Self-Harm/Self Injury and Coping with Overwhelming Feelings:

Woman

Source: Lukas Panek/Unspalsh

Self-harm refers to inflicting injury to one’s own body. There is a high incidence of self-mutilation among survivors of child sexual abuse (CSA), who may resort to inflicting self-harm when memories or feelings of despair and self-loathing emerge. Some of my clients use self-mutilation as a way of managing flashbacks and see self-harm as an act that can convert emotional pain to physical pain. When a flashback occurs, it can last minutes or even hours, and for some clients, self-mutilation is a way of gaining control of the memory by placing their attention and focus on hurting themselves.

When memories of abuse and their corresponding feelings emerged, my client Jessie often resorted to a pattern of self-mutilation as an act to gain control and to decrease the tension and the anxiety associated with the memories that were surfacing. Rather than unwillingly re-experience the traumatic event, Jessie would take control by inflicting pain on herself. For her, self-mutilation was a way of staying in the present and managing the flashbacks, which she says “can feel like an intrusive surge of pain.” Rather than be overcome and flooded with feelings and memories of an event that was horrific and terrifying, Jessie took control by cutting. Jessie exclaimed, “It’s just me and the cutting, and the cutting and me, and nothing else exists.” I asked Jessie what would happen if she did not cut. She said she thought she would detach from her body and never be able to find her way back. She believed she would permanently disconnect from reality. Cutting was her attempt to stay sane, and to her, the self-inflicted pain kept her connected to herself.

Self-mutilation can take on many forms. The parts of the body that were involved in the abuse are usually the parts that are targeted for self-mutilation, and many times the self-mutilation is related to the emerging traumatic memory or flashback. One client would take hot baths to clean her genitals and would also cut her breasts and vagina with a razor. Another client with visual memories of abuse would very slowly cut her eye lids, making small and consistent slash marks with a razor to avoid re-experiencing the trauma via a flashback. She was meticulous and took great pride in her ability to hide the marks from her partner and her children.

Some of my clients have expressed that when they feel guilt and/or a deep sense of shame they may engage in self-injury as a way of punishing themselves for their sense of inadequacy and self-contempt. It is important to realize that self-mutilation does not indicate suicidal ideation; rather, it is a measure taken to reaffirm the self and to take control using pain, this time inflicted by the hands of the abused.

Women who have experienced sexual trauma as children often feel hopeless, powerless, and angry, unprotected, confused, and hold negative beliefs about themselves and the world. Survivors may resort to self-harm and like my client Jessie, who self-mutilated and cut her body with a razor when she became overwhelmed with flashbacks related to her early CSA. Although there are many differences in the stories of women with CSA histories, the one commonality many share is their abuse is linked to their present pain and limited capacity to function because of unhealed child abuse. Self-harm is a temporary coping strategy to deal with overwhelming feelings. It is important the survivor understands what prompts the triggers and find alternative coping strategies and techniques