In the first section of this chapter, the cyclical nature of self-injury is discussed as presented in Figure 7.1 (The cycle of self-injury). Each point in the cycle is examined, and the point at which things need to change to break the cycle is identified. The metaphor of a raging inferno inside employed to describe the cycle of self-injury was the result of an image that sprung to mind when I was grappling to make sense of self-injury many years ago.

Since its first appearance in Healing the Hurt Within, 1st edition (Sutton, 1999) the diagram has been updated several times to facilitate my developing understanding of self-injury. Important to bear in mind, however, is that those who self-injure are individuals, thus their pattern of self-injury may not follow one ‘typical route’.In the second part of this chapter, a further diagram is presented (Figure 7.2, eight Cs of self-injury). This encapsulates eight motivations and meanings of self-injury identified through my research.

Point A: Mental Anguish

The individual may be plagued by intrusive or unacceptable thoughts, images, flashbacks, nightmares, ‘body memories’ (somatic memories) of traumatic events, or burdened by negative self-beliefs, for example, ‘I’m bad, evil, worthless, a waste of space, everything is my fault, I don’t deserve.’ Trapped inside, the mental anguish begins to cause internal chaos.

Self-View Of People Who Self-Injure

Many people that self-injure hold an extremely negative self-view, seeing themselves as intrinsically bad, defective, evil, worthless, or not good enough. Numerous also carry the belief that ‘I don’t deserve’. Additionally, self-criticism and perfectionism are common traits. A constant barrage of self-wounding and self-devaluing words can easily spark strong emotional arousal.

Trauma Triggers

The following situations were identified by respondents as trauma triggers to self-injury:

• ‘When I’m reminded about rape.’
• ‘Remembering abuse.’
• ‘Memories/flashbacks of abuse.’
• ‘Any kind of abuse now.’
• ‘When I can’t cope with the past, or when it comes back to haunt me.’
• ‘Unwanted sexual feelings.’

Flashbacks And ‘body Memories’ (Somatic Sensations)

As mentioned, many people that self-injure are abuse survivors, and flashbacks (traumatic scenes from the past) and ‘body memories’ (somatic sensations) frequently plague abuse survivors’ lives. Soma refers to the body. Flashbacks and body memories are hard to cope with – they can feel alarmingly real – as if the person has been transported back in time and the abuse is happening all over again (with all its associated feelings, emotions and imagery). They can leave people frozen to the spot, or feeling very small and childlike (as if they are that child again).

Flashbacks and body memories are fleeting states of remembered dissociated traumatic material; they can be triggered by anything that serves as a cue to the traumatic event – a smell, sound, taste, touch, voice, or song, for example, or by one’s own thought processes.

They are experienced as traumatic snapshots, which may appear crystal clear or hazy, as a terrifying feeling (panic, dread, terror), or as physical pains or sensations in parts of the body associated with the memory or violation (numb breasts, legs, arms; or pelvic, vaginal, rectal, pain). Frequently flashbacks appear to be accompanied by headaches.

Flashbacks And Body Memories: The Link To Internal Self-Injury

Several female Internet respondents reported injuring themselves internally as a response to severe and/or prolonged child abuse. However, it needs to be borne in mind that there is a huge amount of shame and embarrassment attached to internal self-injury, which is likely to deter people from reporting this particular form, thus it may be significantly underreported. One respondent reported that it’s not easy to ask for medical help; another said she steered clear of seeking medical help because she can’t cope with internal examinations.

Internal self-injury is used as a strategy for ending distressing flashbacks or body memories, and to make the awful feelings go away. Further, it may be used as a form of self-punishment in response to unwanted sexual thoughts, guilt or shame. Symbolically, it can be understood as an attempt to ‘cut the horrific memories out’; ‘cut “him” out of me’; ‘cut out the bad things that happened there’; ‘cut out the “bad” in me’, or to cleanse the body and soul from contamination of the abuse.

Dissociation (mentioned in the above testimony) is discussed later in this chapter (see main heading Breaking the cycle of self-injury). The relationship between dissociation and self-injury is also discussed in Chapter 8 (Dissociation and self-injury), and Chapter 12 (Guidelines for those working with self-injury and related issues).

Dusty Miller, in her insightful book, Women Who Hurt Themselves: A Book of Hope and Understanding, presents an interesting concept which she coins ‘Trauma Reenactment Syndrome’ (TRS). She posits that ‘TRS women do to their bodies something that represents what was done to them in childhood.’ (1994:9)

Additional informative reading on the topic of ‘body memories’ are van der Kolk, B.A. (1994) ‘The body keeps the score’ and Rothschild, B. (2000) ‘The body remembers’ (see references).