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Psychology of Self-Mutilation or Cutting – Causes and Treatment

Self-mutilation or cutting, for most people, is something difficult to understand. Why would anyone hurt themselves? One of the first times I encountered a self-injured child, I observed a boy banging his head against the concrete floor. His caretakers immediately intervened and made him stop but with just one beat he had opened a big cut and was bleeding profusely.

The instinct of those around you is to protect the child and prevent the worst but is this the best in the long run? Lovaas and Simmons (1969) discussed a case in which a child with autism self-injured and noted that the child engaged in this behavior more often when he received attention shortly after injuring himself. They then defended the thesis that the behavior of hurting himself (or self-injury) was maintained by the things people did to him after he emitted this behavior. The solution, at least at the beginning of treatment, was to give him access to adult attention and the result was that his self-harming behavior decreased.

Another pioneer in the development of a treatment was Ted Carr (Carr, 1977). It was around this date that behavior analysts began to say that the behavioral problem in self-harm was a communication problem.

In some cases it appeared that the problem was related to needing more attention or escaping from some unpleasant activity. It has also been suggested that sometimes self-mutilation could be related to the sensory consequences produced by the behavior. That is, the person could enjoy the feeling or perhaps lessen the pain the person was experiencing. Despite the fact that a number of hypotheses about the cases began to appear, one thing was starting to become clear: different people’s self-harm had different causes. That is, each person had a different reason for self-mutilation than the others.

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Brian Iwata and his colleagues (1982/1994) at the Kennedy Krieger Institute in Johns Hopkins revolutionized the treatment of self-injury by developing an assessment procedure, called functional analysis, that helped clinical psychologists identify the cause of self-injury. . They systematically confirmed it was different for different individuals. 95% of the time a specific cause can be found. The results of the functional analysis with 150 people showed:

40% of the cases analyzed – the cause was related to the avoidance of aversive stimuli

26% of the cases analyzed – the cause was related to the care obtained

26% of the cases analyzed – the cause was related to the sensations provoked by the act itself

More than one cause was identified in 5% of cases. The other cases could not be interpreted. Over the years, nearly 200 studies have been made of the functional causes of self-harm.

There are two implications of Brian Iwata’s research. First and most important, identifying the functional cause of self-injury indicates that another response, another behavior that produces the same consequence may be an effective treatment. In the mid-1980s and beyond, the focus of treatment was on developing training techniques for communication. Many studies have indicated that by learning other ways of expressing, of communicating their feelings, people who self-harm stop this behavior. Some studies have shown that it was possible to produce changes without imposing any changes in the behavior of the people around the patient with this symptom. But other studies indicated that changing people around could also be indicated.

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The most important thing to note is the need for a careful analysis of the functional causes of the behavior of self-mutilation, that is, for what reason, why does the person have this behavior? As reported above, there are several possible causes. Later research showed that behaviors such as tantrums and aggression also had a variety of causes.

Over the years, less intrusive forms and techniques have been developed that have proven to be much more effective in the treatment of self-injury. This is due to the ability of clinical psychologists to understand the real causes of the problem, as well as the patient’s understanding that he could get what he wanted with the self-harming behavior without having to self-harm. In other words, it is possible to get attention, bodily sensations of relief, to run away from aversive or unpleasant things without having to resort to self-mutilation.

Original Text – Self-Harm or a Request For Help? Behavior analysts consider problem behavior to be communicative

Published on January 27, 2010 by Bill Ahearn, Ph.D., BCBA-D in A Radical Behaviorist

Translation – Felipe de Souza

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