Why do people hurt themselves?
Imagine you are feeling really upset. Something is going on inside but you may not even know what – you just know a rising sense of desperation and overwhelm is happening and you feel like you can’t cope. Something’s got to give. In your distress you’re ringing your hands. You notice as you unintentionally scrape the skin on the back of your hand against the ring on your finger the sharp sensation distracts you from these powerful thoughts and feelings. Or, perhaps, you’re digging your fingernails into your palms, which you don’t even realize you’re doing, and that somehow eases the pain in your head… A coping strategy is born…
A few weeks ago I was asked to assist Off the Record – a leading youth support service in Bristol – in delivering training for staff at 1625 Independent People on the subject of self-harm. I’ve worked with this pattern of behaviour for some years so my role was to inform the team of the psychology and physiology of why people deliberately hurt themselves. It was hoped that with a deeper understanding, along with their plentiful experience, the team could formulate an updated organizational policy on how to respond to young people in their care who were self-harming. Jonathan Parker, from Off the Record, lead the training and it was heart-warming to see both the level of care and experience amongst the 1625 I.P. staff.
So, what is happening when someone cuts, burns, scrapes, or otherwise harms themselves? Well, the best place to start is in the body. The application of pain or injury to the body stimulates the sympathetic nervous system and the “fight, fright or freeze” response is activated. This is an automatic evolutionary mechanism that enables human beings to survive in hostile situations by defending themselves by fighting or removing themselves from the circumstances. Pain is numbed and muscles are primed. Awareness is moved away from normal processing – hence awareness of emotional pain or disturbing thoughts becomes significantly reduced.
Recent neurological research has reinforced this understanding of how self-harm provides a concrete form of emotional regulation. One particularly fascinating study (Niedtfeld et al. Affect Regulation & Pain in BPD, Biological Psychiatry 2010) detailed how a collection of Borderline Personality Disordered clients (who have a high prevalence for self-harm) and controls were put in a neuro-imaging scanner and then shown three sets of pictures – “positive” ones (kittens etc), “neutral” ones (eg a chair), and “negative” ones (surgical procedures etc). The pictures were designed to generate the corresponding positive, neutral and negative emotions. The scans showed that people with BDP had mostly more than double the level of brain activity response to the pictures in certain parts of the limbic system. The limbic system is associated with emotion, impulsivity, pleasure, as opposed to the pre-frontal cortex – the logical part of the brain – which helps people to moderate behaviour through thinking. It can be inferred from these observations that the BDP subjects experience a significantly greater level of emotion than the control subjects.
The study then goes on to test what happens to this brain activity when pain is applied in the form of a heat pad to the leg. They used the same people and the same pictures but then introduced the pain. And guess what? The brain activity in response to the pictures (read the emotion) reduced in all cases. Simply put: emotional stimulation + pain = less emotion. It is remarkable that we no longer need to rely on anecdotal evidence or theory to understand the function of self-harm – we can observe these pain reduction effects happening in the brain in real-time.
Other studies have supported these findings and explored them further, leading to a suggestion that it is not the introduction of pain per se, but effective distraction, that moderates the emotion. Hence forms of distraction can be extremely useful in helping clients to cope with states that trigger the desire to self-harm.
More next week on the psychological function that SH fulfills and why self harm stops working