Shrink rap

Meet the panel

The abusive coworker  |  The procrastinator
The loner  |  The commitment phobe
The rejected gay son  |  The cutter
The crime victim  |  The serial dater
The fast and the furious  |  The coaster

{Dilemma 6}

The cutter
I’m a 20-year-old student in a visual arts program. I’m in a relationship with an amazing guy, but lately I’m afraid I might be losing him. He’s a photographer and works with a lot of beautiful models. Every time I bring up my suspicions, we end up having a big fight, then he leaves and I cut myself. I did this a little in high school, but not as often as I am now.

dMassimo Balestri: Self-injurious behavior (includes burning or cutting oneself, some eating disorders, and substance and alcohol abuse) tends to be impulsive and unpredictable. Although there are different causes, a general difficulty in regulating one’s mood escalation seems to be at the core. If an individual has trouble modulating or regulating her mood, she might experience rapid escalations in her emotional intensity that, if coupled with poor coping skills, might instigate the use of maladaptive behaviors, such as cutting, to calm oneself down. Although such destructive behaviors are seen as negative, they may have been learned in the past as the only way to cope. When one takes a close look at the past history of individuals with self-injurious behavior, one often finds that they have grown up with people who do not teach adaptive coping skills but rather tend to criticize, reject and pathologize normal emotional experiences.

It seems that the fear of losing her boyfriend has precipitated intense feelings that overwhelm her. Empirically based treatments such as Dialectical Behavior Therapy (DBT) have proven to be highly effective. Using DBT, one would start mapping out the specific events that might trigger the cutting behavior. By using self-monitoring diaries, one can gather specific information about the environment in which the behavior is occurring, the feelings, the thoughts and the chain of events that seem to precipitate the cutting event. During therapy she would learn mindfulness (a form of meditation), interpersonal effectiveness and emotional regulation and distress-tolerance skills. Once she has learned these skills, she might start to apply them to move away from these harmful behaviors. For example, she might begin to identify and anticipate the emotional escalation, and then try exercises to counteract the negative feelings such as listening to her iPod, going for a long walk, taking a bath, calling a friend or drawing. Once the self-injurious behavior is stopped, the individual might start to look more closely at the memories related to past situations in which behavior might have been generated.

Marie-Helene Charlap: Unfortunately, I see this a lot. This is somebody who really needs therapy—she’s afraid of feeling empty and this relationship fills the void. This has a lot to do with her relationship with her parents; there’s a great fear of abandonment and rage, and cutting can be an outlet for these feelings. It’s possible she feels inferior in some way to other people. For someone who is very insecure with no sense of stability or safety, cutting is a way to find control.