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  Healthcare Training Institute - Quality Education since 1979 CE for Psychologist, Social Worker, Counselor, & MFT!! 
  
                Section 19 Question 19 | Test Table of Contents 
 “When I have to get up the next morning and go to work, I have wicked hangovers, and I swear to myself I’ll never do it again. But the sadness just creeps up on me and then I have to have those extra glasses of wine and let the tears just rip. I used to cry that way when I was a kid, just cry and cry and rock myself to sleep. Maybe some part of me wants to be the little kid again and just lose myself in the tears. But oh God, is it ever lonely.” The Craving for Arousal Another aspect of this pattern develops as a by-product of the repetitive cycle of excitement. When a child or adult is in a state of arousal due to intense fear, rage, or heightened alertness or anxiety, the actual chemistry of the body changes. We all have experienced this phenomenon in situations of danger, when our adrenaline flows and we feel a strong sense of being in an altered state. When the child experiences these changes repeatedly, the biochemistry of the body changes permanently, so that it becomes more difficult for the child, and later the adult, to return to baseline levels biochemically (van der Kolk, 1987). The result in the adult is an addiction to excitement. When the adult TRS victim is in a cycle of self-harming, 
                often the planning, the anticipation, the secrecy, and the activity 
                itself all create an experience of pain and excitement or arousal 
                that replicates the excitement in childhood abuse cycles. Many 
                TRS women report that when they stop their self-injurious activities, 
                they feel an intolerable emptiness, dullness, flatness, or depression. 
                They experience a terrible loneliness and sense of being disconnected. 
                It is no wonder that so many choose to return to their self-abusive 
                activities when there seems to be no other way to achieve excitement 
                and the illusion of connection. Laura, another client, talked frequently in the 
                early stages of therapy about how her self-abusive activities 
                were charged with a certain thrill, an undercurrent of excitement 
                that reminded her of some of her childhood experiences with her 
                father. She talked about the way their interactions became like 
                the stalking of a hunter and his prey. Although he always “caught” 
                her at the end of this predatory dance, there was a certain 
                element of excitement, a charge of fear, that heightened 
                all her reactions. Her father often gave her lectures on being 
                tough, being able to take care of herself later on in life. When 
                she practiced her various methods of self-harm, she would think 
                about these messages and reexperience the old thrill of fear and 
                excitement. Female Genital Mutilation/Cutting in the United States 
                
                 - Goldberg, Howard, Female Genital Mutilation/Cutting in the United States: Updated Estimates of Women and Girls at Risk, Public Health Reports / March–April 2016 / Volume 131, 2012. Personal 
    Reflection Exercise #5 Update - Winstone, L., Mars, B., Ferrar, J., Moran, P., Penton-Voak, I., Grace, L., & Biddle, L. (2023). Investigating How People Who Self-harm Evaluate Web-Based Lived Experience Stories: Focus Group Study. JMIR mental health, 10, e43840. https://doi.org/10.2196/43840 
 Andover, M. S., Schatten, H. T., Holman, C. S., & Miller, I. W. (2020). Moderators of treatment response to an intervention for nonsuicidal self-injury in young adults. Journal of Consulting and Clinical Psychology. Advance online publication. Ammerman, B. A., Jacobucci, R., Turner, B. J., Dixon-Gordon, K. L., & McCloskey, M. S. (2020). Quantifying the importance of lifetime frequency versus number of methods in conceptualizing nonsuicidal self-injury severity. Psychology of Violence, 10(4), 442–451. QUESTION 19 | |||||||