Why Some People Harm Themselves

By Hilary Jacobs Hendel, LCSW | Mar. 14, 2018

 

When I met Renee, she told me she was nervous all the time. And, she was cutting herself.

Most people struggle to understand why someone would harm themselves. Many parents have asked me: “Why would my child do something like that?” “Doesn’t it hurt?” “Why can’t they just stop it?” Harming one’s self seems illogical unless you know a little something about trauma and emotions. Emotions—like anger, fear and sadness—are hard-wired survival responses to our immediate environment. We can’t stop them from happening, but we can deal with them in a variety of healthy and unhealthy ways.

Emotions, when they arise, affect the whole body, and if we’ve experienced traumas or adversity, emotions are incredibly overwhelming and harder to manage (especially when we feel alone with them). Our mind and body can block certain emotions with other emotions like anxiety, guilt and shame. These complex and painful emotional cocktails can feel unbearable.

People typically resort to self-harm when they're in this state: overwhelmed by emotions, without knowing how to cope. When we feel utterly alone and out-of-control, we’re capable of doing almost anything to stop the emotional pain including, cutting, purging and even attempting suicide. “I just want the pain to stop” is what I often hear.

Stopping Intense Emotional Pain

When we met, Renee told me that part of her mind was constantly yelling at her, just like her father had yelled at her throughout her childhood.

“You’re a stupid little shit,” the male voice in her head would say.

This made Renee feel like she was a “bad person.” And both the real and imagined anger of other people terrified her—they were huge triggers, connecting her back to early memories of her father’s rage.

Renee’s feelings would come up quickly and were absolutely excruciating. Imagine feeling rage, sadness, fear, shame, guilt and massive amounts of anxiety all at once. It’s like free-falling into a cavern with no bottom or getting trapped in a swirling vortex. All you want to do is stop the bad feelings as quickly as possible. That’s the effect cutting and other forms of self-harm can have—they stop the downward drop and the unbearable pain.

My patients are often relieved when I share a positive understanding of their self-harming behaviors. Symptoms like cutting are often described as “just crazy.” Some of the myths about self-harm include: thinking the person is doing it just to be trendy or edgy; or that the person must have a chemical imbalance, personality disorder or intractable mental illness. Sometimes people who harm themselves are judged as being provocative, rebellious, attention-seeking or manipulative. Another myth is that they want to die. But understanding self-harm requires us to understand what it means to be emotionally overwhelmed, or dysregulated.

So, I taught Renee to approach her behavior with a stance of curiosity and compassion for herself. I invited her to communicate with the part of her that resorts to cutting and ask that part of her how it was trying to help manage her emotions. Renee’s cutting seemed to satisfy three purposes:

  • It stopped the emotions from intensifying any further.
  • It was self-punishment for her perceived badness.
  • It felt relieving.

Coping with Underlying Trauma

I tell my patients from the first moment I learn they are cutting, “It’s not okay to hurt yourself.” And then I reassure them, “Together, we are going to find healthier ways to cope with your big feelings that will serve you for the rest of your life.”

Self-harm itself can be unlearned and replaced with healthier ways to cope and self-soothe, but treating the underlying trauma is the ultimate long-term goal. One of the most effective ways to treat self-harming behavior is to help people work through blocked anger, sadness, fear and disgust. These feelings are often brought on by challenging life circumstances like emotional, physical or sexual abuse, emotional or physical neglect, bullying, feeling too much pressure and more. All people need to learn how to safely experience the emotions that life’s challenges bring.

Symptoms like self-harm won’t go away until the individual has other ways to calm their emotional overwhelm. To ask someone to stop cutting without offering alternative ways to achieve comfort is akin to asking a trapeze artist to give up their safety net. Renee and I experimented with many ways to help calm her emotions such as:

  • Naming and using the emotions she has in the moment (The Change Triangle is a helpful guide)
  • Grounding her feet on the floor
  • Breathing
  • Talking about light-hearted things like her favorite television shows
  • Wrapping a blanket tightly around her
  • Calling me or a trusted friend
  • Taking a hot shower
  • Getting out into nature


Renee and I worked together on calming her anxiety. By learning what emotions were being triggered and accessing and experiencing the anger and disgust she felt towards her father, her brain and body became more regulated. She slowly learned how to tolerate and channel feelings of anger at others in a healthy way. Eventually, Renee grew her capacity to tolerate and make use of the full spectrum of emotions.


