There are certain common patterns in the thoughts, ways of thinking, and perceptions of many individuals who engage in self-harm, especially adolescents. These patterns are frequently encountered both in clinical work and patient interviews. Self-injury behavior is a pre-verbal form of expression, and such individuals often express an inability to explain, express, or articulate their feelings. They describe the reason for their behavior as an attempt to relax, control their emotions, calm down, or reduce tension. The emotions they experience include anger, rage, frustration, and hatred. Although they mention intense emotions prior to cutting or burning, they generally do not express or cannot express what these emotions are tied to. There is only a strong emotional state beforehand.
Contents
It is seen that expressions such as “I hate everything” or “I am so angry,” especially in adolescents, are actually hollow and lack specific content. These intense emotional labels such as “hatred” or “anger” are often used to isolate emotions. Even though self-harm is carried out to reduce emotional pain, the physical pain inflicted on the body contributes to this emotional isolation. Through cutting, individuals attempt to separate their emotions from the experiences, memories, and events associated with those emotions. In other words, they attempt to “cut” the connection between events and emotions, creating a kind of short circuit. Self-injury contributes to this numbing effect and serves a defensive, isolative function.
Examples of these automatic thought patterns include:
- “No one understands how I feel.”
- “Hurting or injuring myself is the only way I can control my emotions.”
- “I deserve to be hurt.”
- “I am a freak!”
- “When I hurt myself, I feel alive.”
- “If I hurt myself, I won’t hurt anyone else.”
- “I am fat and ugly; I hate my body.”
- “Pain makes me feel good.”
- “I like seeing the blood running down my body and feeling it flow.”
- “Hurting myself is the only and best way to push my family away.”
- “The scars on my body show how terrible my life truly is.”
- “Cutting myself is like getting a piercing or tattoo.”
- “Hurting myself is a good way to let things out.”
- “Self-harm is just a bad habit, like smoking. I can stop any time I want.”
- “Most people who self-harm are successful, perfect students.”
- “Many famous people self-harm. I read about it, I know it, and they are still successful and rich.”
The statements above are examples taken from individuals who self-harm. Although some resemble one another, careful examination shows that each contains unique differences. Some statements may suggest guilt; however, cutting and other forms of self-harm refer not to a desire but to a need. Even if individuals say they enjoy it, speaking of desire is not accurate here, because unlike in neurotic structures, individuals who self-harm cannot resolve conflict within the self. When you listen carefully to individuals who self-harm, you will see—similar to substance addicts—that the need to relieve pain, calm down, control emotions, and “cut” the connection between emotions and past experiences is not a desire but a necessity. “Something is taken from the outside, and one calms down; something is taken from the outside, and one becomes numb.”
Some researchers (Farber 2000; Levitt, Sansone & Cohn 2004; Conterio & Lader 1998) describe self-mutilation as “the new anorexia of our time,” suggesting that self-harm and eating disorders share similar dynamics. According to them, cutting behavior conveys a very powerful message, similar to depriving oneself of food. This behavior—
cutting—is a way to quiet the overwhelming emotional echo of the past, the painful memories that resurface with various emotions (Conterio & Lader, 1998; Farber 2000; Nasser 2004; Strong 1998).
Certain populations show higher rates of cutting behavior, particularly individuals with eating disorders (anorexia nervosa, bulimia), substance and alcohol addiction. When Shapiro’s collection of automatic thought patterns is reviewed, it becomes clear that these thoughts reflect a form of addiction that has been normalized. The similarity between the emotional regulation experiences of individuals who self-harm and those of marijuana users—“I can feel myself, it increases my creativity, I calm down, I relax, I stop thinking”—is striking. Clinical interviews with individuals who self-harm indicate that they are far from a neurotic personality structure. However, cutting and other forms of self-harm should not be viewed solely as extensions of personality disorders. In this book, self-mutilative
behavior will be examined as a separate disorder. This is because many of these individuals do not meet criteria for other DSM-IV or ICD-10 personality disorders. Although they are distant from these criteria, they also cannot be fully conceptualized within a neurotic structure.
Tools Used in Self-Injury Behavior
The tools used in self-injury behavior provide information about the severity, extent, level of pain experienced, and the individual's ability to cope with that pain or other emotions. In cases where blades, razors, or utility knives are not used, the self-injury often stems from biological-developmental problems. Individuals with biologically rooted developmental issues more commonly engage in scratching, hitting, punching, or biting themselves. In contrast, the individuals relevant to our topic usually harm themselves using razor blades, small knives, or by burning themselves with cigarettes. In my clinical observations, consistent with the literature, cutting among adolescents primarily occurs with razor blades, utility knives, and pencil sharpeners, while burning with cigarettes is the second most common method. Explanations regarding burning with cigarettes often indicate that it occurs between two friends, as a show of strength or tolerance to pain. Additionally, burning with cigarettes commonly follows intense anger.
Using paper cutters in self-injury carries its own distinct meanings. Cutting with a serrated blade also holds a different symbolic narrative. For example, cuts made with a letter opener or paper clip are quite superficial and are typically seen in the early stages of self-harm behavior. These initial tools often signal the future transition to deeper, more dangerous cutting instruments.
Locations Where Cutting Occurs
The self-injury behaviors examined in this study generally occur inside the home, in a private room. These behaviors do not occur in public (except in cases where the behavior is meant as a display, which has different motivations). Many individuals who self-harm engage in the behavior within their own private space (their office, their bedroom). It usually takes place in their bedroom. If they share a room with a sibling, roommate, or family member, they wait until that person is not present. Although rare, another location where self-harm may occur is the garage (especially noted in studies conducted in the U.S.). The likely reason for choosing such private spaces is to avoid interruption; however, individuals seldom take precautions to prevent interruption, such as locking the door.
The location where the individual harms themselves—whether they take precautions or whether the act carries a message—holds clinical importance. What must be distinguished is whether the “message” is intentional. Some adolescents cut themselves at school, others during summer months, some always in a specific month, while others do it at home. All these details are valuable in understanding the dynamics behind the behavior. Whether the behavior is impulsive, whether the same location is always chosen, or whether a ritual is present can provide clues about the intensity of inner turmoil. Some adolescents describe grabbing a cutting tool the way an addict grabs a drug, stating that they must cut “immediately” to calm down. A teenage girl I treated a few years ago expressed this clearly:
“Before coming to see you, I was going to meet my boyfriend. Suddenly, I felt upset and wanted to hurt myself. I went to the restroom in the shopping mall. I cut my arm there, felt relieved, and then went to meet him.”
This shows that the individual suddenly feels distress and uses self-harm, which they have learned as a coping mechanism, to reduce or end that distress. There is no intention to show this to anyone, nor is manipulation present. They continue wearing long sleeves. Cutting is
motivated by distress, and the goal is to reduce or end that distress.
Sharing of Self-Injury Behavior With Others
- They do it alone and hide the behavior from others. It is a secret.
- They do it alone but share it with a few people.
- They do it alone but tell everyone.
- A few people do it together as a group but tell no one.
- A few people do it together but share it only with a few people.
- A few people do it together and tell everyone (Walsh 2006).
