Issues Treated in Therapy:
The tendency or compulsion to hurt yourself – by cutting or burning, for example – is usually a clear sign of intense inner turmoil, anxiety, and suppressed emotions. While this behavior has long been associated with Borderline Personality Disorder, it is more and more being see not just with BPD, but also as an element of depression, severe anxiety, and post-traumatic stress. It is also increasingly noted in adolescents, and sometimes takes a course similar to a drug or alcohol addiction, complete with secret stashes, rituals, and, of course, a cycle of anxiety, impulse, resistance, tension, release, and, often, shame…then back to anxiety, which is somehow relieved by cutting, burning, or other acts involving physical pain – the only apparent escape from seemingly more terrible emotional pain.
Self-harm is known to be associated with Borderline Personality, but can also occur in other situations. Childhood trauma – severe abuse or neglect – may be a risk factor. However, the causes of self-injurious impulses either with or without a diagnosis of BPD are not universally agreed upon, nor are the appropriate treatments. In recent years, Dialectical Behavioral Therapy (DBT), a kind of cognitive behavioral therapy, has been more widely used with some success. Learning to manage emotions, to pay attention to one’s thoughts and emotions, and to communicate well are important skills for overcoming the ups and downs of self-harm behaviors.
Self-harm can be very frightening for both the person harming himself and those around him. Some “cutters” take great care to avoid serious injury, using sterile blades, cleaning their wounds carefully, using bandages, and avoiding major blood vessels and muscles. Other people – particularly if inexperienced or extraordinarily emotionally escalated – may fail to take such precautions and severely injure themselves. Either way, habitual self-harm can present a serious risk to a person’s health and level of functioning in the short and long term.
Self-harm behaviors are not the same as suicidal behaviors. People who cut and burn themselves are not attempting suicide. However, people who engage in self-harm behaviors often also contemplate, threaten, or attempt suicide. Self-injurious acts are actually a coping skill, and learning new coping skills can help eliminate the compulsion to harm oneself and the persistence of suicidal thoughts or impulses.
Self-harm is a form of emotional release. Psychotherapy can help people who self-injure develop healthy coping mechanisms for dealing with emotional pain. Feelings of inadequacy, low self-worth and self-hatred are some of the emotional challenges that plague people who self-injure. A therapist who specializes in treating self-harm will work with a client to identify the source of the emotional pain. They will guide the client through a process of self-awareness so that the client can discover their inner strengths and tap into their own resources to manage the pain associated with the memory, trauma or feelings that are causing them pain. Learning how to practice healthy behaviors, such as meditation, mindfulness, creative expression and self-esteem exercises will enable a client to cope with their past pain and face any future situations in an adaptive and constructive, rather than destructive, manner.
Cindy, 23, comes to therapy because she has trouble sleeping, and was recently fired from a job for getting too angry. After a few sessions, the therapist notices cuts and burns on her arm, and inquires. Cindy admits to “occasionally” harming herself. She tearfully discloses that she hates herself for it and “the scars are so ugly”, but reports she can find no other release. Cindy eventually is able to disclose a history of depression and a childhood characterized by emotional abuse (her father, before his divorce from her mother) and, later, social isolation (an overprotective mother). Cindy’s anxiety is overwhelming discussing these events, and her urge to cut increases. Through therapy, she learns how to maintain emotional equilibrium and develops new coping skills for managing anger, grief, and loneliness.
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Last updated: 05-14-2013