By Jeannie Chung
The concept of pain usually reminds us of agony, scowls, and terror. Yet, to some, it is a pathway for relief and salvation.
Clinical Social Worker Carolyn O. Lee from Raleigh presented the subject of self-injury at the Psychiatry and Behavioral Sciences Grand Rounds at the Duke Hospital on Jan. 19. She provided a clear image of what motivates “cutting” and other self-injury, and who it may affect. She also suggested solutions.
People who damage their body tissue to experience jolting pain receive a “natural high,” Lee said. These injuries are intentional and non-life threatening and occur generally in socially outcasted people. Cutting, self-burning, pin-sticking, scratching, and self –hitting, interference with wound healing, and bone breaking are the common methods used. The tools used for such actions are analogous to security blankets of young children, and are deemed very precious to the inflictor.
The most prevalent question is “Why?,” since the concept of self-injury goes against most people’s natural instinct for survival. People seek self-injury to cope, to regulate mood, affect, and consciousness, to relieve anxiety and depression, discharge anger, to inflict punishment, and induce pleasure, feel alive, and have a sense of control, Lee said. The injuries on their body are their voices, she said.
The general thought is “How will you know I am hurting if you cannot see my pain? I wear it on my body, and it shows what words cannot explain,” Lee said.
Before the self-abuse happens, the patient feels a sense of tension, worthlessness and anxiety. During the abuse, they may experience pleasure, exhilaration, relief and numbness. And afterwards they lapse into a pool of guilt, shame, disgust, sorrow, and intrigue, feeling out of control.
Self-abuse continues because it can differentiate inner and outer body boundaries or bring attentiveness to a mistreated body, Lee said. It may identify with the aggressor, displace rage, and regulate states of hyperarousal and dissociation.
Psychiatrists also suspect autism spectrum disorders or defects in theory-of-mind to be major factors for the emergence of such behavior. Physiologically, deficits in serotonin play a large part as well.
To treat self-abuse, Dr. Lee recommends a combination of psychoanalytic therapy and medication. She believes the relationship between the patient and the psychotherapist plays a significant role in mitigating the behavior. However, she added that if a patient shows signs of addictive behavior to self-injury, she would consider prescribing medications.