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Inside a Cutter's Mind -- Understanding and Helping Those Who Self-Injure
Jerusha Clark with Dr. Earl Henslin © 2007.
(NavPress: Colorado Springs, CO). All rights reserved.
[Answer 14 of 20 questions correctly to receive
10 hours of Continuing Education credit.]

Chapter 1 – Then and Now: A Survey of Self-Injury (p. 19-31)
1. The majority of self-injurers cut because they
a. are seeking attention.
b. are suicidal.
c. seek relief from seemingly uncontrollable pain or deadening numbness.
d. want to punish themselves for wrongdoing.

2. Which is NOT true?
a. The author prefers to use the phrases self-harm and self-injury rather than self-mutilation.
b. In the Old Testament, God commands His people to not cut their bodies ritually, as their pagan neighbors did.
c. Many people of many different religions injure themselves to gain favor with their deity.
d. People who have never intentionally harmed themselves are unable to empathize with cutters.

Chapter 2 -- What Words Cannot Explain (p. 33-60)
3. Which is NOT true?
a. Many people who injure themselves have little or no idea how they got started.
b. Removing all sharp objects is not helpful to a cutter because he will find something else to cut with.
c. Cutters use seclusion and privacy to establish routines of cutting themselves in the same locations and at the same times of the day. Therefore, being with them and supportive during a difficult part of their day could decrease the likelihood of self-inflicted violence.
d. Once a cutter, always a cutter.

4. Which is TRUE?
a. The author, a non-cutter, began experiencing genuine compassion for cutters when she realized that all of us choose some type of coping mechanisms
b. Self-injury is more of a problem for women than for men.
c. Teenagers who injure themselves usually grow out of this habit and stop doing it.
d. Self-injurers enjoy the pain they cause themselves.

5. Which was NOT one of the reasons given for why people cut themselves?
a. To release my emotional pain when I cannot cry.
b. To make my unending emotional pain a temporary physical pain.
c. Because I feel so overwhelmed or alone.
d. To punish my parents.
e. Because I can't express my emotions any other way.
f. Because I need to control something.
g. To quiet my racing thoughts.
h. To show how tough I am.
i. To feel love (because after my father punished me he would comfort me).

Chapter 3 -- Misery Loves Company: Environmental and Physical Conditions that Often Accompany Self-Injury (p. 61-89)
6. Which is TRUE regarding depression?
a. Moods disorders exist on a continuum, ranging from people with chemical imbalances and/or severely disturbed family functioning to those who have circumstantial hopelessness.
b. After long periods of toxic thought patterns and of experiencing intense feelings of sadness, grief, or rage, it's possible for one's limbic system, the area of the brain that helps control mood, to actually shut down.
c. Depression is best treated by a combination of medication and therapy for changing, for example, negative thought patterns.
d. All of the above.

7. Which is TRUE about cutters and Borderline Personality Disorders (BPD)?
a. All cutters have BPD.
b. All people with BPD harm themselves.
c. Some cutters have BPD
d. The Diagnostic and Statistical Manual of Mental Health Disorders specifies self-injurious behavior as a possible symptom of Obsessive-Compulsive Disorder (OCD).

8. Which is NOT true?
a. It is possible for a cutter to change from a momentary impulse to cut to doing something else that is a healthy alternative, such as walking a dog.
b. With eating disorders, people attempt to manage and control psychological longings by converting them to physical sensations of hunger, fullness, or the temporary extinction of either.
c. No matter what sex-abusers said to their victims, and no matter what pleasure the victims may have experienced, the abuse was not and never will be the fault of the victim.
d. SPECT scans of self-injurers will appear "cool." Their brains also produce lower levels of cortisol.

9. Which is NOT true about dissociation?
a. Dissociation is when your mind goes blank until the threatening feeling dissipates.
b. Since dissociation serves as a psychological defense against traumatic memories, it is rarely dangerous or destructive when used by a cutter.
c. Sometimes self-injury can halt a cutter's descent into dissociation by increasing her awareness of what she is doing to her body.
d. Sometimes a cutter can use dissociation to space out during acts of self-injury in order to block out the pain of hurting herself.

Chapter 4: Is It All in Their Head? -- The Undeniable Influence of Physiology in Self-Injury (p. 91-113)

10. Which is NOT true?
a. Cutting releases the body's natural painkillers -- endorphins, dynorphins, and enkephalins -- which are 8 to 10 times stronger than morphine. Some cutters actually crave the release of these chemicals because they make them feel happy, content, and normal.
b. Initial cutting produces euphoria, but can ultimately produce numbness, as the brain builds up tolerance to the body's natural painkillers. This explains why some cutters must cut themselves more often and more severely to produce the same effects as when they first began cutting.
c. A score of 5 or more on the Amen Brain Subsystems Checklist indicates cingulate malfunctioning and would explain why it is difficult for some cutters to "let go" of self-destructive thoughts.
d. If a cutter answers "very frequently" to just one of the one hundred questions on the Amen Brain Subsystems Checklist, this person should seek medical treatment.

