Why Do People Talk about Cutting Themselves?

I just received the following inquiry: I know some one thats very public about cutting themselves. Is this normal? And why do you think this is?

Here's my answer:

Good question. Although I cannot assume I understand this specific person, I can speak generally about the topic of openly discussing one's own self-injurious behavior.

My first inclination is that the person may be seeking what we call "social reinforcement." There are two types of social reinforcement - positive and negative.

What we call "positive social reinforcement" is what people not in the biz call "getting attention." This would come in the form of sympathy, interest, concern, or even people expressing shock. Particularly if a person feels disconnected / a lack of social support (and want these things), they may be prone to be seeking interaction with other people in this way.

So what we call "negative social reinforcement" does actually not mean punishment. In my experience, people in the public misuse the term "negative reinforcement" quite frequently. Negative reinforcement simply means to remove something aversive or to get out of a responsibility. For instance, an adolescent working on a boring group project might tell her peers that she's a "cutter" so they put less of a workload on her. In this example, if the teen gets out of doing something boring, she is negatively reinforced for telling people she cuts.

This brings us to an interesting point. It is my opinion - which is not shared among people with whom I've worked - that when people are socially reinforced (either negatively or positively) for telling people they self-injure, it isn't necessarily the cutting itself that is affected. What I think is more influenced is the actual disclosure of the behavior. This would mean that if someone is socially reinforced for telling people they cut, the actual act of cutting wouldn't necessarily increase, but the number of times self-injury is discussed would increase. To be crystal clear, I think that social reinforcement may shape the largely impulsive behavior of cutting itself, but not as strongly as the seemingly more deliberate act of discussing the behavior.

It is my opinion that people primarily engage in self-injury for emotion regulation purposes. In other words, to decrease their anxiety or to pull them out of a disoriented state (to learn more, I posted a link about this at the bottom of the page). It doesn't make sense to me that people engage in self-injury just so that they can receive attention for it later. My intuition tells me that the reinforcer of social approval is too far removed from that actual act of cutting to be incredibly potent. To my knowledge though, no research has been conducted to support this. In fact, self-report studies show that people report thinking they engage in self-injury to gain approval, therefore, it is advisable to take this into consideration when considering the thoughts previously expressed.

Perhaps self-injury can start out so that one may gain approval (positive social reinforcement) or even get out of something (negative social reinforcement). It could also be the case that someone starts cutting just for the emotional effects, but then starts telling people about it. I just can't buy into the idea that the only reason someone would cut is for social reinforcement.

Anyhow! I digress. Back to your question. It could be the case that this person is trying to connect with people, shock them, or remove his/herself from responsibility. On the other hand, perhaps he/she is just trying to work through previous shame about the behavior and finds it liberating to talk about it. I really don't know. But these are my best guesses!

Speaking to your question regarding whether or not it is normal: based on no data but my experience, about half of people who cut themselves report telling other people, while the other half don't tell anyone but maybe a mental health professional. While I'm not sure how normative it is for people to talk at length about their self-injury, I have some thoughts about this.

We can't make assumptions that talking about engaging in self-injury is necessarily a maladaptive / bad thing. For instance, perhaps the person will end up getting into the right treatment and get support for stopping the behavior. And as previously mentioned, perhaps the person used to feel much shame about the behavior and is working through it by speaking about cutting. Who knows?

On the other hand, one could make the case that if the person is socially reinforced for disclosing that he/she self-injures, the behavior could be maintained. I'm just not sure exactly why this person may be openly discussing engaging in self-injury.

As you can imagine, it is quite complicated!

Great question though. I've never been asked this.

To read more check this out: http://taradeliberto.blogspot.com/2011/02/why-do-people-cut-themselves.html

For Subscribers

For subscribers, I ended up changing the post about the evolutionary reasons we obsessively check Facebook quite a bit. Check it out here:
http://taradeliberto.blogspot.com/2012/04/keep-them-coming-back-for-more_22.html

The Evolutionary Reason We Obsessively Check Facebook

Today's topic is how we're evolutionarily programmed to obsessively check Facebook.

