Emotional Intelligence | Main page on cutting
Two articles about cutting
Here are two articles about cutting... later I will add more of my comments. But for now I want to say that the word parent or parents was only found once between the two articles.
Here is the only reference to parents (from the second article
Parents may mean well but be too uncomfortable with negative emotion to allow their children to express it, and the result is unintentional invalidation. Chronic invalidation can lead to almost subconscious self-invalidation and self-distrust, and to the "I never mattered" feelings van der Kolk et al. describe.
Article about cutting no longer being rare among teens
Cutting connected to childhood trauma and invalidation
No
Longer Rare Among Teens
Cutting and Other Dangerous Acts Becoming New Cries for Help By
Jennifer Warner
WebMD Medical News Reviewed By Brunilda Nazario, MD
on Thursday, November 21, 2002
Nov. 21, 2002 -- For desperate teenagers
overwhelmed with emotions that
they cannot express, deliberate self-injury is becoming an
increasingly
popular and dangerous form of self-expression.
A British study of nearly 6,000 students shows that over their
lifetime, 13%
of 15- and 16-year-olds have carried out an act of deliberate
self-harm.
Within the past year, an act of deliberate self-harm occurred in
about 400
of the students. Only 50 students went to the hospital, which
suggests that
the problem may be even more widespread. American experts say
those
numbers aren't surprising, but until now there has been
relatively little
research on the issue.
The study, which appears in the Nov. 23 issue of the British
Medical
Journal, was based on a survey conducted in England from fall
2000 to
spring 2001.
Wendy Lader, PhD, co-author of the book Bodily Harm, says an
estimated
1% of the U.S. population as a whole resorts to physical
self-injury to cope
with extreme emotional distress, but that rate is much higher
among
adolescents and females.
Lader says the phenomenon of self-harm has been around forever,
but not
at the level it is now. She says that not only are people talking
about it more
but it's also becoming more common as teens search for a new way
to
rebel and express themselves.
"It's harder for kids to get noticed as individuals, and
they don't have the
words for it," says Lader, who is also clinical director of
the SAFE
(Self-Abuse Finally Ends) Alternatives program at Linden Oaks at
Edward
Hospital in Naperville, Ill. "So they show it -- even if
it's just to themselves
because it makes it real for them. It's almost like their body
becomes a
bulletin board on which to notch their pain."
For some, hurting themselves is a form of suicidal behavior. In
fact, nearly
half of the students surveyed who engaged in the behavior said
they had
wanted to die. But for others, Lader says self-injury is a
survival method.
"It's a coping strategy to deal with intolerable pain, but
it works for them so
it's a way of surviving," says Lader. But she says there is
always the risk
that once the method stops working for them, they could commit
suicide --
either accidentally or purposefully.
Researchers say girls seem to be especially prone to
self-injurious
behavior, and the study found acts of self-harm were four times
more
common among girls than boys.
Lader says that when girls have a strong emotional response, they
tend to
act inward rather than outward because it's not
"feminine" to be that angry.
"Girls will act on themselves and tend to say that they
would rather hurt
themselves than anyone else -- not realizing that no one needs to
get hurt,"
says Lader. Coupled with the fact that girls tend to be very body
conscious
and more dissatisfied with their bodies, she says it's not a
stretch for some
girls to take their anger out on their body.
David Fassler, MD, a child and adolescent psychiatrist in private
practice in
Burlington, Vt., says the study's findings are important because
they show
that there is a significant number of adolescents both in this
country and
elsewhere in world who have either suicidal or other
self-destructive
thoughts, plans, and impulses who actually engage in these acts.
"These are kids that are calling out for help, and we need
to do a better job
at recognizing the warning signs and getting these kids the help
that they
need," says Fassler, who is also a spokesman for the
American Academy
of Child and Adolescent Psychiatry.
Warning signs of self-injurious behavior may include the
following:
A history of emotional problems, abuse, or exposure to violence
(even if
the child was not physically abused)
Drug or alcohol abuse
Anxiety
Impulsive behavior
Low self-esteem
Fassler says emotional events such as a breakup with a girlfriend
or
boyfriend or being kicked out of class or a sports team may also
act as a
trigger for this type of activity. He says many of the
adolescents that resort
to harming themselves suffer from undiagnosed depression or other
mental disorders that require evaluation and treatment by a
trained
professional.
As the study authors conclude, "In many cases, self harming
behaviour
represents a transient period of distress; in others it is an
important
indicator of mental health problems and risk of suicide.
"Our findings support the need for development and
evaluation of school
based programmes for the promotion of mental health," write
study author
Keith Hawton, professor of psychiatry at the Centre for Suicide
Research
at Warneford Hospital in Oxford, England, and colleagues.
