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DVD - Interventions for Cutters Substituting Self Control for Self Mutilation  
Cutters continuing education counselor CEUs

Section 19
Fascination for Excitement

CEU Question 19 | CEU Test | Table of Contents | Self-Mutilation
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

“I understand all about the blues when I’ve been drinking my wine at night. I’ll start out having a glass of wine just to unwind. Then I’ll have another to get mellow. Then the next one makes me feel good, but a little wobbly. Finally it’s that fourth or fifth glass that takes me over the edge into my crying time. I’ll put on some music, especially blues or soul music, and I’ll just cry. I’ll talk aloud to myself or to my cat, telling nobody, really, just how bad I feel. Once in a while I’ll call my friend Ellen when I’m like that, but she gets a little pissy with me and tells me to take a shower and go to bed and sleep it off. Then she’ll give me a lecture the next time I see her about how I drink too much. So usually I just keep myself company when I’m into the crying thing. Someday I’m afraid I’ll kill myself when I’m like that, because I do so much thinking about dying and planning how I’ll do it. But I never actually do anything more than just think about it and talk to myself about it.

“When I have to get up the next morning and go to work, I have wicked hangovers, and I swear to myself I’ll never do it again. But the sadness just creeps up on me and then I have to have those extra glasses of wine and let the tears just rip. I used to cry that way when I was a kid, just cry and cry and rock myself to sleep. Maybe some part of me wants to be the little kid again and just lose myself in the tears. But oh God, is it ever lonely.”

The Craving for Arousal
Arousal is another important function of self-harmful behavior. The TRS (Trauma Reenactment Syndrome) woman often feels a fascination for various forms of excitement. As a child, she gradually learned that even negative excitement connected her to others, until finally violence became synonymous with relationship. Whether she was being beaten or violated and afterward held and caressed by a remorseful abuser, or constantly touched by a hypersolicitous caretaker, or scolded by a usually neglectful parent, the child may have felt closer and more connected during this time than at others. She may have felt chosen, singled out for this sort of connection.

Another aspect of this pattern develops as a by-product of the repetitive cycle of excitement. When a child or adult is in a state of arousal due to intense fear, rage, or heightened alertness or anxiety, the actual chemistry of the body changes. We all have experienced this phenomenon in situations of danger, when our adrenaline flows and we feel a strong sense of being in an altered state. When the child experiences these changes repeatedly, the biochemistry of the body changes permanently, so that it becomes more difficult for the child, and later the adult, to return to baseline levels biochemically (van der Kolk, 1987). The result in the adult is an addiction to excitement.

When the adult TRS victim is in a cycle of self-harming, often the planning, the anticipation, the secrecy, and the activity itself all create an experience of pain and excitement or arousal that replicates the excitement in childhood abuse cycles. Many TRS women report that when they stop their self-injurious activities, they feel an intolerable emptiness, dullness, flatness, or depression. They experience a terrible loneliness and sense of being disconnected. It is no wonder that so many choose to return to their self-abusive activities when there seems to be no other way to achieve excitement and the illusion of connection.

In all forms of self-abusive behavior, each part of the cycle is part of a reenactment of childhood trauma. This reenactment is both painful and paradoxically pleasurable, as well as being familiar and thus oddly comfortable. June talks about how as a teenager she found that the anticipation of going out with someone was often more exciting and satisfying than the actual event. In the same way, the anticipation of getting high is as important as the actual chemical surge or relaxing effect of the drink or drug itself.

Laura, another client, talked frequently in the early stages of therapy about how her self-abusive activities were charged with a certain thrill, an undercurrent of excitement that reminded her of some of her childhood experiences with her father. She talked about the way their interactions became like the stalking of a hunter and his prey. Although he always “caught” her at the end of this predatory dance, there was a certain element of excitement, a charge of fear, that heightened all her reactions. Her father often gave her lectures on being tough, being able to take care of herself later on in life. When she practiced her various methods of self-harm, she would think about these messages and reexperience the old thrill of fear and excitement.
- Miller, Dusty; Women who Hurt Themselves: A Book of Hope and Understanding; Basic Books: Massachusetts; 1994

Female Genital Mutilation/Cutting in the United States

- Goldberg, Howard, Female Genital Mutilation/Cutting in the United States: Updated Estimates of Women and Girls at Risk, Public Health Reports / March–April 2016 / Volume 131, 2012.

Personal Reflection Exercise #5
The preceding section contained information about the addiction to arousal in self-injurers with TRS. Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Adrian, M., Berk, M. S., Korslund, K., Whitlock, K., McCauley, E., & Linehan, M. (2018). Parental validation and invalidation predict adolescent self-harm. Professional Psychology: Research and Practice, 49(4), 274–281.

Andover, M. S., Schatten, H. T., Holman, C. S., & Miller, I. W. (2020). Moderators of treatment response to an intervention for nonsuicidal self-injury in young adults. Journal of Consulting and Clinical Psychology. Advance online publication.

Ammerman, B. A., Jacobucci, R., Turner, B. J., Dixon-Gordon, K. L., & McCloskey, M. S. (2020). Quantifying the importance of lifetime frequency versus number of methods in conceptualizing nonsuicidal self-injury severity. Psychology of Violence, 10(4), 442–451.

Online Continuing Education QUESTION 19
What is a reason that self-injurers who stop their self-harm behavior often feel an intolerable emptiness, dullness, flatness, or depression? Record the letter of the correct answer the CEU Test.

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