How can I hurt myself? Let me count the ways. But first let me distinguish between hurting myself and abusing myself. Hurting myself - self-harm is a term commonly used for physically abusing oneself by cutting, self inflicting blows, pulling out hair (Trichotillomania) skin or nails, starving or food misuse, extreme piercing, or purposely burning ones’ self. Abusing myself - self-abuse covers the entire spectrum of self-destructive behavior, which includes emotional and psychological abuse and unconsciously or indirectly exposing oneself to physical harm via reckless or dangerous behavior. Addiction is viewed as a symptom rather than a cause of self-abuse, but many addictions (i.e. any kind of substance abuse, unsafe sex and even gambling) can become a reckless behavior that leads to physical harm.

When people act in ways that seem abusive to themselves, we shame them. We disparage them as weak, selfish, suicidal. Sometimes we even ostracize them. Thus we are further punishing those who are already punishing themselves. But what do we gain from that reaction? Does this stop the self-abusive behavior? Does it make the underlying issues that instigated the self-abuse disappear?

Self-abuse is an acting out of negative emotions – but it is not about wanting to die or about wanting to hurt others. It is about trying to cope, trying to live. Why do people act out in this manner? It’s because the self-abuse is a recreation of abusive situations from the past that shaped these people. The feeling of being abused is familiar and connotes a way of communicating, because the people who abused them originally were probably people that either loved and took care of them or were supposed to love and take care of them. Hence, self-abusive behavior now as an adult becomes a way of them taking care of themselves.

The betrayal (social, physical, emotional) of children by trusted adults has devastating consequences. And while childhood trauma contributes to the initiation of self-destructive behavior, the lack of secure attachments helps to maintain it.
Here is a young woman’s account of why she abuses herself. “It helps me cope and is a way for me to vent the self hate I was given by my abusers, which I now turn in onto myself. I want the outside to show how I feel on the inside, because I feel I deserve it; because life without abuse is so unfamiliar it’s terrifying; because if I don’t harm myself everyone will decide I’m OK and leave me alone and I am not OK.”
(“Healing the Hurt Within”, 1999)

While self-mutilation is directly linked to childhood abuse – drug and alcohol abuse is more complex. There are those who use substances to self medicate an undetected or undiagnosed emotional disorder (i.e. Depression, Bipolar Disorder, ADD, etc). They self-abuse to relieve psychic pain – but not necessarily pain that arises from childhood abuse. And in families with a history of substance abuse, there is the genetic component - albeit many times a more complex one than susceptibility to addiction. There may be several generations of emotional disorder that led to the substance abuse – most likely Depression.

Let’s look at how self-abuse relieves the suffering. There is a cycle to this behavior, and in a way it is similar to the cycle of domestic abuse:

The person is plagued by memories of past traumatic events or intrusive, shameful and unacceptable thoughts. They are reacting to a negative or faulty self-belief (schema) that tells them that they are bad and worthless.

These feelings are trapped inside and build – just like steam in an engine.

The steam (rage) builds to a point where it has to find release – the person feels as if they will explode.

The person either self injures or turns toward an addictive/compulsive behavior that temporarily dissipates the rage. While the person is in this state they may or may not be conscious of how their behavior is controlling them. They may or may not “feel the pain”. If they self injure, they either disassociate from the feelings or may actually want to feel the pain in order to externalize and concretize the internal psychic pain that they continually experience. Once they have acted out, there is a sense of relief – almost an orgasmic sense of relief. It will not last.

How can people counteract this cycle? First they must understand and acknowledge it. They particularly need to look at the negative, faulty self-belief that tells them that they are worthless and prods them on. Where did this belief come from? Where is the evidence that it is true? Does holding on to this belief serve any purpose or does it just keep me down? Is it truly my belief or the way those around me made/make me feel? If you can reflect on it and slow yourself at this point; if you can come up with a counterargument to the one that has always led you down this path; then you can begin to take back control of your behavior.

The goal is to develop a new relationship with yourself and alternative methods for self-care. This is not an easy road. It may take time. But the first step is always a desire to change.

Roni Weisberg-Ross LMFT

Author's Bio: 

West Los Angeles based psychotherapist who specializes in the treatment of sexual abuse, emotional abuse, clinical depression and social anxiety. Roni works with individuals, couples and families and leads a weekly AMAC (Adults Abused as Children) support group at the Family Resource Counseling Center