--------------------------------------------------------------------------------
SOURCES: British Medical Journal, Nov. 23, 2002 • David
Fassler, MD,
child and adolescent psychiatrist in private practice in
Burlington, Vt. •
Wendy Lader, PhD, clinical director of SAFE (Self-Abuse Finally
Ends)
Alternatives at Linden Oaks at Edward Hospital in Naperville,
Ill., and
co-author of Bodily Harm • American Self-Harm Information
Clearinghouse
web site • American Academy of Child and Adolescent
Psychiatry web
site.
Cutting Behavior and Suicidality Connected
to Childhood Trauma
Etiology (history and causes)
Past trauma/invalidation as an antecedent
Van der Kolk, Perry, and Herman (1991)
conducted a study of patients
who exhibited cutting behavior and suicidality. They found that
exposure to
physical abuseor sexual abuse, physical or emotional neglect, and
chaotic
family conditions during childhood, latency and adolescence were
reliable
predictors of the amount and severity of cutting. The earlier the
abuse
began, the more likely the subjects were to cut and the more
severe their
cutting was. Sexual abuse victims were most likely of all to cut.
They
summarize, ...
neglect [was] the most powerful predictor of self-destructive behavior. This
implies that although childhood trauma contributes heavily to the initiation
of self-destructive behavior, lack of secure attachments maintains it.
Those ... who could not remember feeling special or loved by anyone as
children were least able to ...control their self-destructive behavior.
In this same paper, van der Kolk et al.
note that dissociation and frequency
of dissociative experiences appear to be related to the presence
of
self-injurious behavior. Dissociation in adulthood has also been
positively
linked to abuse, neglect, or trauma as a child.
More support for the theory that physical or sexual abuse or
trauma is an
important antecedent to this behavior comes from a 1989 article
in the
American Journal of Psychiatry. Greenspan and Samuel present
three
cases in which women who seemed to have no prior psychopathology
presented as self-cutters following a traumatic rape.
Invalidation independent of abuse
Although sexual and physical abuse and neglect can seemingly
precipitate
self-injurious behavior, the converse does not hold: many of
those who
hurt themselves have suffered no childhood abuse. A 1994 study by
Zweig-Frank et al. showed no relationship at all between abuse,
dissociation, and self-injury among patients diagnosed with
borderline
personality disorder.
A followup study by Brodsky, et al. (1995) also showed that abuse
as a
child is not a marker for dissociation and self-injury as an
adult. Because of
these and other studies as well as personal observations, it's
become
obvious to me that there is some basic characteristic present in
people
who self-injure that is not present in those who don't, and that
the factor is
something more subtle than abuse as a child. Reading Linehan's
work
provides a good idea of what the factor is.
Linehan (1993a) talks about people who SI having grown up in
"invalidating
environments." While an abusive home certainly qualifies as
invalidating,
so do other, "normal," situations. She says:
An invalidating environment is one in which communication of private
experiences is met by erratic, inappropriate, or extreme responses. In
other words, the expression of private experiences is not validated;
instead it is often punished and/or trivialized. the experience of painful
emotions [is] disregarded. The individual's interpretations of her own
behavior, including the experience of the intents and motivations of the
behavior, are dismissed...
Invalidation has two primary
characteristics. First, it tells the individual that
she is wrong in both her description and her analyses of her own
experiences, particularly in her views of what is causing her own
emotions,
beliefs, and actions. Second, it attributes her experiences to
socially
unacceptable characteristics or personality traits.
This invalidation can take many forms:
"You're angry but you just won't admit it."
"You say no but you mean yes, I know."
"You really did do (something you in truth hadn't). Stop lying."
"You're being hypersensitive."
"You're just lazy." "
I won't let you manipulate me like that."
"Cheer up. Snap out of it. You can get over this."
"If you'd just look on the bright side and stop being a pessimist..."
"You're just not trying hard enough."
"I'll give you something to cry about!"
Everyone experiences invalidations like
these at some time or another, but
for people brought up in invalidating environments, these
messages are
constantly received. Parents may mean well but be too
uncomfortable with
negative emotion to allow their children to express it, and the
result is
unintentional invalidation. Chronic invalidation can lead to
almost
subconscious self-invalidation and self-distrust, and to the
"I never
mattered" feelings van der Kolk et al. describe.
--
Then there was a section on "Biological Considerations and
Neurochemistry"
It has been demonstrated (Carlson, 1986) that reduced levels of serotonin
lead to increased aggressive behavior in mice. In this study, serotonin
inhibitors produced increased aggression and serotonin exciters
decreased aggression in mice. Since serotonin levels have also been
linked to depression, and depression has been positively identified as one
of the long-term consequences of childhood physical abuse
(Malinosky-Rummell and Hansen, 1993), this could explain why
self-injurious behaviors are seen more frequently among those abused as
children than among the general population (Malinosky-Rummel and
Hansen, 1993).
