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Emotional Neglect and Self-Harm

Cutting Behavior and Suicidality Connected to Childhood Trauma

An article, by Van der Kolk, Perry, and Herman (1991) strongly suggests that abuse, not low emotional intelligence, is the primary cause of self-destructive behavior. Here are some excerpts

... neglect [was] the most powerful predictor of self-destructive behavior.

This implies that although childhood trauma contributes heavily to the initiation of self-destructive behavior, lack of secure attachments maintains it.

Those ... who could not remember feeling special or loved by anyone as children were least able to ...control their self-destructive behavior.

In effect, self-harm is a way to escape otherwise intolerable
emotional pain

In contrast to the findings from this study, the leading academic researchers in the field of emotional intelligence, Mayer et al, still seem to believe that self-harm is a factor of low emotional intelligence. See Emotional Intelligence and Self Harm.


Original Article "Childhood origins of self-destructive behavior". BA van der Kolk, JC Perry and JL Herman. Department of Psychiatry, Harvard Medical School, Boston, Mass.

Full Article PDF


More Quotes From the Article

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More quotes from the article

Here are more notes about self-harm and abuse from the Healthy Place article - (with a few of my comments - S. Hein)


Etiology (history and causes)

Past trauma/invalidation as an antecedent

Van der Kolk, Perry, and Herman (1991) conducted a study of patients
who exhibited cutting behavior and suicidality. They found that exposure to
physical abuse or sexual abuse, physical or emotional neglect, and chaotic
family conditions during childhood, latency and adolescence were reliable
predictors of the amount and severity of cutting. The earlier the abuse
began, the more likely the subjects were to cut and the more severe their
cutting was. Sexual abuse victims were most likely of all to cut. They
summarize, ...

neglect [was] the most powerful predictor of self-destructive behavior. This
implies that although childhood trauma contributes heavily to the initiation
of self-destructive behavior, lack of secure attachments maintains it.
Those ... who could not remember feeling special or loved by anyone as
children were least able to ...control their self-destructive behavior.

In this same paper, van der Kolk et al. note that dissociation and frequency
of dissociative experiences appear to be related to the presence of
self-injurious behavior. Dissociation in adulthood has also been positively
linked to abuse, neglect, or trauma as a child.

More support for the theory that physical or sexual abuse or trauma is an
important antecedent to this behavior comes from a 1989 article in the
American Journal of Psychiatry. Greenspan and Samuel present three
cases in which women who seemed to have no prior psychopathology
presented as self-cutters following a traumatic rape.

Invalidation independent of abuse

Although sexual and physical abuse and neglect can seemingly precipitate
self-injurious behavior, the converse does not hold: many of those who
hurt themselves have suffered no childhood abuse. A 1994 study by
Zweig-Frank et al. showed no relationship at all between abuse,
dissociation, and self-injury among patients diagnosed with borderline
personality disorder.

A followup study by Brodsky, et al. (1995) also showed that abuse as a
child is not a marker for dissociation and self-injury as an adult. Because of
these and other studies as well as personal observations, it's become
obvious to me that there is some basic characteristic present in people
who self-injure that is not present in those who don't, and that the factor is
something more subtle than abuse as a child. Reading Linehan's work
provides a good idea of what the factor is.

Linehan (1993a) talks about people who SI having grown up in "invalidating
environments." While an abusive home certainly qualifies as invalidating,
so do other, "normal," situations. She says:

An invalidating environment is one in which communication of private
experiences is met by erratic, inappropriate, or extreme responses. In
other words, the expression of private experiences is not validated;
instead it is often punished and/or trivialized. the experience of painful
emotions [is] disregarded. The individual's interpretations of her own
behavior, including the experience of the intents and motivations of the
behavior, are dismissed...

Invalidation has two primary characteristics. First, it tells the individual that
she is wrong in both her description and her analyses of her own
experiences, particularly in her views of what is causing her own emotions,
beliefs, and actions. Second, it attributes her experiences to socially
unacceptable characteristics or personality traits.

This invalidation can take many forms:

"You're angry but you just won't admit it."
"You say no but you mean yes, I know."
"You really did do (something you in truth hadn't). Stop lying."
"You're being hypersensitive."
"You're just lazy." "
"I won't let you manipulate me like that."
"Cheer up. Snap out of it. You can get over this."
"If you'd just look on the bright side and stop being a pessimist..."
"You're just not trying hard enough."
"I'll give you something to cry about!"

Everyone experiences invalidations like these at some time or another, but
for people brought up in invalidating environments, these messages are
constantly received. Parents may mean well but be too uncomfortable with
negative emotion to allow their children to express it, and the result is
unintentional invalidation. Chronic invalidation can lead to almost
subconscious self-invalidation and self-distrust, and to the "I never
mattered" feelings van der Kolk et al. describe.


