Just cut it out: legal and ethical challenges in counseling students who self-mutilate

Professional School Counseling, April, 2004 by Janet Froeschle, Mike Moyer

RISK FACTORS

Are other behaviors linked to self-mutilation? Research indicates that those who have been repeatedly abused are the most likely to inflict self injury (Favazza & Rosenthal, 1993; Kehrberg, 1997; McLane, 1996; Simpson, 1981; Zila & Kiselica, 2001). Additionally, self-mutilators are more likely to have eating disorders, abuse drugs and alcohol, have above average intelligence, and more often than not are employed in the medical field (Simpson). Walsh and Rosen (1988) found other variables determining risk of self-mutilation. These include loss of a parent, peer conflicts, sexual abuse, having another self-mutilating family member, and observing family violence. The most common events leading to self injurious behaviors in teenagers are recent loss or death, peer conflict, intimacy problems, impulse disorder, and a rejection of human interconnection (Kehrberg). Cutting is an out of body experience in which the person bypasses the body's defenses and desires pain (Levenkron, 1998).

Precipitants

Feelings of shame, humiliation, and rage may preempt self-injurious behaviors in these individuals. Failure (accompanied by feelings of low self-worth; Richards, 1999) and pent up rage often precede cutting with these subjects (Prescott, 2000). Mutilation is a way to alleviate stress, depression, rejection, hyperactivity, numbness, and feelings of alienation. The onset of menstruation and inability to handle emerging sexuality has been linked to self-mutilating behaviors particularly with rape or incest victims (Zila & Kiselica, 2001). Cutting becomes a re-enactment of childhood trauma, a method of communicating the unspoken, and a way to manage the psyche (Levenkron, 1998). The use of alcohol or drugs may be another method of inflicting self-harm and has been shown to induce self-mutilating behavior. A romantic breakup, conflict with a parent, or any other incident leading to feelings of alienation may bring about the onset of self-mutilation (Zila & Kiselica). It seems all self-mutilations are precipitated by a need to regain control by injuring the body.

MYTHS

A huge dilemma for counselors and self-abusers arises as a result of the lack of knowledge people have about the issue. Since discussion follows concerning legal and ethical issues as well as best practices, information on myths is included to help heighten awareness.

Myth #1. Self-mutilators use this behavior to manipulate other people. Physical pain is inflicted in an attempt to replace emotional rage. The victim's attempts to conform to expectations of normal behavior lead to silence about the event. Victims go to great lengths to present themselves as uninjured and normal and rarely seek to manipulate others through mutilation (McLane, 1996).

Myth #2. Self-mutilation is synonymous with suicide. Self-mutilation is a ritual performed for different reasons than suicide and should not be compared or confused with the latter. The self-mutilator uses pain to mask emotional pain but does not intend to destroy the entire body (Levenkron, 1998; Zila & Kiselica, 2001).