In The Know Zone

how self injury hurts

Editor's Note: the content of this Web article may be triggering for those who self-injure.

How can they bear the pain?

Pain in the world of SI is a paradox. The majority of those who practice it (67 percent according to the most quoted survey)[25] report feeling little or no pain, 23 percent experience only moderate pain, and only ten percent report feeling great pain.

The paradox is that pain is often precisely what is desired, as an anodyne against a far more profound pain of a different sort. One prominent writer on the subject of self-injury has described this as “fake pain.”[26] The pain, to be sure, is quite real, but it serves as means of rendering bearable and controllable the intolerable and uncontrollable psychic pain the victim is enduring. Letting the internal pain out through the cuts is a constantly encountered theme in the writings and statements of those who engage in SI.

Another common theme is re-focusing through cutting. These reports address the detachment and depersonalization associated with dissociative states. One 18-year-old self-injurer drew an enlightening parallel:

It's like sometimes when you're just walking down the street and you trip? That sudden jolt of reality is all you need to snap you back into life.[27]

Cutting (or any injury) releases natural opiates, called endorphins, in the brain that reduce pain. Being opiates, it was theorized, they might also be addictive, causing an increase in pain-inducing behavior as a result. The research to date on the subject, involving drugs that counter the opiate effect (naloxone and naltrexone)—and other pharmacological therapies, for that matter—have been small, largely restricted to stereotypic self-injury (See footnote 2), and are inconclusive or merely anecdotal as regards superficial/moderate SI.[28] Nevertheless, they do suggest that an addictive element may exist in at least some forms of self-injury.

Preliminary research in individuals who engage in stereotypical self-injury also suggest a link with disturbances in levels of serotonin, one of the brain's chemical neurotransmitters. Small-scale studies showed some success in treating obsessive-compulsive disorder (OCD)-related stereotypic self-injury with the tricyclic antidepressant clomipramine.[29]

[25] Female Habitual Self-Mutilators quoted in Secret Shame: Etiology of SIV, p. 5, available at Accessed 9/22/04

[26] Martinson, Deb, in Secret Shame: Self-help, p. 14

[27] Ibid.

[28] Secret Shame: Personal Stories, p.1.

[29] Azar, B., The body can become addicted to self-injury, APA Monitor, December 1995, available at Accessed 1/7/2005



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