#1 Anger Arising from Limitations
The first manifestation of anger is anger arising from limitations.  Clients who experience chronic pain find themselves constantly frustrated by the reduced scope of their abilities.  Because of their loss of independence, clients become angry at themselves for their lack of ability but also those who do not accept or recognize their limitations.  When another person asks a client to perform beyond their capabilities, the client becomes enraged at him or herself for not being able to accomplish it and also the other person for not recognizing and validating the client’s condition.

Carol, age 31, had an enflamed disc in her spine that caused her constant pain.  One day, a new manager at her office asked her to carry a box down to the warehouse.  Unable to carry the box, but also equally unable to explain her weakness to her manager, Carol instead asked one of her friends to do the task for her, but still complained about the ignorance of her new employer.  Carol stated, “He didn’t even ask me if I could carry that box, he just ordered me to!  He’s such an inconsiderate ass!  I bet if he expressed one ounce of concern for his employees, his head might implode.”

Carol’s unwarranted anger was quick in passing, but I still asked her to explain her condition to the manager the next day.  I stated, “I know that you know people cannot read minds.  If you do not explain to the people around you about your back pain, you will only find yourself becoming more and more angry at your situation.”  I asked Carol to make a list of people that should know about her condition to reduce the frequency of her angry outbursts.

Think of your Carol? Is he or she angry about his or her limitations?

For #2 and #3 Manifestations of Anger go to Pain Management Course

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# 1 – Relieve Anger
As you probably have observed, self-mutilating clients tend to live with the myth that when someone gets mad, somebody has to get hurt. Usually, this stems from a childhood home that valued repressing angry emotions.

Crystal, age 16 stated “My family almost never showed any anger, but when they did, it sure got bad. My fantasies are that I want self-injury to the point of death. Sometimes I feel like if I self-injure, maybe someone will notice me.” Crystal’s emotionally repressive family left little room for self-expression. I felt Crystal’s need for someone to notice her is a way for her suppressed emotions to make themselves known. Many times, Crystal believed that it was better for her to hurt herself than to hurt someone else, or to let someone else hurt her first.

# 2 – Indirect Means of Retaliation
A second reason for self-mutilation in addition to a “notice me” kind of anger is it can serve as an indirect means of retaliation. In this case, self-injurers who have been abused as children think that mutilation of themselves will cause pain to their aggressor. Unable to express their feelings of wrongdoing coupled with their belief that those feelings would be ignored, clients like Sylvia repress their emotions until they’re released through self-injury.

Sylvia, age 19… was abused by her father when she was 7. She stated, “My parents never publicly recognized the abuse. Every time I confronted them, they denied the whole thing. They really never addressed my feelings of betrayal or loss of trust. I thought ‘I’ll show them’ and that’s when I started cutting.” At the end of this track, I will discuss how I how I utilized a “Fantasy” exercise with Sylvia’s feeling of indirect retaliation.

# 3 – Means of Control
A third reason for self-mutilation in addition to a “notice-me” kind of anger and indirect retaliation, I have found clients sometimes use self-mutilation as a means of control. Generally, this is a result of an abusive or traumatic childhood.

As you know, clients who experienced sexual manipulation have lost a sense of control of their environment and self-mutilation is a way to regain it. They decide when and how long the pain will endure, not their aggressor. Sylvia stated, “I felt that when I inflicted pain on myself, I was reclaiming what I had lost.” Sylvia described her pain as a way of forcibly establishing a line between herself and her aggressor, in this case mainly her father.

# 4 – Test Loyalty
A fourth reason for self-mutilation: Sylvia also used her self-injuries to test a person’s loyalty to her. She would be very open about her self-mutilation. She stated, “One pattern in my life that I’d like to change is my need to sort of poke at people in order to see how much I can trust them and whether or not they’ll leave me.” Her loss of trust as a result of her childhood abuse caused her to feel alone and helpless.

# 5 – Engage Caring Responses
Cutting herself and talking openly about it was her way of protecting herself from a second loss should someone she trusted betray her. As you are aware, many times, clients who reveal their self-mutilation in public also want to assert a personal declaration. Tony, age 17, stated, “I liked the attention I got from people. I felt like I was different or tough. I told myself that I was strong enough to take it and everyone else was impressed with my strength.” In addition to relieving anger, maintaining control, indirect retaliation, and a test of loyalty, clients use self-mutilation to engage people’s caring responses.

For “Fantasy” Technique, 2 Steps go to Self-Mutilation Course

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