- Mental Health
Safer Substitutions for Cutting and Self-Mutilation
It is difficult to accurately track the number of people who self-mutilate. Many do not share their experience with healthcare professionals, but the numbers are estimated to be around 3 million Americans who engage in some form of self-mutilation, with the most common type of self-mutilation being cutting.
As a psychiatric nurse, I have had many patients who self-mutilate. What I typically see is a teenage girl who has a history of some type of abuse, frequently sexual abuse, and who is going through some type of current stress, whether it be romantic relationship problems, family discord, bullying, etc. Something that is often misunderstood is that people who self-mutilate usually do it to cope rather than to get attention. Many people seem to believe it is simply attention-seeking behavior, but that does not explain the millions of people who cut in private and who wear long sleeved shirts in summer and who are deeply ashamed of their scars and injuries.
Why Do People Self-Mutilate?
Self-mutilation is a coping skill used to deal with intense emotions the self-injurious person does not have the ability to deal with otherwise. Why do they use self-mutilation? Because it works for them. With a history of child abuse, it is unlikely the person learned positive coping skills as a child. Instead, the person learned how to survive and survival skills are impulsive. Self-mutilation also is impulsive and it is a survival skill, as much as those of us who do not self-mutilate can understand. The person who self-mutilates may describe cutting as the only thing that makes them feel better. That is survival.
Imagine a time when you were absolutely overwhelmed with painful emotion. Examples are finding a partner cheating on you or an unexpected death of a loved one. In order to understand self-mutilation you have to understand the pain behind the injury. How did you cope with your painful emotions? Did you feel like you might just die from the emotional pain? Did you even hope that you would die or disappear or disintegrate into the bed or the floor? If you can imagine those feelings it will help you understand better a person who self-mutilates.
Epinephrine & Endorphins
When a person is feeling overwhelming emotional pain, physical pain becomes a distraction from the emotional pain. Also, self-mutilation improves mood in a biological way. When a person cuts or injures themselves, the body releases epinephrine (adrenaline) and endorphins (an opiate-like chemical). These substances dramatically improve mood. Epinephrine increases heart rate and provides a “rush” sensation, while endorphins are the same substances that are released when a person has an orgasm or eats delicious food. Having an understanding of this also will help you understand how a person can become addicted to self-mutilation.
Substitutions for "In the Moment"
Now that we understand the reasons why people self-mutilate and what it is they are looking for when they self-mutilate, we can focus on finding healthier substitutes, such as:
- Punching pillows or a punching bag
- Ripping up stuffed animals (buy and keep cheap ones around for this purpose)
- Slamming a bag of ice down on the ground
- Listening to intense music loudly and singing along
- Ripping up paper or magazines
As the first wave of intense emotion passes, you may still feel the need to self-injure. The following are calming techniques to use to get you through those feelings:
- Draw on yourself with safe, washable red markers where you would like to cut or injure
- Draw a picture of yourself and draw the cut marks on the picture
- Listen to calming music
- Take a shower or a warm bath, if you can resist the urge to make it scalding hot
- Turn the lights down
- Hum your favorite song
- Pray or meditate
- Stretch or do yoga
- Have someone brush your hair gently
- Ask someone for a back rub
- Journal about your feelings
- Say your feelings out loud to an empty room
- Identify 3 things about yourself that are good. If you don’t know 3 things, ask someone
- Give yourself permission to feel your feelings. It is okay to be angry or sad or lonely or outraged or whatever you feel. They are your feelings.
- Call someone you love and just talk about anything. You don’t have to talk about self-mutilation or your feelings. Just talk.
- Clean something (the bathtub, mop the floor, etc.)
- If you are calm enough to drive, go to a park. Listen to children laughing.
- Hike (be safe about it)
- Go swimming
- Make a craft
- Count backwards from 10
- Do deep breathing exercises
- Hold something that makes you feel safe (e.g. a stuffed animal from childhood, a piece of jewelry from someone you love, etc.)
- Remind yourself that nothing lasts forever, not even this pain
If you have tried the techniques that usually work for you, but you are still feeling the urge to hurt yourself, call a hotline or your doctor or therapist. 1-800-273-TALK is a 24/7 free hotline for people who are feeling the urge to self-harm.
**If you are feeling like you want to die or kill yourself, call 9-1-1 or have someone take you to a hospital.**
There are a number of great self-help and family/friend help books on the market to help us better understand and cope with cutting and self-mutilation. These are just a couple of the better ones, and they are fairly inexpensive. If you or a loved one suffers from self-mutilation, I strongly recommend reading some of these additional resources. Understanding is one of the keys to overcoming.
© 2013 Leah Wells-Marshburn