March 14, 2018

By Hilary Jacobs Hendel, LCSW


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:


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