Maria is 14 years old. Two years ago she began to injure herself, dropped out of school, began using drugs and alcohol and eventually isolated all of her friends. Self injury involves the deliberate damaging of ones body. Cutting the skin with razor blades or broken glass is the most commonly seen method, while burning, interference with wound healing, self punching and scratching are among other examples.
Maria notes that when her peers discovered she was cutting she was ridiculed and shunned. Her parents and support systems became overwhelmed. They tried reasoning, pleading, bribing, grounding, and taking away privileges. At times they screamed and threatened to kick her out of the house. Nothing was working to reduce her self destructiveness.
While not all individuals who cut are diagnosed with Borderline Personality Disorder, in Maria’s case it was quickly recognized that she struggled with BPD and recurring depression. Eventually a treatment program was developed to help her cope with her distressing symptoms. An important clue to discovering her diagnosis was the simple question of asking what she feels when she cuts. Her answer was “either nothing or everything”. Maria states she often feels empty, as though she doesn’t exist, like she is invisible. At other times she feels as though she is going to explode with feelings. Asking her to describe her emotions, she stares blankly as large silent tears pour from her eyes. She quietly says she really doesn’t know how to discuss sadness, anger, or joy. She feels alienated from herself and her feelings.
When asked to describe the circumstances behind the various cuts on her body, she is able to let the cuts talk for her. The deep one on her arm was the result of being rejected by her peers after being told she was a freak. She recalls going blank as though she was starting to die or disappear. The cut served the purpose of letting her feel something, albeit pain, and reminded her that she was in fact still alive. The cuts on her stomach occurred when she thought back to past abuse by a relative. This time she was flooded with so many painful feelings that she cut to stop the emotional pain from overwhelming her and focused on the physical pain.
The reasons are complex, varied and unique for each individual. Maria noted that for two years everyone around her talked a lot about what she needed to do to change. The problem was that nobody was listening to her profound statement “I don’t know why I do what I do, all I do know is that I either feel nothing or everything”. It is as though her nervous system is hard wired to experience basic human emotion on an intense and dramatic level. If she doesn’t release the intensity by cutting or anger, she may shut down, dissociate or engage in other behaviors to blank out the painful feelings.
As therapy progressed, Maria’s behavior became less destructive. She gradually became able to recognize and discuss her emotions. She learned to simply observe her emotions without becoming overwhelmed by the intensity. In turn, this allowed her to develop strategies to solve her problems without harming herself. Most importantly, her parents learned to validate her emotions. She can now say she is sad or angry without being told that she shouldn’t be feeling a certain way or that she has no right to feel the way she does because she is loved, has a nice home, material objects, etc. Her parents now work with her to brainstorm ideas on how to address the challenges she faces. In the past they would have dictated what she should do and how she should feel.
If you know someone who sounds similar to Maria, please remember not to dismiss their feelings. The feelings are real and valid and to have their expressions of emotion shot down or dismissed is a painful and invalidating experience. They learn quickly to not trust what they feel. In many cases, it has been shown that cutting is not a suicide attempt but rather a manifestation of the tremendous internal pain they experience. Those who cut are often traumatized further by the understandable but misguided labels that others apply to them of being nothing more than dramatic and manipulative.
Like Maria, many teens who cut are extremely sensitive. They feel their own pain on a profound and intense level. They also tend to be highly intuitive and empathic with respect to the suffering of others. These troubled but exceptionally sensitive people are in need of therapy by a professional who can understand the dynamics behind their pain. If you are seeking assistance for yourself or a loved one, please ensure that the attending therapist has a sound knowledge of the treatment needed to address this challenging struggle.