Why People Cut and Hurt Themselves?

Role of Emotions, Sleepiness and Fatigue in Self-Mutilation

By A. Golbin, MD, PhD

When we hear about someone who cuts his own skin several times, or repeatedly burns himself with cigarettes, pulls out the hair on the head, eyebrows or eyelashes, our first thought is that such individual is psychotic, uneducated, and just simply dumb.  In reality, that is not the case. The majority of self-cutters are intelligent, sensitive, and educated. Regardless, one might reply, “But it is very painful and may deform one’s face and the body!”

Yes, self-mutilation can deform the body and face – no question about it – but pain is another issue. Pain has many faces and stages and has its sneaky way to get inside one’s brain. Let me give a short example.

A 23-year-old successful architect started to experience significant difficulties at his new job. He was at the top of his class in college and was sure he would continue to be very successful in his career. Unfortunately, his very first project brought serious troubles to his self-esteem. He lost sleep because he was getting more and more agitated during the night, thinking about revenge to those co-workers who “put him down.” After many sleepless nights, he was very tired during the day and made many mistakes because he was inattentive, which, in turn, caused him more trouble. One night when he could not sleep he went to his garage where he accidentally poked himself with a nail. The resulting pain “woke him up” from the confused state he had been in. He clearly saw himself “from the outside” and suddenly realized what he should do to make the whole project work well. He felt enlightened by his vision, his “eureka.” Since that time, his behavior at work changed and soon he was recognized and accepted by his peers.

There was only one small problem: during his time of difficulty he lost sleep and needed to poke himself until he bled in order to “come back to reality”. Soon, he lost his sense of acute pain and missed it, because the more acute was the pain the more effective it was in getting him back into a state of creativity and calmness. With time he had to inflict himself with more and more serious wounds and ended up in the emergency room with complications. It took a year to treat him and free him of this “bad habit.”

In reality, each self-cutter could tell you his or her personal story that would sound like a tale from Edgar Allan Poe’s collection. The medical aspects of self-destructive habits have been intensively studied. Here we would like to dispel a few myths about it and increase awareness of this problem.

Myth #1. Self-destructive behavior is very rare.

Not at all.  If you add all the patients with hair-pulling (trichotillomania), self- cutters, head-bangers, or those who pretend to be terribly sick in order to have surgery performed on them (Factitious Disorder), you will get about 10% of population. And this excludes sexual self-destructive perversions.

Myth #2. Self-mutilators are from “low class” psychotic poor families. 

 Not at all. The majority of afflicted persons are sensitive and intelligent people from any level of society including a middle-upper class of educated, caring, and successful families.

Myth #3. It is just a very bad habit and these people could easily stop inflicting pain to themselves with willpower.

Wrong. It is a serious psychological and medical disorder that patients cannot just stop. It is like diabetes: if untreated it will get worse, sometimes resulting in death.


Myth #4. The nature of self-destructive habits is unknown and treatment is not available.

False. We now know a lot about the nature and treatment of this affliction.

Briefly, the nature of this serious condition lies in immaturity or exhausted stress-fighting brain mechanisms. Indeed sleepiness, fatigue, and tense emotions that narrow consciousness are the most significant triggers of self-mutilation.

Research has shown that unusual behaviors are started as compensatory mechanisms to “offset” the pressure and release the emotional or muscle tension. That is why such habits are so resistant to treatments based on a direct suppression of the symptom. Soon, however, the initial reactions are not sufficient to compensate for the problem and the next level when more “sick” behaviors appear and become “habits.”

Fortunately, the “offset” hypothesis explaining habits, including self-destructive behaviors, as a hierarchy of specific compensatory mechanisms led to creating new and more efficient ways to treat the problem; not by the direct suppression of the symptom, but by correcting an underlying balance in the physiological system, so that there will no longer be a “need” to maintain a destructive behavior.

Sleep Disorders represent a strong basis for developing self-destructive habits. Many habits begin when we start falling asleep or increasing alertness and excitement.  They function as “switches” or “stabilizers” for alertness, mood,
and performance.
  If you or some people you care about have self-destructive habits, please, do not judge them, but recommend that they see a doctor, either their primary care physician, a sleep specialist, or
psychiatrist who has experience in treating these difficult problems.  The good news is that treatment is available.