Let's just say that you log on to Facebook and get a good laugh out of a friend's status. You log on a few more times that day, but nothing is interesting. But of course, before going to bed, you log back on one more time just in case. And lucky you - you get another late night chuckle.

First, in this little story, the funny statuses play the role of the reinforcer. Second, the fact that you never know when someone is going to write something clever makes the reinforcer intermittent - or, in other words, random. Put them together and what do you get? A little term us psychologists call intermittent reinforcement.

So the interesting thing is this: when we are intermittently reinforced, we tend to display obsessive behavior (e.g. gambling). Following the rule that intermittent reinforcement leads to obsessive behavior, in this example, never knowing when you're going to read something funny partially explains why we tend to check Facebook all the time as a species. [We also find humor, human interaction, and gossip particularly rewarding.]

So what may the evolutionary advantages to intermittent reinforcement be? Well, I'm not sure if there are too many evolutionary advantages to obsessively checking Facebook, but there certainly are for the underlying mechanism.

Specifically, I was thinking that animals may have evolved to become sensitive to intermittent reinforcement because if we become more persistent in the face of scarce reinforcement / resources, we may increase our chances of success.

Let's consider the definition of perseverance: steady persistence in a course of action, a purpose, a state, etc., especially in spite of difficulties, obstacles, or discouragement.

In that definition, if "difficulties, obstacles, and discouragement" is conceptualized as a lack of reinforcement, then "persistence in a course of action" can be viewed as the somewhat obsessive behavior seen when intermittent reinforcement is given.

While perseverance (with a positive connotation) is readily associated with success, before today, I never considered perseverance as the behavioral result of an environment that is intermittently reinforcing. I'm guessing that will power comes into play too... but honestly, who really knows?

Now, while being sensitive to intermittent reinforcement may be helpful for us to persevere when times are tough, this tendency likely shaped by evolution won't serve us well in every scenario.

There is definitely a darker side to all of this. For instance, if you're more sensitive to intermittent reinforcement, you might be more inclined to stay in a roller coaster relationship, become a compulsive gambler or get engrossed with more trivial matters to increase your mood (e.g. check Facebook more times than you'd like to admit).

We typically think about engaging in these types of activities as a means to avoid feeling negative emotions like boredom, sadness, etc. It may certainly be the case that we engage in behaviors like obsessively checking Facebook to both avoid life and gain pleasure. At the same time, the obsessive nature of Facebook checking may be attributed to the underlying process may be one of intermittent reinforcement.

On a related note, rather than viewing psychopathology in terms of reward sensitivity, I wonder if sensitivity to specific types of reinforcement (or "schedules" as we call them) matters. Namely, sensitivity to intermittent reinforcement may be at the root. Food for thought.

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[And some food for later thought: perhaps this whole idea of valuing one's own naturally persevering nature somehow relates to asceticism. Together they combine to a pretty intense personality that is sensitive to reward.]

Teaching a Little Guy to Recognize Emotion

Here on this rainy lazy Sunday in NYC, I was drinking my usual morning green tea and thinking about the cases I've seen of alexithymia - or the inability to recognize emotions - in children.  What do we do about alexithymia?  Well, definitely the usual stuff like playing games like emotion charades where we have to guess what emotions / feelings we're acting out, practice problems solving / acting out solutions to various conflicts, etc.  But what else?

Here's a made up case to illustrate my thoughts:

Let's say that I'd been treating a 8 year old boy with alexithymia with the usual techniques until one day his mother asked to talk to me womano-a-womano.  She says that he doesn't understand important feelings she has about a specific family situation and takes the opportunity to tell me about her emotions.  So I go into session and directly discuss what mom might be feeling in these tough family scenarios.  The boy is surprised to learn how she might be feeling and feels a bit badly about his behavior.  Then we discuss what he can do differently in the future that takes his mothers emotions into consideration.  During the next week's session, mother reports that the boy was appropriately attentive to her from the moment they left therapy and throughout the entire week.

