Inside a Cutter's Mind -- Understanding and Helping Those Who Self-Injure

by Jerusha Clarke with Dr. Earl Henslin, PhD Clinical Psychology, LMFT 

This book addresses the Continuing Education content areas of:
Counseling Theory/Practice and the Helping Relationship, particularly,
    A. the
"diagnosis and treatment of mental disorders", as the DSM-V classifies cutting as "non-suicidal self-injury (NSSI) in Section 3.
    B. "the mind-body connection and its applications in the counseling setting", especially the connection between emotional pain and cutting.
2. Human Growth and Development, particularly,
"normal and abnormal human behavior". Self-harm is considered "abnormal." Criteria for non-suicidal self-injury (NSSI) require 5 or more days
          of intentional self-inflicted damage to the surface of the body without suicidal intent within the past year.
    B. Patients also must engage in the self-injurious behavior with at least one of the following expectations:
        (1) To seek relief from a negative feeling or cognitive state,
        (2) To resolve an interpersonal difficulty, or
        (3) To induce a positive state.
    C. The behavior must also be associated with 1 of the following criteria:
        (1) interpersonal difficulty or negative feelings and thoughts (eg. depression, anxiety),
        (2) premeditation,
        (3) and ruminating on (non-suicidal) self-injury.
    D. Socially sanctioned behaviors, like body-piercing and tattooing, do not qualify for the diagnosis, nor do scab-picking or nail biting.

In the Foreword, Daniel G. Amen, M.D., says " Cutting is not understood by the general public and the vast majority of mental-health professionals. This book is an important resource for us all." (p. 10)

The authors write: "Self-inflicted violence is all at once a psychological, physical, and spiritual battle. Consequently, this book will examine all three aspects." (p. 16)

Counselors of clients who self-injure will learn these skills and knowledge:

1) How and why self-injury begins (Everyone has a coping mechanism), including:
    To release emotional pain when I cannot cry
    To make my unending emotional pain a temporary physical pain
    To control something, and
    To quiet my racing thoughts.

2) How cutters use seclusion and privacy to establish routines of cutting themselves.

3) That removing all sharp objects is not helpful to a cutter because he will find something else to cut with.

4) Environmental and physical conditions that often accompany self-injury, including:
    Depression, low self-esteem, eating disorders, parent/child conflict, manipulation and/or habitual lying, oppositional defiance, aggressive behavior,
    suicidal ideation, a history of sexual abuse, PTSD, dissociation, and addiction.

5) How a cutter can change from a momentary impulse to cut, to doing something else that is a healthy alternative, such as walking a dog.

6) How a cutter can sometimes use dissociation to space out during acts of self-injury in order to block out the pain of hurting herself.

7) How cutting releases the body's natural painkillers (endorphins, dynorphins, and enkephalins) which are 8 to 10 times stronger than morphine.
    How some cutters crave the releases of these chemicals because they make them feel happy, content, and normal.

8) Why its difficult for some cutters to let go of destructive thoughts.

9) Fifteen possible signs of self-injury, including wearing long sleeves in hot weather, having friends who self-injure, self-condemnation, resistance to
    visit the doctor, and outbursts of anger or tears.

10) How to help a cutter endure feelings of loneliness, loss, rage, remorse, and disillusionment, without acting upon them.

11) How to be empathetic to cutters and help them without using shame or guilt messages.

12) How to help a cutter identify and express feelings of anger, fear, guilt, or hurt.

13) How to help a cutter manage stress in non-destructive ways such as exercise, reading, hobbies, and prayer, instead of destructive ways such as
       sexual promiscuity, drinking, drugs, or self-injury.

14) How, according to Christian teaching, Jesus Christ bled and died one time, for every reason a cutter "needs" or "wants" to cut.

15) How cutting can never satisfy the ache within.

16) How God's grace helps a cutter overcome shame by accepting the cutter fully and irreversibly. How grace takes away a cutter's rejection and
      abandonment and imparts worth and value. How grace gives a cutter power to face fear and pain.

17) How cutters should express to God what they truly feel, think, and desire, even their fear, rage, self-contempt, and doubt in God.

18) How Christ truly understands cutters because He Himself experienced unimaginable pain, grief, and abandonment.

20) How the Bible confirms that "God is grieved when we fail, but God quickly draws us to His forgiving heart and accepts us just as if it never
      happened." (Psalm 103:10)