“You might imagine that a person would resort to self-mutilation only under extremes of duress, but once I'd crossed that line the first time, taken that fateful step off the precipice, then almost any reason was a good enough reason, almost any provocation was provocation enough. Cutting was my all-purpose solution.” ― Caroline Kettlewell, Skin Game
Coping with stress is something that both plants and animals experience, according to the late UC Berkeley philosophy Professor Emeritus Wallace Matson. It is not uncommon. While plants may cope passively, animals have the power to take action to alleviate stress—by moving to a new location, by eating, by standing their ground or by modifying their behavior. As animals, people use these ways in order to cope with their emotional pain, with their anger, with their frustration and with everyday events. Alleviating stress on the body is a good thing—unless the behavior is something that could do more damage than the stress itself. So why do some people find comfort in self-injury? This type of coping behavior and its signs, symptoms and pathology are of great interest to UC Berkeley Extension instructor Karen Kaufman, Ph.D.
An Early Decision to Become a Child and Family Psychologist
Dr. Karen Kaufman is a psychologist who has been in private practice for more than 30 years in the Bay Area. She has provided individual, group and family therapy for adolescent addicts and their parents at Kaiser Permanente in Walnut Creek, and for adult addicts and their families at Kaiser in Oakland, Calif. She began her teaching career in one of Philadelphia’s elementary schools at age 20, herself a young adult. Seeing first-hand the issues her students were experiencing, Kaufman shifted her career focus to psychology in order to more effectively help children with problems that overwhelmed their abilities to be successful in school. Her enthusiasm for this population and for treating self-destructive behaviors—including self-harm or self-injury in adolescents and young adults—is just as passionate today as it was then.
“There were a few incidents that remain indelibly imprinted in my memory from those times,” recalls Kaufman. “Some of the children who attended the inner-city school where I worked would come to school hungry. They would share the emotional, social and familial problems that they had witnessed or were victims of—events which made it very hard to settle down to the learning tasks at hand. It didn’t help that during my first week of teaching, the mothers of two of my students independently brought wooden paddles to school and announced—with their children at their sides—that I was to use these, as needed, if their children misbehaved. This was not an acceptable practice within the school system, and it was illegal. I was stunned and speechless. Over time, I came to find out that there were teachers at this school who used corporal punishment with the permission of the parents.”
Kaufman was motivated to pursue a career shift. “I wanted to teach children that they had a right to say ‘no’ if an adult hurt them or made them feel uncomfortable or frightened,” she says. “I wanted to be able to meet with parents to help them understand that they have alternative methods of discipline. But the culture, the times, the lack of education within the parent community, the school’s practice of ignoring an unethical behavior on the part of seasoned and respected teachers, and my inexperience and complete lack of psychological skills left me in the most difficult and lonely position. These incidents led me to believe I needed to learn how to help children and parents in a way that teacher training did not prepare me; I applied to graduate school to pursue a career as a psychologist.”
Understanding the Draw of NSSI
The Mayo Clinic describes self-injury as “the act of deliberately harming the surface of your own body, such as cutting or burning yourself.” Non-Suicidal Self-Injury (NSSI) is not typically behavior meant as a suicide attempt but is used as a way to cope with unmanageable feelings.
“Most people, including therapists, who have not worked closely with this population find the self-injurious behavior so hard to understand because it seems counter-intuitive to deliberately want to cause harm to the body without the intent to kill oneself,” explains Kaufman. “One of the frequent explanations my patients who self-injure give is that hurting their bodies helps them feel like they are able to ‘do something to manage feelings’ when they don’t know what else to do or whom to talk about what they are experiencing emotionally. It is, ironically, a method of controlling the source of the pain by being in charge of inflicting it, instead of feeling like a helpless victim. People don’t usually think hurting themselves would relieve stress, but in effect, this is the way self-injurers manage pain—inside and out.
“When there is an injury to our bodies, there is an automatic release of endorphins—the ‘feel good’ chemicals in the brain—that help us cope,” continues Kaufman. “As with ‘runner’s high,’ the brain doesn’t make distinctions between self-intended or unintended injury; it just releases those natural chemicals to help the body recover from the stress. So, it makes sense that with self-injury, the brain also helps people to physiologically feel better. The problem is that this behavior then can become even more self-reinforcing (for example, when a person takes drugs to change feelings and it becomes a cycle), such that it becomes an addiction.”
“Despite causing suffering and shame, NSSI behaviors can provide a feeling of self-control.”
There isn’t a lot of current research available on the occurrence of self-injury, as it is often unseen and underreported. However, some of the latest research indicates that adolescents are at increased risk for self-injury, with 15 percent of teens having reported the behavior and the rate increasing to 17–35 percent by the time they enter college.
Dr. Kaufman understands that although there is a well-established relationship between NSSI and eating disorders, it doesn't mean that everyone with an eating disorder does NSSI. “People with an eating disorder and NSSI do share certain personality characteristics that lead to self-destructive behaviors (co-occurring or intermittently), and they can switch from one to the other,” she explains. “Just as there are certain innate characteristics of personality and temperament that contribute to these disorders, there are likely predisposing factors as well as social and cultural pressures involved. Eating disorders and NSSI have a copycat effect; many teens learn the ins and outs of self-injury and eating disorders by being online and by seeing others glorify their destructive behaviors.”
The Importance of Treating NSSI
“Despite causing suffering and shame, NSSI behaviors can provide a feeling of self-control, similar to how some anorexics express feeling proud of their abilities to deny hunger and overcome the desire to eat,” says Kaufman. “However, there is pain, avoidance, shame, and fear connected with these symptoms. There is also the consequence of lifelong scarring, which in some cases are more obvious and difficult to cover up than others. Obviously, it’s harder to stop these self-harming behaviors than to start doing them. Since self-injury may contribute to momentary relief, people who rely on NSSI often do not develop other, more adaptive means of coping with unbearable feelings. They become ‘addicted’ to the behavior, similar to what traditional substance abusers experience with drug and alcohol use. And yet, information about how to stop is not nearly as available or accessible as it is with substance abuse, and insurance companies may not provide sufficient coverage particular to this population and their needs.”
While not everyone feels the need to self-injure in times of stress, more must be done to detect the underlying issues and provide help to those who feel powerless. One of the many ways parents can begin to help their children who may suffer from these disorders is to listen and support without judgment. For clinicians and psychologists entering or already in the field, truly understanding self-injury and being able to treat it would be a great asset. Sadly, the demand for this specialization continues to grow.
“There is is a great deal of misunderstanding, judgment and anger from parents who see their children's behavior as bizarre, provocative or crazy and who are therefore often frantic, angry, ashamed or embarrassed, instead of supportive,” points out Kaufman. “As for in the therapeutic community, there is a growth in literature to promote better understanding and training, but we have yet to make the knowledge and understanding of NSSI more universal. For example, people still see alcoholics as disgusting, out of control, weak-willed, self-centered, stupid, worthless, immoral or frightening—and consequently, judge and reject them. This is because their behavior is so hurtful and destructive. Addiction evokes anger far more than compassion. Instead of shunning and rejecting people who exhibit self-injurious behaviors, we need to see process addictions (i.e., eating, gambling, internet gaming, hair pulling, sex, cutting, etc.) and substance addictions as illnesses that require compassion, education, treatment, boundary setting, love, support, and in some instances, detachment.”