The complex motivations for self-harm

If you ask the average person in the street why some people cut themselves you’ll get the answer that they’re trying to ‘get attention’ which is a common but unhelpful stereotype.

The reality is that motivations for self-harming are complex. Some people find it helps control their intense moods by externalising the pain, other are punishing themselves, others are responding to psychosis, others self-harm for a combination of reasons.

A new study in the Journal of Adolescence looks at motivations in online accounts of self-harm and gives an insight into the various ways young people describe their actions.

The research aims to examine ‘magical thinking’ in explanations of self-harm but this doesn’t necesarilly mean magical thinking in the sense associated with psychosis (i.e. unknown forces and jumping to conclusions) but in terms of how metaphors and symbolism and woven into young people’s explanations.

Part of the article gives examples of various forms of symbolic ‘magical thinking’. It’s a bit wordy but it illustrates some of the psychological complexity of self-harm.

1. Magic substitutions. This term refers to the magic belief in the transformation of one category of phenomena into another, e.g. emotional pain into physical, bad self into blood. For example, “I can’t handle mental or emotional pain, so I turn it into something I can handle, which is physical pain.”

2. Transanimation of objects. Scored if an inanimate object, such as the blood, body or cutting instrument, is described as an active subject independent of the self. For example, “the blade is always so nice, like with every cut it lets the pain flow out; it lets it flood like a river of blood.” This example would also be scored as a magical substitution, where blood magically substitutes for emotional pain.

3. Transanimation of processes. Scored as present if a behaviour or phenomenon is seen as having autonomous agency. For example, “I still cut myself. Because to me that is my only true friend.”

4. Auto-relatedness. Scored if the narrator wrote about himself or herself as a separate person or a poorly integrated part. For example, “Don’t worry me, me will take care of you. It’s okay me, me is here now.”

5. Split between inside and outside. Scored if the narrator describes a metaphysical difference between the inside and outside of the body. For example, “I feel so ugly inside, so dark and cold, on the outside I’m not exactly warm, but I’m not as cold.”

6. Scars reminding and communicating. Scored if scars or cuts communicate with or remind the narrator or others. For example, “I feel better when I see the cuts on my arms, I don’t know why, I mean I hate them. But they seem to make me feel like I guess someone gets it, gets why I do this to myself.”

Unfortunately, the ‘doing it to get attention’ stereotype is also maintained by lots of health professionals as self-harm is also stigmatised by the people who treat these young people.

It’s a complex and frustrating behaviour and, therefore, one that needs some of the most careful consideration in psychiatry.
 

Link to locked study on magical thinking in self-harm.

13 Comments

  1. Kyle
    Posted April 5, 2012 at 12:28 am | Permalink

    I’ve had an on-off relationship with self-harming throughout most of my life, and even I have a hard time explaining it. It’s such a primal urge that I don’t know how to translate it into something logical. On one level it’s a way of relieving stress, but it’s also a distraction. When you’re completely overwhelmed, it gives you something immediate to focus your attention on. For me it wasn’t even the actual cutting that was important, but the process of cleaning and bandaging the wounds. That always felt therapeutic to me.

    Disclaimer: I no longer actively self-harm, and I’m working with a therapist to keep it that way.

  2. deloris lee
    Posted April 5, 2012 at 3:16 am | Permalink

    As a former cutter, this post was very interesting to me. I think that my reasons for doing it are not covered, and I wonder how odd they are not considering why other people do it. I still think that the stereotype of “attention seeking” is partly true because so many people that do it show it off, which is something I never did. I hid mine is fear and shame that someone would see, and eventually changed to cutting my thighs so that no one would see it. Anyone that has taken pictures of their cuts, posted it online, or shown a friend but not under the “I need help to stop this” guise, is definitely doing it for attention. Especially since their reasons for doing it are very “romantic” for lack of a better term i.e. making the pain visible etc.

    I did it because I was overwhelmed by my intense feelings. I would end up having panic attacks due to my intense feelings about things and cutting was a way for me to “numb out” and calm down. I do have pretty mild OCD, so I tended to make 3 or 5 cuts depending on the severity of my panic attack so that I could calm down. Once I cut, I would start to feel numb, and then when I was done I would go lie down and go to sleep. This was not a reason listed in the study (that I cannot see other than what you posted), and I now wonder if this is a completely odd reason for cutting that the majority of cutters never experience.

    I am glad to report that I have not cut in over 5 years, and never feel the need to. I have learned to handle my emotions and no longer have panic attacks either. All of that really really sucked. So did the cutting. I regretted it every single time I did it.

    • Posted April 5, 2012 at 2:07 pm | Permalink

      Hi Deloris Lee,

      A story that describes reasons similar to yours is included in the book “the boy who was raised as a dog” by Bruce Perry and Maia Szalavitz. A lot of detail is given about why cutting could have that effect. You might be interested in it.

