I work with many young women who have both eating disorders and self-harming behaviors. The way I see it, it is a way for someone to use their body as a way to communicate.
Whether they are burning, cutting, or picking at themselves, or bingeing, restricting or purging food, it is often symbolic of some deeper issues. Of course, there are different degrees of this – sometimes it’s just a bad habit, like nail biting, but sometimes it’s more serious.
The body as a communication tool
The body is a powerful communication vehicle, so when I work with a child or adolescent, we address the disorder empathically in that way. We look at why they feel compelled to use their body to communicate or expunge some sort of feeling. Then people can start to understand the purpose of their behavior in a different way.
Self-harm is a very deep-seeded, core issue. It’s similar to eating disorders, in that every person that I’ve worked with has their own story, their own history, and background that leads them to find the unconscious solution of relief in self-harm.
Through therapy, I help people piece together their psychological puzzle. Typically people have already been in treatment, and they have improved a bit, but they still have urges and compulsions, and they know something still isn’t quite the way it should be. In therapy, I help them understand their urges more deeply and with more insight so they can adapt and change and sustain the changes over time.
Psychodynamic Theory vs. CBT
I work psychodynamically, which is quite different from Cognitive Behavioral Therapy (CBT). A lot of the young women I work with have been in and out of facilities and through various therapies, including CBT. And those therapies are part of their recovery, yet when my patients arrive at their next adventure of therapy they are typically seeking a deeper look at relationships and communication, which is when a psychodynamic approach works really well.
A lot of the work we do in psychodynamic therapy is looking at communication patterns. We look at understanding who they are as individuals and their role within the family. We want to work out what they want to do in life, and what might be holding them back.
A lot of my work with young women, whether it’s self-harm or an eating disorder, is to help them put what’s behind their actions into words. We seek to uncover the underlying anxiety.
I encourage young women to look deeper when they are pursuing anxiety-driven behaviors like self-harm. Seek to understand the deeper anxiety. If you are anxious about your body, look deeper. What else is going on?
Next, we can work to develop emotional regulatory skills so they can manage their emotional, psychological and physical world. Not that anxiety can be completely eliminated, but you can learn to understand and manage it in a constructive manner.
Symptom-free but still work to be done
When someone is in the midst of self-harming behavior, it’s all they think about. Once they get to the other side, they discover a whole other world of anxiety and living.
The beauty of the eating disorder and the self-harm is that it protects them from dealing with larger issues of anxiety. It allows them to focus all of their anxiety on their bodies and food.
After a while, they begin to recognize the underlying issues, and then it’s not the symptoms we’re dealing with. It’s everything that drove the symptoms to surface in the first place.
What to do
If as a parent you believe that your child is self-harming, whether they have done it once or 50 times, then you should understand that your child is desperate to communicate, to expose something unconsciously.
The best possible thing you can do is to step up and say “I’m going to take care of you by taking you and our family to someone who can help us with this.”
I really encourage parents to seek outside, professional, experienced help with self-harming behaviors, since it can be very troubling for a parent to deal with the fear and anger that is natural when you discover that your child is intentionally harming herself. Finding a helpful professional who can accurately assess self-harm and differentiate it from suicidal tendencies is very important.
Angela Wurtzel, MA, LMFT, CEDS, specializes in the psychotherapeutic treatment and guidance for women and men of all ages working to overcome eating disorders, self-injury, and compulsive shopping. With over 20 years of clinical experience, Angela’s expertise lies in the emotional and personal development of each person she works with. Angela combines a high level of clinical skill with understanding in a safe, empathic environment. She helps individuals to identify underlying emotions and find words to express feelings without using the body as a means to harm oneself. Angela assists her clients in achieving lives free from destructive tendencies. Website