Dr. Sharon Farber, author of When The Body Is The Target: Self-Harm, Pain and Traumatic Attachments and therapist, believes self-injury is addictive and counsels people on self-injurious behavior ranging from cutting, burning, and general self-mutilation to eating disorders, including bulimia (binging and purging). She discussed the trauma that can lead to self-harm and how to recover from a lifetime of self-injury
David HealthyPlace.com moderator.
The people in blue are audience members.
Self-Injury Conference Transcript
David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Getting Help For Self-Harm." Our guest is author and therapist, Dr. Sharon Farber.
Our topic tonight is "Getting Help For Self-Harm." Our guest is author and therapist, Dr. Sharon Farber. Dr. Farber is a board-certified clinical social worker and author of the book: When The Body Is The Target: Self-Harm, Pain and Traumatic Attachments.
Dr. Farber maintains that there's an addictive-like nature to self-injury. We're going to be talking about that along with the role that childhood neglect, abuse and other trauma play in self-harm, along with why it's still difficult to find qualified therapists to treat this problem and where you can get help.
Good Evening, Dr. Farber, and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Could you please tell us a little more about yourself and your experience in the area of self-harm?
Dr. Farber: I have been in practice for around thirty years. My interest in self-harm came about when I developed a specialty in treating people with eating problems. (Detailed information on different types of eating disorders.)
I came to understand that a lot of people with eating problems, especially those who binge and purge, have problems with self injury (especially picking their skin or scratching themselves, sometimes even more obtrusively through burning). Then I went on to do some original research. I wanted to understand why people who injure themselves may also have some kind of disordered eating, or why people who have disordered eating may injure themselves.
I did research where I compared bulimic behavior with self mutilating behavior for similarities and differences. The similarities were extraordinary. Very powerful. I became fascinated and began treating more patients who self-injured. (Symptoms of Bulimia Nervosa)
I should also tell you, when I use the word self-injury or self-mutilation, I am also talking about a passive form of self-mutilation, and that includes people who compulsively get their bodies pierced or tattooed or branded.
David: What were the similarities between those with bulimia and those who self-mutilated?
Dr. Farber: Well there were quite a lot of similarities. Both of them seemed to be an individual's attempt to solve emotional problems, to make himself or herself feel better. They really served as a form of self-medication. Just as drug addicts and alcoholics use drugs or alcohol in order to medicate themselves, in order to calm themselves down or to rev themselves up, they use self-mutilation to make themselves feel better.
I came to regard both the binging and purging and the self-injury as functioning as someone's drug of choice. I found that the self-injurious behavior and the bulimic behavior, especially the purging (which is the most painful part of that experience), were being used as an attempt to release tension or to interrupt or end a feeling of depression or extreme anxiety.
David: In the introduction, I mentioned that you believe there's an addictive nature to self harm. Can you elaborate on that, please?
Dr. Farber: Sure, what happens is that a person may start out scratching at their skin or pulling off scabs. It starts out, usually, in a milder form, possibly in childhood, and tends to, for the time being, make the person feel better. The problem is that it doesn't last - the feeling better. So what happens is then they have to do it again-and-again; just as an alcoholic becomes an alcoholic (what is an alcoholic?). He develops a tolerance for the alcohol, so he has to drink a greater quantity and much more frequently. The same thing happens with the self-injurious behavior. So someone who starts as picking at the skin, then turns to mild cutting, which then becomes more wild and severe. In other words, they develop a tolerance for the self-injury, so they have to up the ante and do it more severely.
One of the things that I have found that was very interesting has to do with symptom substitution. That is, if somebody tries to give up their self injury but they are not psychologically ready, but they are doing it to please somebody (a boyfriend, parent, therapist), what will happen is another self-destructive symptom will crop up in its place.
One of the things that I have found in my study that was very, very interesting is that both the cutting and the purging (very, very painful and violent) seem to have the same kind of strength as a form of self-medication. Both are extremely powerful, and so often people will react as if they took instant or immediate-acting Prozac. It's that powerful as a form of self medication and that is why it tends to be so addictive. Of course, it means that if they need something so powerful to make themselves feel better, getting into treatment with a therapist that is knowledgeable and understands how the self-harm behavior works is very, very important. The right kind of treatment can help enormously.
David: We have several audience questions on what we've discussed so far. Let's get to those and then we'll continue with our conversation.