    • Posted April 9, 2012 at 6:13 am | Permalink

      Research shows that cutting creates an inside-the-body opiate response, which is the numbing sensation. Ulrich Lanius and others write about this opiate response being a form of dissociation.

      So glad you found other ways to soothe yourself!

    • Rachel
      Posted April 29, 2013 at 3:05 am | Permalink

      I did it for the a lot of the same reason you are talking about. Cutting literally calmed me down. When I tried to explain it to my counselor I told her it was like a small child who is crying uncontrollably but there is that one object that will calm him/her down…a blanket, toy, etc. For me, it was the blade. It was almost like I was mesmerized by the action, all my focus was put into making the cut(s).

  3. Anonymous
    Posted April 5, 2012 at 5:30 pm | Permalink

    What about self-harm as a form of personal self restraint? I have been known to bite and scratch myself rather than disintegrate into a physical fight with others.

  4. Anon
    Posted April 6, 2012 at 1:12 pm | Permalink

    Can’t read article because it is locked but when I used to self-harm it was to do with control.

    I felt emotionally out of control – cutting made me feel calm.

    I wonder if cutting releases something that causes a calming sensation?

    I only cut in places that could be fully covered and unseen by anyone.

  5. See Bee
    Posted April 7, 2012 at 12:15 am | Permalink

    As a former cutter I would identity with using cutting to handle emotional pain and also with using the scars as a reminder of that pain. For the weeks following a cutting I ‘liked’ to feel the scars under my clothes – well, I didn’t like it but it was a distraction.
    Also like Deloris I switched to cutting my thighs as I they last thing I wanted was for others to see the scars on my wrists.
    I haven’t cut myself in 5 years. BTW I’m a 45 year old male.

  6. Peder
    Posted April 8, 2012 at 11:30 pm | Permalink

    As a psychiatrist who works with Mentalization Based Treatment for BPD I would consider self-harm as a way of regulating overwhelming emotions.
    There are, as seen in the comments, other gains from scaring, bandaging etc. I’d consider those as secondary for most.
    It is also my experience that most of the clients I’ve had don’t show their cuts to others.

  7. anon
    Posted April 9, 2012 at 1:51 pm | Permalink

    As an older person who’d never had any such inclinations before, it was shocking to me that I suddenly started self harming after several years of being terrifyingly stalked and the police and other responsible authorities not doing a thing about it.

    The terror of being stalked and the probably even worse trauma of the authorities not caring a fig (and, worse, their mind-bending excuses and lies for not doing anything and trying their darndest to ‘make me go away’) was beyond shocking and overwhelming.

    I stopped self harming as I began to think about the phenomenon more rationally. I worked out that essentially both the offender and the authorities were working to damage me in their own ways and that the ONLY way I could feel some control in the total mess they’d made of my life was to do the damage myself.

    Then I gradually decided that I had to find other ways of wresting back control and stopped harming. I still don’t have the normal, healthy measure of control of my life because the offending continues and the police and other authorities are factually, evidentially negligent still (I’ve already won a legal case for negligence and abuse against one statutory authority). But I feel a bit better because I’ve decided that I’ll probably utilise the ultimate self-control one of these days.

    No one can live even half-way healthily when one is under attack and being ‘gaslighted’ by those who have a duty of care.

    My take on self-harm now is that behind every case is a hidden history of disgusting psychological and physical abuse. The professionals definitely don’t help either as they generally just cannot grasp that other ‘reputable’ authorities and their own colleagues can perpetrate such horrors on vulnerable patients/clients/service users. The blame is forced onto the poor self-harmer as if she or he exists in a vacuum where the self-harm somehow magically appears from nowhere but the individual’s mind. Total nonsense of course, but this really IS the way professionals and ‘helping’ agencies ego-defend themselves.

    Thus, as far as I see it, self-harm is probably entirely the outward and visible sign of the deeply dark side of human beings and their often appalling covert aggression towards more vulnerable and disadvantaged others.

    c.f. RD Laing: ‘If the patient is disturbed then the family is disturbing.’

    • Posted April 10, 2012 at 5:48 am | Permalink

      Dear anon,
      I really hope you find a solution besides ‘ultimate self-control’ if by that you mean suicide.
      I have had an early life full of abuse. I’ve been on a real roller-coaster.
      When suicide took one of my friends, I took a look at its position in my life as being a last resort, my worst case scenario where I was still making the choice and had some control. Then I looked at the friends, families and community that my friend tore apart. It was a dispersal of her pain into everyone in her life, never to be healed.
      Sadly it also meant that whatever it was she was meant to become, someone strong and vibrant, as she learned to overcome and grow from her experiences, it was snuffed out along with all she might have been able to offer to others facing the same challenges. There will forever be a Natalie shaped hole in the universe rippling through the space-time of future humans who’s lives will never be touched by her.

