The first time I met someone who used self-injury to cope with her distress was during one of my hospitalizations. I felt very sad for her because I understood the depth of the pain she must have been dealing with and how desperate she must have felt. I did some research to try and understand this coping mechanism and found that the root causes were very similar to the reasons why many of us develop other self-defeating behaviors as a result of being abused such as binge eating, prostitution, and drug abuse.
Problems arise when children grow up with immature, self-absorbed parents who do not have appropriate childrearing expectations, and wouldn’t take classes even if they were offered. Add to that the fact that far too many homes are violent and abusive. When children are brainwashed to keep the “secret” to protect the abusers in the family, the only place we, as survivors, feel we can go to express our pain is to direct it at ourselves.
Internal self-injury (such as internal verbal abuse or the intrusion of painful images) is common with survivors and can serve the same variety of functions that physical self-injury does (e.g., cutting themselves), which is to stimulate or numb strong emotions, trigger dissociation, or reinforce a sense of control and strength.
Survivors are often frightened and ashamed of this behavior, seeing it as evidence that they are crazy or bad. Efforts to control it by trying to stop usually ends in failure, increasing their fear and shame. Survivors usually cannot see the connection between the trauma they endured and their self-injuring behavior—so it feels like there is no reason for the behavior other than their “craziness.” Many survivors keep it a secret because they feel they are insane. The truth is, people who intentionally harm themselves are in a lot of emotional pain and were never taught how to deal with their intense feelings in a healthy way.
In therapy, it is helpful to focus on finding alternative ways to meet the functions served by the self-injury, not just on eliminating the destructive behavior. This is a more positive way of dealing with the issue and allows the survivor to build on his/her strengths.