Sunday, November 26, 2017

"Delicate' Cutting

On November 18, 2017, the Tampa Bay Psychoanalytic Society, Inc hosted Shelly Doctors, PhD  who read a paper titled Advances in Understanding and Treating Self-Cutting in Adolescence. Doctors sees “delicate” (careful, superficial) cutting as a strategy for coping with overwhelming affects. With the lack of a reliable partner in mutual regulation, a child with insecure attachments learns from experience that others cannot be counted on to soothe and regulate painful feelings, so the child relies instead on strategies of self soothing.

Cutting can serve to both down regulate and up regulate extreme ends of arousal of the autonomic nervous system. This is how I understand it: The hyperarousal of the sympathetic (fight/flight) nervous system is calmed by the release, upon cutting, of endogenous opioids. The parasympathetic (freeze) nervous system’s numbing and deadness are up-regulated when it is likewise dampened by the brain’s opioid release.

Doctors notes that this kind of self “management” does not necessarily include suicidal ideation. What others see as problematic, the cutter sees as problem solving, a way of attending to an unbearable affect state or self state which, Doctors says, heralds self loss. This fragmentation of the sense of self is frightening, experienced as an assault on the self, and cutting, paradoxically, restores the self [by regulating overwhelming, that is, fragmenting, affect]. Cutting may be a response to separation, rejection, or loss, when the patient feels utterly alone, tense, or angry. Self-cutting increases when other means of self-regulation are blocked (for example, in prison, when drunk, etc).

1 comment:

Jane said...

I emailed this blog entry to my consultation group as we were just discussing our patients who are "delicate" cutters. It's such a comprehensive way to think about cutting. It's very helpful.