      I still see suicide as the worst possible scenario, but now it is one that I pull back from, it is the line I choose not to cross. I use it as a tool to gain perspective and courage to do things that may have been considered too radical or severe, but compared to suicide, they become viable options. I have moved towns many times, changed entire sets of friends just as many times. I have sold or given away EVERYTHING, or near everything and walked away, started fresh and felt liberated.
      My issues and lessons follow me, but I see them with fresh eyes, and that gives me a chance to learn from them and move on. If I can learn from a horrible experience, then I can detach my emotions from it and I don’t feel like it was a complete tragedy if I have grown stronger from the experience.
      My friend killed herself, some who loved her went nuts others switched their feelings off and never loved again, I grew strong and learned to overcome the pain by focusing on the lessons within each experience. Even though she is gone now, I’m so glad she was in my life even if that means experiencing that pain. My life is richer for it!

      Life still has pain and suffering and things I can’t control, but I’ve come to realize that is a natural part of life. I have turned to philosophy, Taoism, Zen Buddhism, Wabi Sabi, Fur Yu, even finding much wisdom in Sci-fi, modern and classic literature.
      In my experience there is wisdom everywhere.
      For instance something i like to do regularly is: Ask a question, put it out there, let it go into the world around me and go about my day as normal, open myself up to the answer and it will find me, it will come often from the most unlikely places or chance encounters.

      This has helped shape the way I see the world/universe around me, as a living breathing quite possibly sentient interconnected thing. I feel always supported and provided for, I feel connected to something bigger than me, something good, so I can let go of that feeling of terror and just float down stream, enjoying the ride.

      Walt Disney said “Keep moving forwards.”

      Abraham Hicks said “Everything you want is downstream, you don’t ever have to struggle against the current, just relax and let your boat flow down stream”

      Fur Yu means “Wind and Stream”
      Wabi Sabi is about ‘the effect time has on things’. And the ‘beauty of imperfection’.
      Taoism Means “The Way.” it is ancient Chinese poetry describing observations of the natural laws of the universe.

      I found all of these things very soothing and uplifting. I hope you find your way.

  8. Posted May 28, 2012 at 8:27 pm | Permalink

    It seems quite clear, as others have posted, that self harm is a method of regulating overwhelming emotions. I think it’s important to point out that it is also not new. For instance there are many accounts of people gashing and scratching themselves at funeral ceremonies in various cultures. This is often seen as not only normal but laudable, as a sign of grief. It is extreme and can be dangerous, but the impulse is not crazy or bad. It is a sign that less drastic coping mechanisms are overwhelmed.

  9. lee
    Posted September 18, 2013 at 11:05 am | Permalink

    Interesting article to read.
    I am a cutter, but before today I would have said I was a cutter as I stopped cutting for going on 5 and a half years untill today. Today i broke out and cut numerous times again. (no it wasn’t because of this article).
    I am 43 years old, female. Onall accounts to the outside world I am a normal, working and functioning individual, who, seemingly, hasnt a problem in the world. I started cutting at a very young age, in early teens for much of the reasons discussed here in this forum. It helped with the pain, it externalised the inner feelings, helped me let go of anger, was a way for me to personally punish myself for my faults etc etc.
    I believe self harming never goes away, and can never be totally given up on, even if it seems like it can,even if you have bouts of normality.
    When I stopped cutting, it wasnt really by choice, I met someone who even to this day he is ignorant of my desire to self harm, though by my scars he is aware of my past and of some pains in my past, but he has no idea that I still desire t o and have relapsed. (although I would not reallysay it is a relapse)
    When I stopped harming by cutting, i substituted for something else, a lifestyle of Dominant/submissiveness, i am now the submissive in a D/s relationship, have been for those 5 and a half years…and i say substituted because the side of the lifestyle We lean to is the consentual giving and receiving of corporal pain. The only thing is now, I self harm by proxy of the relationship, I allow my partner to cause me the pain I need to feel, and it is more intense.
    I self harmed/cut today because circumstance lately has made it impossible to play our roles the way I would like, and I am craving the pain, and the feeling it gives me now, so i cut again, and its not attention grabbing, infact the opposite, for me its become like a drug, it is the rush,and the switching off into that darkness that has always held me in its arms … withoutself harming in any way, I am disfunctional, lost, and numb and unsure how I would cope.
    So for me, i guess i differ in the reasons given in the article to some extent although initially my reasons were alike. Now, it is a way of life for me, a private, well hidden life,and an addiction I cannot escape.
    I fear for those young ones who cut, get the help now while you have the resources.. before it takes over your life.


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