After about six months of treatment, Renee grew much more compassionate towards herself. She came to understand how trauma affected her, and she stopped self-harming. She still had painful and powerful feelings like we all do, but now Renee was relieved and proud that she had new, better ways to cope.

 

Patient details have been changed to protect confidentiality.

 

Hilary Jacobs Hendel, LCSW, is the author of It’s Not Always Depression (Random House & Penguin UK), a book which teaches both the general public and psychotherapists about emotions and how to work with them to feel better. She received her BA in biochemistry from Wesleyan University and an MSW from Fordham University. She is a certified psychoanalyst and AEDP psychotherapist and supervisor. She has published articles in The New York Times and professional journals. Hendel was also the Mental Health Consultant on AMC’s Mad Men. She lives in New York City. For more information and free resources for mental health visit: https://www.hilaryjacobshendel.com/

 

Comments
Kathryn Mauro
Thank you for the article. I suffered trauma at sixteen and self harm. I'm still in therapy but I still pick at myself until I bleed to relieve the stress and pain. I know that it is not healthy but it seems to be self soothing. I let my therapist and health provider know when I am doing it. Hopefully it will stop in the near future.
4/4/2018 8:01:25 PM

Boni
I found this article both informative and helpful. I'm in the health care profession and imagined this could be useful to someone trying to cope with overwhelming emotions. Thanks.
3/23/2018 12:11:49 AM

Lizanne Corbit
I think self-harming behavior is very complex and highly individualized to each and every person experiencing it. I think the key thing is that it is a coping mechanism, so having the focus of finding other, healthy/safe options is the goal, but getting there can be a process. Taking time to really understand the main motivation behind the behavior is so important.
3/19/2018 6:38:34 PM

Tommie
I need help with ptsd bi polar...depression chronic...anxity....sever pain from trauma
3/17/2018 6:48:40 AM

Bridie
Spot on. I'm 54 now ... cutting began when I was around 18 and ended in my 30s (following a third suicide attempt); some of the scars have faded; far more remain.

It stopped emotions from intensifying.
It was self-punishment for my own perceived badness.
It felt relieving.

If I could tell my younger self any one thing, it would be: You are loved, no matter what you say, what you do, where you've been or where you're going, you will always be loved. But first, love yourself.
3/16/2018 3:59:24 PM

Carol
The article is trying to explain self harm...and it is sharing what worked for Renee...
Self harm comes from pain. The goal is to fix or eliminate the pain AND also to have viable ways to cope with/get through the pain.

I find objectivity...take the emotion out of it... And perspective to be effective AND they have worked for me in a career environment...but they are not necessarily effective for everyone.
3/16/2018 11:46:51 AM

Carol
My daughter was 12/turning 13 (2010)when it began in earnest for her; hospitalized almost Non Stop till Oct 2014... We learned a lot. Accurate dx is imperative albeit difficult in teens. Validate how they feel. Empathize with how they feel. Praise teens when they make good choices (not saying they are awesome every time they turn off a light! Lol).
They need therapy that works; that is effective for them! Therapists cannot do the same thing for every patient. We've had the range of mental health professionals who were beyond terrible at their job all the way to some who were decent or good therapists. Parents want results for their teens; some teens are quite resistant to therapy. Good question for teens to ask themselves -- is this healthy for me? Help them learn to think think think--what are choices, options; if I do this-what could happen. Help them see whole picture/learn perspective... Help them learn to turn things around;it is a skill) to get something positive out of everything in life even if it is only a hard learned lesson. Help them develop plans when bullied that don't include suicide and help them learn about resiliency... I also think helping them learn about God will give them something to cling to when things are bad; knowing God hears and answers prayers in His way/in His time; He closes one door yet opens another...
3/16/2018 11:40:01 AM

Nevaeh
This just makes it sound like selfharm can be stopped by making simple adjustments to someones way of thinking. Thats not it at all. This article is a joke.
3/14/2018 10:17:44 PM

Diana
This makes me cry. To be in so much pain that you inflict pain on yourself. My daughter did it when she was a teenager. I see my grandson picking at himself constantly because of the pain and anxiety he feels inside. I can only lend my love and support and a listening ear.
3/14/2018 9:55:44 PM