Now, even though our hypothetical session - that is a hybrid of multiple sessions with various patients - apparently produced the most effective behavior change outside of session, it was probably the most (mildly) aversive session we ever had.  Compared to past sessions where I have been teaching through games, this was no walk in the park.

During a game like emotional charades, the emotions remain impressionistic by nature. So where do we go from there? Sure this may be a good starting point and we also spend some time discussing issues that are upsetting outside of the session, but what about evoking real emotion in session?

By discussing the feelings that his mom might have, a little light bulb went off in his head.  He first reported feeling sad, but after some pressing, he also reported feeling a little bit guilty about his lack of attentiveness to his mother. After all, we are talking about a very kind child, here.

Notably, those emotions of sadness and guilt were freshly created as a direct result of newly learned content in the session. These emotions were not re-conjured from past events outside of session, nor impressionistic. Something to think about.

Because this session was mildly aversive though, my concern for next week was that he would not want to come back. After all, in his mind, we typically just play games. (Sure, these techniques can produce some change, but it is my opinion that they remain surface.)

Flying in the face of my nagging worry, this little guy was actually quite eager to return to session the following week. I suppose that I'll never be sure as to why. We can only speculate that perhaps it was because of a long standing therapeutic rapport and a learning history that coming to therapy is fun. A second option is that he did not experience the sadness and guilt intensely enough for it to deter him longer term.

But what about the results of Walter Mischel's studies?  We know some children can appreciate something more aversive & meaningful in the long-term, but not a barrel of laughs in the short term. 

Maybe this little guy appreciated learning something new and subsequently having his environment change.  After all, mom did say things were much better at home following that session.

Who knows?

To summarize, there are three ways of dealing with emotion in session:
1) evoking then processing new emotion in session as a result of new information / insight
2) rehashing previously felt emotion
3) creating impressionistic expressions of emotions

Maybe #1 is preferable.  Something to think about.

That "Gut Feeling" is Actually in Your Gut

I'm spending this particularly sunny Saturday in Manhattan doing some literature reviews near an open window overlooking people eating at an outdoor cafe`on 3rd avenue. Unbeknownst to them, I've been watching and wondering about the connection between the food they're eating, their bellies, and their brains. I know I shouldn't get derailed from finishing my work, but I couldn't resist writing this post.

I just came across a review paper called "Gut feelings: the emerging biology of gut-brain communication." Cool stuff. Apparently, there has been talk since about 1850 of a nervous system I've never heard of before: the enteric nervous system (ENS). Technically, it is considered the 3rd branch of the autonomic nervous system, which I'm certainly familiar with, but still! The ENS seems a bit too important for me to have been enveloped in the field seven years before learning about it. It could just be me... but I'm guessing the folks in psychology are not all that knowledgeable of the ENS.

That being said: the ENS, - or the interaction system between the brain and the gut - is referred to as the 'second brain' because it is similar in complexity to the one we have in our heads. It turns out that the second brain may have a pretty big impact on emotions, motivation, and [get this] intuitive decision making. In other words, the gut is quite literally involved in making gut decisions.

Who would've thought? Actually, the guy who coined the phrase "gut feeling" may have.

Consider the fun little notion that maybe we have been able to identify that intuitive decision making comes from the gut all along, without ever having scientific evidence. I love the idea that purely being mindful of your own physiological sensations can be an accurate source of information. How incredible.

Another interesting piece of knowledge this article has to offer is this: disruption of the ENS is associated with inflammatory gastrointestinal disorders, obesity, and eating disorders. To me, this certainly makes a lot of sense!

Specifically relating to over-eating, the paper proposes that the underlying biological mechanism is the mismatch between the big expected reward from eating food, and the relatively small actual reward experienced. The idea is basically that people keep thinking they are going to really enjoy food, are left unsatisfied, and keep coming back for more. While this may certainly be a big part of the picture, I have some other ideas about this... Something to think about for later.

Reference:
Mayer, E. (2011). Gut feelings: the emerging biology of gut-brain communication. Nature Reviews, 12, 453-466.