The Determining Role of Abuse in Self-Harm

Physical, sexual, emotional, and economic abuse can cause both physical and psychological harm in children, as well as have some effects in adulthood.

These include: developmental disorders, sleep disorders, eating disorders, alcohol or drug addiction, depression, anxiety, panic disorders, increased criminal and violent behavior, self-harm and suicidal tendencies, and the tendency to use the same methods on their own children (Diaz et al., 2002, Gershoof, 2002).

Determinants of Self-Harm Behavior in Abuse

The person who has been abused may occasionally recall these traumatic life experiences, which causes distress.

When recalling past abuse, it is observed that these individuals tend to harm their own bodies more. These abuses can be physical, mental, emotional, or sexual. Abused children have learned to seriously shake their bodies and see it as a way to transition to the unbearable feelings they are experiencing. Self-harm behavior parallels sexual abuse as much as it does physical abuse and neglect. In cases, it is observed that self-harm behavior appears at high anxiety levels, when alone, and with a tendency to hide the scars.

This presentation suggests that self-harm behavior is not so much manipulative but helps reduce high levels of anxiety by substituting bodily pain.

Women who were sexually abused in their childhood mention that they cut themselves to suppress emotional pain. When the abuse occurs within the family, it may later lead to sexual problems. Incest cases tend to engage in self-punitive behaviors because they are ashamed of themselves. Guilt, shame, negative self-image, and feelings of betrayal are formed as a result of the abuse experienced in childhood.

Self-loathing, hatred, and feelings of worthlessness arise as a result. Family pressure during childhood, preventing the child’s relationships, weakens social skills, which increases feelings of helplessness in the child. Thus, the child makes a distinction between themselves and others. Abused children do not experience shame during the abuse, but shame emerges more in dreams or mental activities. Depression is often seen in children who have been abused. Self-harm, suicide attempts, or other behaviors indicate symptoms like sadness, withdrawal, excessive exhaustion, and fatigue. In response to the frustration and anger caused by the abuse, the child gains strength by harming themselves. Cutting is used as a precaution against depersonalization. It also manifests as anger and self-punishment. Moreover, it can be said that self-harm behavior is related to sexual abuse, and based on this, self-harm behavior serves as a signal for the presence of sexual abuse. Individuals, as a result of increasing psychological distress, reduce these distressful feelings by harming themselves. When recalling past traumatic events or the people who caused harm, they reduce their anger and frustration by harming themselves.

Miller and Favazza investigated the reasons why people cut themselves and listed the factors causing self-harm as follows:

• 1. A sense of emptiness, escaping from depression and unrealistic emotions,
• 2. A sense of relief,
• 3. Suppressing emotional pain,
• 4. Showing what they have experienced by moving away from the sense of emptiness.

Relationship Between Self-Harm and Abuse

Self-harm and abuse studies have yielded the following results:

Experiencing physical and sexual trauma in childhood leads to personality disorders and self-harm behavior in later years.

It has been reported that 60% of those who self-harm have a history of physical and/or sexual abuse. Additionally, it is stated that women who self-harm have a higher frequency of childhood sexual abuse compared to those who do not.

A study investigating the relationship between self-harm behavior and eating disorders in patients with a history of sexual abuse; the sociodemographic characteristics of 42 adult female patients with a history of sexual abuse were evaluated in terms of self-harm, eating disorders, and suicide attempts, and the patients were divided into two groups as those who self-harmed and those who did not. In the group with self-harm behavior, the frequency of eating disorders and suicide attempts was found to be statistically significant compared to the other group. Self-harm behaviors were ranked in frequency as follows: hitting body areas (especially the head) 71%, biting themselves 64%, pulling hair 5%, cutting themselves 2%, and non-mandatory multiple surgeries 2%. Among the 42 patients, 9 were diagnosed with anxiety disorders (20 with post-traumatic stress disorder), 4 with dissociative disorders, 5 with borderline personality disorder, 12 with major depression, 1 with somatoform disorder, 1 with organic disorder, and 1 with mental retardation. In general, the reasons for self-harming in abused individuals can be summarized in eight categories:

1. Self-punishment: A frequently encountered situation in individuals who have been abused. Individuals may blame themselves for the events they have experienced.
2. Inability to suppress emotions: They may have difficulty dealing with emotions that cause harm or distress. When they encounter situations that remind them of the event or when the event comes to mind, they cannot get rid of these distressing thoughts.
3. Inability to cope: Usually seen as a result of childhood trauma. Difficulty in solving problems shows that the person is unable to cope with the issues.
4. Self-control: For some individuals, cutting means “Look! Now you have control.”
5. Seeking revenge: Cutting as a way of expressing anger, for a person isolated from their family, the body becomes the only way to communicate with them.
6. Showing what they have experienced: Those who self-harm often describe their feelings as numb or dead. Cutting themselves shows them in some way that they are still alive and living.
7. Realizing anger: Cutting is another physical way of crying. Negative emotions like anger or hurt play a significant role in self-harming.
8. Symbolizing: Writing words on their bodies to symbolize things they do not want to forget, writing or burning the first letter of a loved one's name on their body, or expressing the message they want to give to people by getting a tattoo.