The first psychoanalytic evaluation of self-injury behavior was carried out by Emerson (1913). From a dynamic perspective, it was stated that cutting the skin serves multiple purposes. Accordingly:
a) Self-injury behavior provides direct sadomasochistic pleasure,
b) It produces a wound that devalues the experienced pleasure,
c) It may be a symbolic castration aimed at preventing actual castration,
d) Additionally, it is considered part of “self-penetration,” symbolizing both feared and desired penetration.
Emerson (1913) stated that cutting the self symbolically replaces masturbation, and similarly Fenichel (1945) used the term "masturbation equivalent".
Freud regarded sexuality (libido) and self-preservation as the two dominant forces governing humans, and in light of these ideas, initially gave relatively little importance to aggression. After the 1920s, this view changed. In his writings on the ego and id (1923) and later texts, he proposed a new duality: the instincts of life (Eros) and the instincts of death.
Freud described this theoretical development as follows: “Based on interpretations regarding the origins of life and biological parallels, I concluded that alongside the instinct to preserve living matter, there must also exist an instinct that strives to break these units apart and return them to their original, inorganic state. In other words, there is a death instinct as well as an Eros.” (S. Freud, 1930). When directed toward the organism itself, the death instinct becomes a self-destructive drive.
The death instinct, when combined with sexuality, transforms into less harmful drives expressed in sadism and masochism. Although Freud argued several times that the power of the death instinct could be diminished (Freud 1927), the fundamental assumption remained unchanged: humans are governed by a drive that aims at the destruction of themselves and others.
The conclusion drawn from this is that, in terms of the death instinct, aggression is not primarily a reaction to drives but a continuous stimulation arising from the structure of the human organism. Like Freud, Lorenz described human aggression as an instinct fueled by a constantly flowing source of energy, claiming it is not the result of external stimuli (K. Lorenz 1966). According to Lorenz, aggression is not primarily a reaction to external stimuli but an internal excitation embedded within the individual, striving for release regardless of whether external triggers are sufficient. “What makes the instinct so dangerous is its spontaneity” (K. Lorenz 1966). Lorenz’s aggression model, much like Freud’s model of sexual desire, resembles the pressure exerted by water or steam stored in a closed container, and thus is called a hydraulic model.
Believing in Freud’s fundamental dual drives of life and death, Menninger argued that self-injury is a form of compromise between aggressive impulses and protective instincts. According to this, the body part that is cut becomes a kind of sacrificial offering in this compromise. Kafka J.S. (1969), attempting to understand the motivation for self-injury, referred to Winnicott’s concept of transitional objects.
Describing the reaction of a self-harming patient, Kafka recorded the patient’s feeling of relief as her “warm” blood flowed over her skin. Kafka argued that the blood acted as the patient’s internalized maternal representation, externalized during crises as a soothing transitional object. Thus, the motivation for self-injury stems from the need to reduce unbearable tension. Kafka suggested that in order to self-harm, a patient must temporarily regard their skin as “not mine.” Pao approached this issue more broadly, proposing that the individual enters an altered ego state when initiating cutting. Comparing this condition to depersonalization and derealization, Pao stated that dissociative states exist in some patients during self-harm and that temporary suspension of ego orientation allows direct self-injury to occur.
Because individuals who self-harm frequently use primitive defense mechanisms such as denial, dissociation, and projective identification, psychodynamic theorists tended to associate such behaviors with pre-oedipal developmental pathology. Graff H. and Mallin R. (1967) claimed that developmental injuries occurring during “preverbal stages” were common among these patients, and therefore attempts were made to express tension through “physical, preverbal messages.”
Grunebaum and Klerman approached the issue by noting that many patients grew up without a mother, suggesting that they introjected the mother to protect themselves from maternal rejection. Thus, these individuals could cope with this loss by destroying part of themselves, while the pleasurable feelings arising from cutting offered both an opportunity to punish the one who abandoned them and a form of self-stimulation compensating for the lack of external stimuli. Observing that these patients frequently split defensively in their relationships with hospital staff, the authors stated that “the patient who cuts their wrist belongs to a syndrome within the borderline personality disorder group.” They therefore recommended “an inpatient treatment based on ego psychology,” with strong emphasis on understanding the interpersonal dynamics of the ward environment.