Then there was a section on "Biological Considerations and Neurochemistry"

It has been demonstrated (Carlson, 1986) that reduced levels of serotonin
lead to increased aggressive behavior in mice. In this study, serotonin
inhibitors produced increased aggression and serotonin exciters
decreased aggression in mice. Since serotonin levels have also been
linked to depression, and depression has been positively identified as one
of the long-term consequences of childhood physical abuse
(Malinosky-Rummell and Hansen, 1993), this could explain why
self-injurious behaviors are seen more frequently among those abused as
children than among the general population (Malinosky-Rummel and
Hansen, 1993).

Then some more chemical stuff and then this paragraph

When these results are considered in light of work such as that by Stoff et
al. (1987) and Birmaher et al. (1990), which links reduced numbers of
platelet imipramine binding sites to impulsivity and aggression, it appears
that the most appropriate classification for self-injurious behavior might be
as an impulse-control disorder similar to trichotillomania, kleptomania, or
compulsive gambling.

Comparing cutting to stealing or gambling and calling it a "disorder" seems pretty useless, but typical of those in the psychiatry profession.

Later the article says this, sort of an chicken and egg question:

It is not clear whether these abnormalities are caused by the
trauma/abuse/invalidating experiences or whether some individuals with
these kinds of brain abnormalities have traumatic life experiences that
prevent their learning effective ways to cope with distress and that cause
them to feel they have little control over what happens in their lives and
subsequently resort to self-injury as a way of coping.

Then the article continues....


Knowing when to stop -- pain doesn't seem to be a factor

Most of those who self-mutilate can't quite explain it, but they know when to
stop a session. After a certain amount of injury, the need is somehow
satisfied and the abuser feels peaceful, calm, soothed. Only 10% of
respondents to Conterio and Favazza's 1986 survey reported feeling
"great pain"; 23 percent reported moderate pain and 67% reported feeling
little or no pain at all. Naloxone, a drug that reverses the effects of opiods
(including endorphins, the body's natural painkillers), was given to
self-mutilators in one study but did not prove effective (see Richardson
and Zaleski, 1986).

These findings are intriguing in light of Haines et al. (1995), a study that
found that reduction of psychophysiological tension may be the primary
purpose of self-injury. It may be that when a certain level of physiological
calm is reached, the self-injurer no longer feels an urgent need to inflict
harm on his/her body. The lack of pain may be due to dissociation in some
self-injurers, and to the way in which self-injury serves as a focusing
behavior for others.

Behavioralist explanations

NOTE: most of this applies mainly to stereotypical self-injury, such as that
seen in retarded and autistic clients.

Much work has been done in behavioral psychology in an attempt to
explain the etiology of self-injurious behavior. In a 1990 review, Belfiore
and Dattilio examine three possible explanations. They quote Phillips and
Muzaffer (1961) in describing self-injury as "measures carried out by an
individual upon him/herself which tend to 'cut off, to remove, to maim, to
destroy, to render imperfect' some part of the body."

This study also found that frequency of self-injury was higher in females
but severity tended to be more extreme in males. Belfiore and Dattilio also
point out that the terms "self-injury" and "self-mutilation" are deceiving; the
description given above does not speak to the intent of the behavior.

Operant Conditioning

It should be noted that explanations involving operant conditioning are
generally more useful when dealing with stereotypic self-injury and less
useful with episodic/repetitive behavior.

Two paradigms are put forth by those who wish to explain self-injury in
terms of operant conditioning. One is that individuals who self-injure are
positively reinforced by getting attention and thus tend to repeat the
self-harming acts. Another implication of this theory is that the sensory
stimulation associated with self-harm could serve as a positive reinforcer
and thus a stimulus for further self-abuse.

The other posits that individuals self-injure in order to remove some
aversive stimulus or unpleasant condition (emotional, physical, whatever).
This negative reinforcement paradigm is supported by research showing
that intensity of self-injury can be increased by increasing the "demand" of
a situation. In effect, self-harm is a way to escape otherwise intolerable
emotional pain.

Sensory Contingencies

One hypothesis long held has been that self-injurers are attempting to
mediate levels of sensory arousal. Self-injury can increase sensory
arousal (many respondents to the internet survey said it made them feel
more real) or decrease it by masking sensory input that is even more
distressing than the self-harm. This seems related to what Haines and
Williams (1997) found: self-injury provides a quick and dramatic release of
physiological tension/arousal. Cataldo and Harris (1982) concluded that
theories of arousal, though satisfying in their parsimony, need to take into
consideration biological bases of these factors.


More Related Information on the healthyplace site:

Study of Patients Who Exhibited Cutting Behavior and Suicidality
Depression: Suicide and Self Injury
Psychological Characteristics Common in Self-Injurers
Depression is Common in People Who Self-Injure: Therapist's Comments
Cutting: Self Mutilating to Release Emotional Stress
Self Mutilation: Self-Injurers Often Suffered Sexual or Emotional Abuse
Teen-Depression Treatment Teaches Kids to Handle Anxiety
Eye Movement Desensitization Reprocessing to Treat PTSD