1. CUTTING: THE ACT OF SELF-HARM “DO NOT DISTURB” TOLD I TALKED TOO MUCH MADE TOO MUCH NOISE I TOOK UP A SILENT HOBBY- BLEEDING. http://www.captivpoetry.com/disturb.htm

2. What is Cutting? Cutting is a deliberate, self -injurious act that yields immediate physical harm.

3. What is Self -Mutilation? “ Self- mutilation is a frightening barrier that keeps us from seeing a person who is lost, in pain, and in desperate need of help.” ~Steven Levenkron Act of damaging seriously by altering an essential part Damage rarely life threatening Location of wound in an easily hidden spot Damaged skin results in scarring Cutting represents individual psychopathology: mental illness Skin piercing: an adolescent trend- NOT cutting Cutting not officially recognized as a disorder

4. What Makes it Pathological?  Direct-intentional behavior; full awareness of its harmful effects  Repetitive in nature  Cut is severe enough for tissue damage (scarring)

5. Who is the Cutter?  Females are more likely to cut than males  Females are not socialized to express violence externally  Females tend to vent on themselves  Males act out / females act in  Males are not effected by chronic invalidation since they are brought up to hold emotions inside

6. How the Disorder Takes Shape  Self-mutilation is a feature to a larger disorder (e.g.: anorexia, bulimia, OCD, anxiety, depression)  Cutter responds to strong tactile stimulus  Dissociative cutter’s goal is to numb the pain (more difficult to treat)  Nondissociative cutter’s goal is to feel pain  Reaches disorder status when other symptoms are less used

7. At-Risk  Victims of physical or sexual abuse  Suffer from physical or emotional neglect (isolation)  Chaotic family conditions during childhood  Grow up in invalidating environments  Lack secure attachments** (fuse pain with security)  Mostly young people who are often inarticulate and emotionally imperceptive

8. Self -Wounding  Pain is the goal – not by-product  Some repress feelings-causing them to be disguised  Continue abusive patterns  Self-hatred

9. Symptoms and Signs  Inability to cope  Feelings of depression, rejection, self-hatred, separation anxiety, guilt, and depersonalization  Need for sensory stimuli  Low self-esteem  Parental emotional deprivation  Are from a dysfunctional family (alcoholism, incest, etc…)  Overwhelming tension and isolation-derived from a fear of abandonment, self-hatred, and apprehension about being able to control one’s own aggression  Overwhelming tension and isolation culminates in a sense of unreality and numbness

10. Cutting: An Act of Anger  Uses physical pain to ward off emotional pain  Self-inflicted pain – substitute for anger toward another – an unconscious desire to inflict pain on the other person  Sense of control over the pain  Escaping numbness: rather feel something than emptiness  Brain chemistry

11. When they cut Usually in a trance state; seeks pain and blood Overtaken by the compulsion to commit the acts Not consciously intended Cutting has a calming effect on the more painful, psychological state Out of touch with reality, in a psychotic or dissociated state

12. Cutting: An Act of Self-Medication  When body is injured, endorphins are released to fight anxiety and depression  Releasing the chemical may become addictive and may be used to self-medicate mood disorder  Brings a rapid release from tension and anxiety  Escape from emptiness, depression, and feeling of unreality

13. The Exhibitionist and Secondary Gain  Damage oneself in full view of the world  Secondary gain Is the attention given even though it is negative  Secondary gain is unconscious, they are not aware of their motives

14. Becoming Comfortable with Pain  Cutter becomes desensitized to the self-harming behavior  As a connection between patient and therapist becomes stronger, the benefits of self-wounding becomes weaker

15. Diagnostic Criteria: Classifying Self-Mutilation Recurrent cutting or burning of one’s skin Tension immediately before the act Relaxation, gratification, pleasant feelings, and numbness with physical pain Shame and fear of social stigma; hiding scars and evidence of self-harm

16. “Attachment is a vital part of all human relationships, commonly defined as joining or binding by personal ties. Self-mutilators suffer from severe deficits in the ability to form personal relationships.” ~Steven Levenkron

17. Personality Traits of a Capable Helper  Stay confident  Remain empathetic  Appear knowledgeable: the self-wounder hopes that the helper is right most of the time.  Understand the despair. In the beginning the helper does most of the talking; don’t ask too many questions because she’ll think you are unknowledgeable.  Use nurturing posture continuously directed toward her  Be optimistic about her future and the ability to overcome her feelings.