Podvoll EM (1969), in his discussion of self-harming patients, emphasized the social function of the symptom. According to the researcher, the patient partially aims to protect themselves and external objects from the patient’s devouring and overwhelming demands. “There is a flight from deep dependence on an early love object toward autoerotic use of the body.” This symptom signals more regressive efforts toward the therapist and staff. By redirecting aggression inward, “the patient finds a safe home for their anger and explosive character in a stable and seemingly indestructible object”—their own body—thus protecting their split and idealized internal object. Stone MH (1987) documented that many borderline patients who self-harm had been sexually abused by an older person earlier in life. Stone later stated that excessive guilt associated with sexual impulses meant that self-harm functioned not only to punish the patient but also to punish the original abuser. Kernberg OF (1987), meanwhile, urged caution before attributing specific meaning to self-harm symptoms, questioning the practical value of building “metapsychological theories” about the meaning of self-harm given the patient’s distance from their internal experience. He advised therapists to avoid premature interpretations. Kernberg did not dismiss the idea of meaning entirely; rather, he emphasized that such interpretations may lack practical value in treating severe personality disorders, especially in early treatment phases.
Theoretical psychodynamic discussions about individuals who self-harm are relatively few. In general, such formulations suggest that these patients exhibit significant deficits in early ego development. These deficits may explain their capacity for dissociative states and reliance on primitive defenses. The damage inflicted on their bodies may represent attacks on internalized representations of others or efforts to undo guilt. Episodes of self-harm may be temporally linked to crises in significant relationships. Ego psychology offers a useful framework for understanding these individuals and constructing psychodynamic psychotherapy.
Periods of rapid cognitive development are also periods of high affective vulnerability. The most dramatic periods of cognitive development occur in the first year of life and again during puberty/early adolescence, which are also periods of intense idealization (Hauser ST and Smith HF, 1991). Mosses Laufer (1991) viewed self-injury, anorexic, and bulimic behaviors as reactions to a severely punitive maternal image, noting that these behaviors appeared in adolescent girls after beginning masturbatory activity. Laufer emphasized that the adolescent girl perceives her body as an attacking, punishing object and that her body image is shaped by the object relationship with the mother. According to Fisher (1989), early relationships with parents influence later sexual behavior, and fundamental object relations play a key role in the development of body image.
As with other affects, aggression has a developmental sequence. Irritability and anger are present from birth. The threshold for intensity is largely influenced by genetic factors. Anger is the organism’s reaction to escaping harmful stimuli. Anger and hostility appear in the second half of the first year. In the second half of the second year, these emotions consolidate into hatred, becoming stable and persistent. These affects ultimately shape ambivalence, sadism, envy, prejudice, and revenge. The child’s attempts toward increasing autonomy between nine and sixteen months initiate an inevitable conflict, which becomes an internal ambivalence. Inhibition, denial, displacement of hostility, and splitting begin to emerge. This is followed by early internalizations of maternal judgments, forming the precursors of the superego. The child fears not only losing the mother’s approval and love but also the destructive potential of their own anger. As the child oscillates between forming good relationships and the allure of autonomy against the backdrop of symbiosis alarm, internalized resentment and hostility take the form of hatred. Such feelings may be displaced outward as scapegoating, prejudice, and sadism, or inward as self-harm and masochism. Eventually, as the subphase of forming good relationships transitions into the oedipal phase, hostility becomes reorganized around curiosity and competitiveness (Parens H, 1991).
In many personality types, intentional self-injury has been observed during periods of acute regression. In a psychodynamic context, when an individual experiences an intolerable crisis in relationships during rapprochement (Mahler M., 1975), self-harm is thought to represent a “masochistic surrender.” Therefore, intentional self-injury may appear more frequently in borderline, obsessive, or histrionic personality development or in more mature personalities during acute regression. Apter et al. (1997) examined ego defense mechanisms in adolescents reporting self-directed aggression and suicide attempts, concluding that “while sublimation may be a protective factor, excessive use of displacement is associated with increased risk of suicide and aggressive behaviors; immature ego defenses may amplify aggression, and maladaptive use of introjection, displacement, and repression ultimately works against the individual.”
In 1954, Bruno Bettelheim reinterpreted initiation rites, circumcision, and subincision in his book “Symbolic Wounds.” He argued that these rites must be understood within their unique anthropological context. Bettelheim’s disagreement with Freud stemmed from the hypothesis that each sex envies the sexual attributes of the other. Just as women envy the penis, men envy the vagina. Initiation rites (circumcision, subincision) symbolically fulfill this unconscious wish. According to Bettelheim, the source of omnipotence lies not in the phallus but in the vagina-uterus complex. While subincision symbolically allows men to acquire a vagina, it does not free them from castration anxiety caused by fears of a "captive penis." This artificial vagina may also symbolically represent an enlarged penis due to postoperative swelling.
For the Australian Aborigines studied by Roheim, the female vagina remains symbolically a wound, and the vagina obtained through subincision does not lose its penis-like quality. Nevertheless, the wound remains a gift, a tribute. Information passed from prehistoric times retains its significance. Thus, the sign of femininity and the wound become symbolic equivalents of the female genital organ and may substitute for one another.
