What makes people hurt themselves? How come some people choose to cut into their own bodies, inflict pain upon themselves? Is it self-destruction they are after, or is it a way to survive in difficult circumstances? Do they do it for attention?

I believe many people who automutilate have been sexually abused as a child.Certainly the reverse is true, survivors of chidhood sexual abuse often display some self-destructive behaviors, self-sabotage and self-injury. Some start cutting to bleed off the tension of an impossible situation at a very early age. Most often it's teenagers, but I've heard cases of 7 or 8 year olds finding creative ways of hurting themselves. Some try to hide it from the world, thinking well about where they cut and how deeply, others are blatant about it and cut in highly visible places, showing people their cuts as a dramatic expression of their own inability to keep from doing it.

What is automutilation exactly?
The thesaurus keeps it at: Automutilation = Self-injury, the act of intentionally hurting oneself. One manifestation of this is known as cutting.
First point I'd like to make is that automutilation is like a container-word. It includes people cutting into their own skin, or causing themselves (cigarette) burns, but also people who induce vomiting for the pain it causes, who overexercise, starve themselves or eat untill it hurts, any of these behaviors intended to hurt the body, I consider automutilation.

I believe automutilation is a natural response to an incredibly difficult set of circumstances. At a time when the individual is trying to shape it's personality, childhood and puberty, the individual is repressed, often forced and co-erced. This leaves lasting shortages in the individuals development and while a lot is then beyond your control, at least you can control the pain you inflict upon your own body.

This is what survivors of childhood sexual abuse often say is the reason for their cutting, over-eating, starving themselves: a sense of control about their own body. Their body has been used for the abusers satisfaction but here they regain in a small sense some control over their body. This is something they can do, often the only thing.

In classic behavioral therapy the self injury is taken away from them by the therapist. These young people find themselves in psych wards without the means of self-injury. The one thing they could control is put beyond their control, the result: another soul-injury. As difficult as it may be I believe there's a better answer than that. Obviously if someone is doing dangerous type of self-injury, through deep cutting, starvation (anorexia) or other eating disorders, endangering their very life, intervention is necessary. Intervention should, in my opinion, center upon the life-threatening aspects of the behavior. For the survivor of childhood sexual abuse, the behavior is not intended to be suicidal. In fact, it's often a rather desperate attempt to stay alive, to keep the soul, the identity, the part of the person that is individual and unique, alive and kicking. It's a healthy impulse even if the behavior is destructive.

Personally I ate. I ate till it hurt so bad that I couldn't eat anymore, and then I'd eat some more. I wouldn't purge, I guess I was too proud for that, it always seemed like a loss of control for me, not a means of control. I ate because I didn't want to be attractive. I ate to punish myself. I ate because it was something that was all mine, something I could do in my own way.
When I started healing it wasn't through a diet that I curbed my eating habits. It was facing up to the fact that I had felt completely helpless and defenceless at the time. That eating was my way of dealing with emotions that I couldn't handle any other way, simply because that aspect of my personality hadn't yet been developed prior to the abuse. I had to develop brand new ways of dealing with emotions, like crying, getting angry, feeling lost and alone (and not "solving" that with food). Likewise I've counselled quite a few people who used cutting, overexercising or starving themselves to avoid feeling the raw emotions of their abusive childhood.

When you find a way that works, to dampen your fear or to control you anxiety, you stick with it. Even if it doesn't work in the long run, in the short run it helps. So you keep doing it. It becomes a habit. Also, avoiding the stress and anxiety becomes a habit. Slowly you withdraw from life and this increases the stress of going out and doing stuff: your world shrinks to a minimum. If you don't have to go out into the stress and duress of normal every day living, you unlearn skills associated with that. Everything becomes unfamiliar and stressfull. And stress and fear are a reason to dampen your anxiety by your chosen means of self injury.

This is how it goes from bad to worse. The self injury doesn't really work against the deepseated fears, it just dampens them. It is needed more often and sometimes at a deepening level. Instead of just overeating and purging you start eating things that provide you with a maximum pain when they come out. Instead of cutting into the outer layers of skin, you cut deeper, through the skin and into the flesh in an effort to gain the same sense of relief.

Breaking the habit, stopping the self injury on a behavioral level leaves the door open to the worst fears. Sometimes, with proper therapy and loads of understanding, this works. You break the habit. More often though, survivors are "put through" therapy without the element of choice. They are hospitalized after some dangerous self injury and are forced to give up the behavior. This results in tremendous fear: esspecially since their original fear is often centered around the loss of control over their own body. In the clinic people then are put on medication.

There are many survivors who reside in psychiatric hospitals more or less on a permanent basis. Suicidal ideation, extreme fear, obsessive compulsive behavior and self injury result in enforced inclusion in clinical psychiatry. I believe that for many of them, the fear has gotten too overwhelming to face. I also believe that with specialized therapy for childhood sexual abuse, it is possible to overcome the fear, rather than to dampen it. The result of overcoming the fear is a much stronger, more resilient individual. Life can become a wonderful and exciting adventure.