Then some more chemical stuff and then this paragraph
When these results are considered in light of work such as that by Stoff et
al. (1987) and Birmaher et al. (1990), which links reduced numbers of
platelet imipramine binding sites to impulsivity and aggression, it appears
that the most appropriate classification for self-injurious behavior might be
as an impulse-control disorder similar to trichotillomania, kleptomania, or
compulsive gambling.
Comparing cutting to stealing or gambling and calling it a "disorder" seems pretty useless, but typical of those in the psychiatry profession.
Later the article says this, sort of an chicken and egg question:
It is not clear whether these abnormalities are caused by the
trauma/abuse/invalidating experiences or whether some individuals with
these kinds of brain abnormalities have traumatic life experiences that
prevent their learning effective ways to cope with distress and that cause
them to feel they have little control over what happens in their lives and
subsequently resort to self-injury as a way of coping.
Then the article continues....
--
Knowing when to stop -- pain doesn't seem to be a factor
Most of those who self-mutilate can't quite
explain it, but they know when to
stop a session. After a certain amount of injury, the need is
somehow
satisfied and the abuser feels peaceful, calm, soothed. Only 10%
of
respondents to Conterio and Favazza's 1986 survey reported
feeling
"great pain"; 23 percent reported moderate pain and 67%
reported feeling
little or no pain at all. Naloxone, a drug that reverses the
effects of opiods
(including endorphins, the body's natural painkillers), was given
to
self-mutilators in one study but did not prove effective (see
Richardson
and Zaleski, 1986).
These findings are intriguing in light of Haines et al. (1995), a
study that
found that reduction of psychophysiological tension may be the
primary
purpose of self-injury. It may be that when a certain level of
physiological
calm is reached, the self-injurer no longer feels an urgent need
to inflict
harm on his/her body. The lack of pain may be due to dissociation
in some
self-injurers, and to the way in which self-injury serves as a
focusing
behavior for others.
Behavioralist explanations
NOTE: most of this applies mainly to stereotypical self-injury,
such as that
seen in retarded and autistic clients.
Much work has been done in behavioral psychology in an attempt to
explain the etiology of self-injurious behavior. In a 1990
review, Belfiore
and Dattilio examine three possible explanations. They quote
Phillips and
Muzaffer (1961) in describing self-injury as "measures
carried out by an
individual upon him/herself which tend to 'cut off, to remove, to
maim, to
destroy, to render imperfect' some part of the body."
This study also found that frequency of self-injury was higher in
females
but severity tended to be more extreme in males. Belfiore and
Dattilio also
point out that the terms "self-injury" and
"self-mutilation" are deceiving; the
description given above does not speak to the intent of the
behavior.
Operant Conditioning
It should be noted that explanations involving operant
conditioning are
generally more useful when dealing with stereotypic self-injury
and less
useful with episodic/repetitive behavior.
Two paradigms are put forth by those who wish to explain
self-injury in
terms of operant conditioning. One is that individuals who
self-injure are
positively reinforced by getting attention and thus tend to
repeat the
self-harming acts. Another implication of this theory is that the
sensory
stimulation associated with self-harm could serve as a positive
reinforcer
and thus a stimulus for further self-abuse.
The other posits that individuals self-injure in order to remove
some
aversive stimulus or unpleasant condition (emotional, physical,
whatever).
This negative reinforcement paradigm is supported by research
showing
that intensity of self-injury can be increased by increasing the
"demand" of
a situation. In effect, self-harm is a way to escape otherwise
intolerable
emotional pain.
Sensory Contingencies
One hypothesis long held has been that self-injurers are
attempting to
mediate levels of sensory arousal. Self-injury can increase
sensory
arousal (many respondents to the internet survey said it made
them feel
more real) or decrease it by masking sensory input that is even
more
distressing than the self-harm. This seems related to what Haines
and
Williams (1997) found: self-injury provides a quick and dramatic
release of
physiological tension/arousal. Cataldo and Harris (1982)
concluded that
theories of arousal, though satisfying in their parsimony, need
to take into
consideration biological bases of these factors.
More Related Information
Study of Patients Who Exhibited Cutting Behavior and Suicidality
Depression: Suicide and Self Injury
Psychological Characteristics Common in Self-Injurers
Depression is Common in People Who Self-Injure: Therapist's
Comments
Cutting: Self Mutilating to Release Emotional Stress
Self Mutilation: Self-Injurers Often Suffered Sexual or Emotional
Abuse
Treatment
Teen-Depression Treatment Teaches Kids to Handle Anxiety
Can Caviar Cure Depression? Fishing for Health
Eye Movement Desensitization Reprocessing to Treat PTSD
Coping with Feelings and Thoughts of Suicide - Transcript
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