In short, it is not rebellion or attention-seeking, rather it is them trying to self-medicate. Perry and Szalavitz (2017) note that “Cutting releases brain opioids which makes it particularly attractive to those who have been previously traumatized and found relief in dissociation” (p. 211). A dissociative state is where one becomes disconnected from and lacks continuity between their thoughts, memories, surroundings, actions, and identity.
Self-mutilating becomes an adaptive response that can be soothing to the person who needs an escape from anxiety or revisit memories or thoughts, or wish to avoid difficult surroundings and challenges. In a dissociative state, your child becomes removed from any and all reality, entering into a dream-like consciousness where they feel little emotional or physical pain. In this dream-like state, there is a high release of opioids. These are the brain’s natural heroin-like faculties, which kill pain and give a calming effect detaching them from all their problems.
Research in rodents has shown that when these animals are totally restrained – a highly stressful experience for them, their brains flood with natural opioids, known as endorphins and enkephalins (Perry & Szalavitz, 2017). I mention to my clients in therapy that this is similar to what happens when opossums pass out or fainting goats. I would venture to say this happens when a prey animal has exhausted all its energy, avoiding a predator lying down for the kill. They used to show these things on the nature programs when I was growing up, and anyone who remembers them would know exactly what I am referring to. Those country folks who hunt regularly know this as well. These animals’ adaptive responses involve the brain being flooded with natural opioids, blood is shunted from their limbs, and the heart rate slows down. The brain prepares them for injury, and these natural opioids release killing any pain, producing calmness and psychological distance from what is happening.
People feel the same way when they experience life-threatening experiences. Time stands still for them. It is a dream-like experience where their whole life flashes before them. They often describe a sense of disconnection and unreality (Perry & Szalavitz, 2017). This numbness is very similar to what people experience when they take opioid drugs. Endorphins and enkephalins are an integral part of the brain's stress response system, preparing the body to handle physical and emotional pain. Knowing this will help you as the parent to empathize with what your child is going through. They are not crazy and they are not beyond help!
If your child suffers from self-mutilation, depression, anxiety, PTSD, or the like, seek a therapist that does not pathologize their symptomatic behaviors such as cutting, burning, picking skin, opening wounds, head-banging, hair-pulling, etc. Children are more responsive to a counselor who views these behaviors as natural efforts, protectors that are sought out to resolve a current crisis.
Perry, B. D., & Szalavitz, M. (2017). The boy who was raised as a dog. NY: Basic Books.