18. What does a person who undertakes to help a self-wounder need?  Have some knowledge of what does and does not constitute danger.  Be comfortable talking casually with the patient about the physical harm.  Ask about new injuries.  Look at the wound. Examining the damage regularly creates the anticipation of non-privacy.  Confront the affliction without drama. Let her know she is cared for, loved, and isn’t invisible.  Interpret the wound by its severity.  Request the cutter reflect on what her thoughts and feelings were preceding, during, and after the act.  Do not show signs of anxiety or nervousness.

19. Family of a Cutter The most important family behavior is communication.  Questions all family members should ask themselves about the way they communicate within the family: Do I sort out my feelings before I speak? Do I take responsibility for how I affect others? Do I deal directly with each family member in a considerate manner? Do I apologize when I am wrong? Am I honest in expressing what I want and need from other family members  Family counseling: provides a flow of information and instructions and it furnishes emotional support.  Reparenting: psychological process of changing the parental stance to a warmly authoritative, more directive approach making the self-harmer feel younger and more protected.

20. Cutters learn to expect instantaneous relief; they have no faith in gradual change. They feel that if a change does not change now then it will never occur. “You often talk about the gradual progress I am making. The trouble with thinking about the meantime, while I’m waiting to complete my recovery, is that the ‘meantime’ is such a MEAN TIME.” Once a cutter has established the attachment- trust-dependency axis, they can use a helping person to calm them down, allowing the mean time to elapse while they recover. In order to help these disturbed individuals we must first understand and overcome the feelings of our own disgust. ~Steven Levenkron

21. Breaking the Cycle Analyzing and Confronting the Past  Serious confrontation: It is better to have them take place with a professional.  Incest & physical abuse: Confronting the inflictor allows the victim to stop hurting herself/himself. She/he needs to focus her/his anger on the perpetrator so she/he can heal.  Shame of Mental Disorder: Remind them of their enormous achievement & the education they received in therapy. Self-help groups help them cope.  Blaming: The cutter feels she/he does not deserve to recover or be treated as a success. Letting go of the blame is important for healing.  Fear of Incomplete analysis: The cutter needs to remember that perfection is not a healthy goal.  The scars: The scars of cutting become permanent; they became a stigma.

22. Medication and Self-Esteem  Medication cures neurological problems, not cutting.  Medication without therapy will result in a relapse.  Recognition by the cutter’s family, friends, & therapist of the credit due the cutter for her/him using a therapeutic relationship to find a solution will support the patient’s new found self esteem.  Everyone involved needs to help the recovering cutter forgive herself/himself.

23. Warning Signs of Relapse  Renewed sense of isolation or lack of commitment on the part of the self harmer  Superficially cheery mood  Increase in withdrawal from normal activities

24. Look Beyond the Urge Crisis in the Moment Strategies : Anything that doesn’t self-injure and will produce intense sensations: Biting into a hot pepper or a lemon, placing Ben Gay under your nose, squeezing ice, etc. Questions the cutter should ask of herself/himself when she/he feels the urge to cut:  Why do I feel I need to hurt myself? What has brought me to this point?  Have I been here before? What did I do to deal with it? How did I feel then?  What have I done to ease this discomfort so far? What else can I do that won’t hurt me?  How do I feel right now?  How will I feel when I am hurting myself?  How will I feel after hurting myself? How will I feel tomorrow morning?  Can I avoid this stressor or deal with it better in the future?

25. Routine discussions of the injuries and deciding what to do about them increases trust, begins to integrate the person’s sense of relationship to another person, thus replaces self-mutilation with attachment.  Remember…

26. Resources  SAFE (Self-Abuse Finally Ends) 1-800-DON’T-CUT  Levenkron, Steven. Cutting: Understanding and Overcoming Self-Mutilation. New York: Norton and Company, Inc., 1998.  http://crystal.palace.net/~llama/selfinjury/self.html  http://members.tripod.com/~justADream/cutting.htm

27. Return to… Reynolds HOMEPAGE HOMEPAGE Replay “Cutting” PresentationCutting