Chapter 5: How Will You Know? -- Understanding the Messages Self-Injurers Send (p. 115-135)


1. Frequent cuts, burns, or bruises are "explained away."
2. Clothing seems ill-fitting or ill-suited for the climate or season.
3. The person demonstrates a reluctance to change or try on clothes in front of someone else.
4. The person appears to have strong body dissatisfaction.
5. There is intense resistance to routine doctor visits or to seeking medical attention for wounds that clearly need treatment.
6. The person wears accessories to cover the skin.
7. There are clusters of similar markings on the body.
8. The person's friends self-injure.
9. A normally outgoing person withdraws from family and friends.
10. Dramatic mood swings occur in a short time frame. Anxious or distraught, then
11. The person continually uses language that expresses low self-worth or the need to be punished.
12. The person displays continuous outbursts of anger, tears, or extreme emotion.
13. The family has a history of mental health issues.
14. You find hidden stashes of gauze, bandages, sharp instruments, or other implements that could be used to self-injure or soothe a self-injurious wound.
15. Someone else tells you that your friend/spouse/student/child self-injures.


11. One San Diego therapist recommends that parents of “notice me” self-injurers take their child to ________, where self-inflicted violence is NOT a cool or fashionable thing but rather a sign of mental-emotional disturbance.
a. church
b. the emergency room
c. the school principal

Chapter 6: What Can I Do? – The Crucial Role You Can Play in a Self-Injurer's Recovery (p. 137-156)
12. Which would be least helpful to a cutter?
a. Validating her feelings of anger, fear, guilt, or hurt.
b. Teaching her how to endure uncomfortable emotions – like loneliness, loss, rage, remorse, and disillusionment – without acting upon them.
c. Telling a cutter that if she forgives the person(s) who hurt her, her need for cutting would probably go away.
d. Refraining from using any shame or guilt messages.
e. Learning to listen to the meaning the cutter affixes to their self-inflicted violence rather than demanding they stop it.
f. Being empathetic.
g. Helping the cutter to make her environment less compatible with cutting, such as asking her if she would lock her razor blades in a box.
h. Offer to help a cutter with chores or accompany her to an appointment, knowing that being with her offsets loneliness.

13. Self-injurers benefit from seeing all of the following thoughts and behaviors modeled EXCEPT
a. Having a healthy self-worth.
b. How, when, and why to articulate feelings.
c. Patiently enduring difficulties.
d. Accepting that we cannot control everything.
e. Establishing and maintaining healthy boundaries.
f. Occasionally having the freedom to scream or yell, validating one's passionate emotions.
g. Giving and receiving appropriate physical affection.

Chapter 7: Dressing the Wounds – Methods of Treatment and Why They Matter (p. 157-178)

14. The author says that “therapy is almost always crucial to a self-harmer's recovery.”
What does individual therapy help a cutter accomplish?
a. To identify and express her feelings.
b. To learn non-destructive ways of managing stress, such as exercise, reading, hobbies, or prayer (instead of destructive ways such as sexual promiscuity, drinking, drugs, or self-injury.
c. To limit self-examination so it doesn't lead to narcissistic thinking.
d. All of the above.

15. In a typical ______ session, the therapist facilitates the movement of the client's eyes while the client focuses on a destructive event. Sets of eye movements are controlled until the memory becomes less disturbing and is associated with positive thoughts and beliefs about one's self.
a. Dialectical Behavioral Therapy (DBT)
b. Theophostic Prayer Ministry (TPM)
c. Eye Movement Desensitization Reprocessing (EMDR)
d. Biofeedback

Chapter 8: When the Body is Ravaged, the Soul Cries Out – Exploring the Spiritual Implications of Self-Injury (p. 179-207)
16. When did Gretchen realize she no longer needed to cut herself?
a. When she read “The Book of God” by Walter Wangerin, Jr.
b. When she realized that no cut she made would ever satisfy the ache within her.
c. When she discovered that Jesus bleed (died) one time for every reason she “needed” or “wanted” to cut.
d. All of the above.

17. Which is NOT true about shame?
a. When we feel shame, we should do something to make us feel better.
b. Shame makes us feel disgusted with ourselves.
c. When we internalize a shame message, we make wrong conclusions about ourselves based on that message.
d. Shame and contempt are an assault against the glory God intends His children to bear.

18. How does God's grace help a cutter?
a. Grace overcomes shame by accepting the cutter fully and irreversibly.
b. Grace takes away a cutter's rejection and abandonment and imparts worth and value.
c. Grace gives a cutter power to face fear and pain.
d. All of the above.

19. Which is NOT true?
a. Cutters should express to God what they truly feel, think, and desire, even their fear, rage, self-contempt, and doubt in God.
b. Christ truly understands cutters because He Himself experienced unimaginable pain, emotional grief, and abandonment.
c. One of the benefits for cutters who learn the disciplines of prayer and meditation is endorphin release.
d. There are no examples of self-injurers in Scripture

20. The author says, "I would love to share with every self-wounder this paraphrase of
a. Psalm 103:10 "He [God] is grieved when, but He quickly draws us to His forgiving heart and accepts us just as if it never happened."
b. II Corinthians 10:4 "The weapons of the war we're fighting are not of this world but are powered by God and effective at tearing down the strongholds erected against His truth."
c. Hebrews 4:15 "For Jesus is not some high priest who has no sympathy for our weaknesses and flaws. He has already been tested in every way that we are tested; but He emerged victorious, without failing God."
d. Isaiah 53:5 "But He was hurt because of us; he suffered so. Our wrongdoing wounded and crushed Him. He endured the breaking that made us whole. The injuries He suffered became our healing."