occur first before any behavioral change. Especially long-term behavioral change.
1. Acknowledge that the behavior of cutting is unhealthy.
2. Turn to a professional for help.
3. Medical needs must be taken care of by a professional.
4. Determine the reasons why you would want to stop this behavior.
5. Determine the reasons why you had previously chosen this behavior.
6. Realize that your isolation protected you from feeling embarrassment or other social/emotional issues. Hence, don’t isolate. Turn to friends and loved ones. They can be great supports when they realize what is going on and how much you want to change your behavior.
7. Therapy needs to address the reasons why you chose and maintained this self-destructive behavior. If you don’t understand why you did what you did, you will merely repeat it.
8. Realize that there are probably triggers or stimuli that have caused you distress in your past. Planning for and managing these triggers will be important.
9. You need to consider strategies regarding how you will handle perceived stress when it does occur in the future. This process is referred to as Anticipatory Guidance.
10. Medication might prove beneficial if Depression or Anxiety is a contributing factor.
11. You need to develop helpful methods to deal with uncomfortable emotions (anger, rage, embarrassment).
12. Learning to set appropriate boundaries in your life with others is helpful.
13. Self-directed relaxation training is important from a preventive perspective as well as to cope with specific situations.
14. Individuals who engage in this pattern of behavior can learn new and healthier ways to cope with their perceived stress. Cognitive-Behavioral therapy often provides understanding and relief from this negative cycle. Though, short-term relief is experienced, the young adults learn that they never resolve the problems and in fact they might even make the situation worse. Learning more adaptive coping mechanisms is vital for them to feel a sense of control. Helping the individual realize that life is not about perfection but rather how they handle the imperfection is quite helpful.
Dr. Harold Shinitzky, Psy.D.
Licensed Psychologist
Private Practice, National Consultant, Mental Health Correspondent
727-560-2697
www.drshinitzky.com
Author – A Champion’s Mindset: 15 Mental Conditioning Steps to Becoming a Champion Athlete (www.amazon.com)