What Causes Self-Mutilating Behaviour?
A Blend of Needs, Urges, and Emotions Feed Self-Harm Behaviour
Aug 2, 2009
Self-mutilating behaviour, suicide fantasies, attempts, or completed attempts are prevalent in some emotional and personality disorders, including major depression, but are found most commonly in borderline personality disorder.
Means of Self-Mutilation
Self-mutilation can be done in a number of ways, most commonly by repeated burns or through repeated cutting or slashing, or both. The means of mutilation may depend on the needs or moods of the one mutilating, or it could also be whichever means is most convenient at the time.
Some means are more easier to remove or hide than others, such as knives, razor blades, lighters, and candles. Others, such as stoves, are not so easily taken away. And still others, such as machetes and other sharp gardening tools or power tools such as saws, may not be thought of as dangerous to self-mutilators. But they are.
Often, the cutting will take on a ritualistic approach, however simple or elaborate.There are several common forms of self mutilation that may be practiced:
- Cutting or slashing wrists and arms;
- Slashing thighs;
- Making scars in other places, such as the abdomen, and slicing over those scars repeatedly so that they are highly noticeable; and
- Repeated burns with lighters and candles or heated hair styling tools, or "accidents" with stoves and ovens.
Urges Fulfilled by Self-Mutilation
According to medical reports, self-mutilating behaviour is addictive, and for the brief respite from emotional pain that it provides, those who cut continue doing it for this temporary comfort.
Cutting may also make someone feel safe, if, for example, she or he carved a large "x" across their abdomen, thinking it will render them undesirable, and keep them in control. This could be the case with persons with repressed feelings about sexual molestation when they were children.
Why Do Some People Self-Mutilate?
Sometimes the pain outside gets so bad that, for some with the above-mentioned disorders, physical pain and flowing blood provide a short respite. Suicidal fantasies also can seem soothing to persons who are seriously depressed or who have borderline personality disorder.
Medical reports show that self-mutilation does release epinephrine into the brain, which creates a short-lived “high” and temporarily relieves other physical and emotional pain that might be present.
Emotions and Self-Mutilation
Emotions also play a large part in the puzzling equation of self-mutilation.
Depressed persons, or people with eating disorders, for example, may feel worthless and weak and cut to punish themselves. This kind of slashing brings the least “relief” to those who engage in it, because they are punishing, and the pain and the blood are never quite enough to fix what is broken inside them.
Persons with borderline personality disorder often exhibit self-mutilating behaviour, and that is one of the cornerstones of diagnosing this difficult disorder. Think of Glenn Close’s character in Fatal Attraction, who exhibits cutting behaviour on two occasions. This disorder also is diagnosed by a person’s need for others and fear of abandonment. Again, think about Glenn Close’s character's obsession in the film. Cutting may temporarily assuage some of those fears, or be done as a means of trying to hold onto someone.
Signs of Self-Mutilation
Some common signs of self-mutilation exist. However, they are not always obvious to loved ones, and therefore it is important to stay vigilant if someone has received a diagnosis of borderline personality disorder or has shown a tendency toward such behaviour.
Here are a few signs to look for:
Long sleeves or long leg coverings to hide scars or fresh cuts or burns;
Unexplained bandages or gauze coverings;
Burns, especially on the hands or arms, or on the face around the hairline, where a curling iron might be used.
Dealing with Self-Mutilation
Since destructive behaviours can even go so far as fantasies of suicide that seem soothing, those studying borderline personality disorder suggest offering other options to a person who practices self-mutilation.
- Physical activity such as running or vigorous exercise.
- Soothing activities such as relaxing in a bubble bath, sitting quietly in a peaceful setting, and masturbation.
- Simulation of self-harming: holding ice cubes, for example, can alleviate the need for greater pain infliction, and for those soothed by the sight of their own blood, they can paint their arms with a magic marker.
- Arrange a strong support system that can include suicide hot lines, strong friends, and support groups.
- Make the environment as safe as possible. Potentially harmful elements, such as guns, should be removed or locked away. Unnecessary medications should be thrown away, and necessary medications supervised or locked away.
- Protect others in the home. Everyone should have a safe place to go, arranged ahead of time, in event of a crisis.
- Learn to respond to suicidal threats. They should always be taken seriously, and professional help sought. Hospitalisation might be necessary, whether voluntary or involuntary.
Studies show that a diagnosis of a personality disorder accompanies completed suicides in almost 30 percent of cases. That is why repeated cases of burning or cutting should be closely watched by loved ones. More than 70 percent of all patients with borderline personality disorder have a history of suicide attempts or self-mutilation, compared with only 17.5 percent of patients with other personality disorders. The risk of suicide contines into the patient's 60s, if they do not accomplish it before then.
More women than men are diagnosed with borderline personality disorder, and more men are diagnosed with personality disorders such as antisocial behaviour.
Cutting, whilst soothing to the one doing it, can be a serious precursor to a much more dire situation. Self-mutilating behaviour should be taken seriously and the cutter should be given sustained help and support. Only in this way will the symptoms and urges grow fainter and may even disappear, rather than escalating into tragedy.
Source: Sometimes I Act Crazy (with an index of the various studies consulted for the book), by Jerold J. Kreisman, M.D., and Hal Straus, John Wiley & Sons, Inc., 2004.
 |
