In
addition to self-destructive impulsiveness that can accompany PTSD,
the person struggling to regulate their mood can resort to willful
physical injury or self-mutilation, one type of addictive behavior
that is used as a coping mechanism. Self injury may include a whole
variety of behaviors from cutting rituals to hair pulling or
interfering with wound healing.
People who experience PTSD contend with very difficult and disturbing symptoms of mood and behavior. They often become anxious quite easily because of seemingly innocuous things which they perceive as threatening. To cope with feelings of numbness and the opposite extreme of feeling overwhelmed and overstimulated, a traumatized person might manifest self-injury as a complex mix of fear and hostility that words cannot express. Trauma repetition may also feed into self-injury, though every individual seems to identify different reasons for doing so, if they are even self-aware enough to figure out why they indulge in the behavior.
People who experience PTSD contend with very difficult and disturbing symptoms of mood and behavior. They often become anxious quite easily because of seemingly innocuous things which they perceive as threatening. To cope with feelings of numbness and the opposite extreme of feeling overwhelmed and overstimulated, a traumatized person might manifest self-injury as a complex mix of fear and hostility that words cannot express. Trauma repetition may also feed into self-injury, though every individual seems to identify different reasons for doing so, if they are even self-aware enough to figure out why they indulge in the behavior.
There
are multiple reasons offered by experts and victims for this often
misunderstood behavior which is associated with certain types of
trauma – particularly in complex trauma and childhood sexual abuse.
Expression
pain or aggression that cannot be verbalized. Self-injury
becomes a non-verbal testimony which expresses that something very
terrible has occurred. The suffering person may have no other way or
permission to express what has happened to them.- Conversion of emotional pain to physical pain. Physical pain makes emotional pain tangible, and it can be expressed, released and resolved when the individual feels as though their emotional pain is locked away.
- Alleviation of pain and anxiety. Self injury is thought to stimulate natural pain killers that the brain generates in response to pain in order to self-soothe.
- Dissociative Grounding. When the experience of numbness and dissociation leaves an individual feeling nothing, self-injurers report that pain returns them to the present and grounds them, taking them out of the feelings of deadness. It reminds them that they remain alive.
- Dissociative distraction from a greater pain. Self injury may also be used as a way of escaping or distracting oneself from a greater threat or trigger when the self injury activity creates a state of dissociation. When a traumatized individual uses self injury to break through numbness, they are essentially using the dissociation created by self injury to attempt to break out of a different, more threatening state of dissociation.
- Creation of an illusion of control. During their initial trauma, the victim has no control, but by recreating a situation wherein the are in control of the injury, it renders them with some sense of the control.
- Creation of a sense of mastery. As previously mentioned, self injury can be viewed as a type of laboratory for creating a traumatic event that gives the traumatized person the sense that they are able to work through their pain using self injury as an alternate method.
- Purging of feelings of self-recrimination directed inward toward self. Self injury can be a way of expressing emotions that should be directed toward the abuser by turning them in on the self. Rather than seeking justice by retaliating against the aggressor, the traumatized person turns this impulse on themselves. It may also be an expression of lack of self-value and self-image as well as the pervasive pessimism and nihilism experienced in chronic trauma.
- Protection against further abuse by making the self unattractive. This behavior and motivation often seems to be a defense against continued sexual abuse. (This is also true of weight management.
- Creating need for self-care. When a person suffers a lack of ability or restraint of self-care, self injury creates a demand for it. The person can then feel good about caring for self without guilt. Sadly, they also learn to associate self-injury with self love, care, and pleasure associated with the aftercare rituals that they develop.
- Direct repetition of abusive behavior and a related means of bonding with the abuser. Children tend to develop behaviors as a type of imitation of the abuse they've suffered. In addition to pure repetition, the victim may be attempting to bond with the abuser through shared behavior. It may seem like the only way that they connect with their abuser.
- Creation of a sense nostalgia through familiar and predictable experience. As discussed, human beings tend to seek out the familiar, even when the familiar presents threat of harm or pain.
- Triggering of response from others. Self injury may be a way of expressing trauma to others in an effort to manipulate them into responding, triggering nurture from a significant other or caregiver.
- Etc.
As with
all behavioral addictions, the rate of recidivism (returning to
repeating the behavior) tends to be rather high because they are
highly addictive. The brain generates its own, directly acting
neurochemicals through the behavior, and their effect becomes far
more potent than any ingested substance. Triggering of PTSD can
easily cause the behavior to resurface long after it is has been
believed to be controlled or arrested.
Alderman
T. The Scarred Soul: Understanding and Ending Self-Inflicted
Violence. Oakland, New Harbinger, 1997.
Herman
JL. Trauma and Recovery. New York, Basic Books, 1992
Levy
MS. A Helpful Way to Conceptualize and Understand Reenactments. J
Psychother Pract Res 7:227-235, July 1998
Miller
A: Thou Shalt Not Be Aware. New York, Meridian, 1984
Van
der Kolk BA. The Compulsion to Repeat the Trauma. Psychiatric Clinics
of North America, 12(2), 389-411, June 1989.
Van
der Kolk BA: The psychological consequences of overwhelming life
experiences, in Psychological Trauma, Van der Kolk (editor),
Washington, DC, American Psychiatric Press, 1987, 1–30.
For
further reading until the next post:
- Judith Herman's Trauma and Recovery
- Peter Levine's Waking the Tiger: Healing Trauma
- Bessel Van der Kolk's The Body Keeps Score
