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Section 24
Feeling Singled Out: Cutters in the Family Dynamic

Question 24 | Test | Table of Contents


In some families there are multiple siblings who self-injure—usually one or more siblings picks up the habit from the one who starts it first—but more often than not, one sibling in the family is the full-blown self-injurer.

Some of our patients tell us of siblings who have engaged once or twice in a behavior that qualified as injurious, but the habit did not escalate from there. Others describe siblings with different impulse-control problems, such as drug and alcohol abuse or eating disorders. Still others say their brothers and sisters are perfectly normal, and no one in the family can fathom the one exception.

It may seem odd that children who grew up in the same family, often under basically similar conditions, might turn out so vastly different from one another. Why should one sibling develop a harmful habit derived from severe psychological problems, while another sibling—perhaps close in age and of the same sex—does not? The reasons are numerous and complex, and often cannot be pinpointed. Perhaps a good analogy would be to ask why one child in the family ends up a violin prodigy or a tennis star, while the others may be talented in the field but not exceptional.

As you know, sometimes in troubled families certain children are singled out for the abuse. In a dramatic and highly publicized child-abuse case in New York City, a single mother with seven children deliberately starved one of them to death. While the other children were given meager but adequate provisions—food, clothing, and school—one girl was kept caged in a crib, hidden away and denied nourishment or care. The five-year-old girl died at sixteen pounds.

While most cases are not nearly so extreme, many self-injurers describe being tagged for degradation or abuse, either in overt or subtle ways. Sometimes they felt like they were the ones who always got picked on, and sometimes they actually were the ones whom the abusive parent actively sought out the most. Again, it’s important to point out that sometimes the parents of se1f-injurers report that they were as evenhanded as possible among their children, and yet the child who self-injures perceives that she was left out, slighted, or unfavored in some way.

Other times there seems to be no concrete explanation for why one person becomes a self-injurer and a sibling remains healthy. Some people live through unbearably awful childhood abuse and grow up emotionally stable, and some people grow up in seemingly normal homes and emerge with terrible psychological difficulties.

At times experts use sibling differences to try to argue that self-injury has biological origins: if one sibling has it and another doesn’t, mightn’t that point to a genetic mutation or difference of some sort?

We don’t buy that argument. Some self-injurers may be born with a kind of predilection toward hypersensitivity, but we believe the manner in which the caregivers respond to this sensitivity ultimately determines how a child begins to cope with life’s demands.

Each family has its own idiosyncrasies that may or may not prompt someone exposed to them to turn to self-injury. Below are three examples of people who grew up under very different circumstances and who all became the only self-injurer in the family.

Ceci J.: Singled Out
Ceci J., the youngest of eight children, is a self-injurer. Cory, her twin sister and “best friend,” is not. Neither is her brother Charlie, the next oldest, who is extremely close to both twins and has been throughout their lives. Neither are any of the five eldest siblings, two boys and three girls.

Ceci is thirty-eight years old, single, thin, and attractive. She wears preppy clothes, parts her shoulder-length blond hair in the middle and feathers it to the side. Ceci holds a law degree, as well as a high-paying job as a lawyer for a pharmaceutical company. An avid runner and exercise fan, her proudest day was when she completed her first marathon.
Ceci started injuring in her early twenties, but not until age thirty-five was she first hospitalized, at S.A.F.E. Alternatives. She spends a lot of time ruminating on her family situation and why she became a self-injurer, the only one. She knows of one time that her twin sister smashed a glass during an argument with their mother and cut herself with a shard, but that was an isolated event; most of the time Cory is “one of the strongest people I know.

“I don’t understand why I’m the one in my family who has feelings like this,” Ceci says, sitting in a lounge at S.A.F.E. and discussing the situation with her brother Charlie during visiting hours. “I can remember even being a little girl and hitting myself, taking a hairbrush and looking in the mirror and saying, ‘You’re so ugly, I hate you.’”
Ceci and Charlie spent some time together during Ceci’s stay at S.A.F.E. trying to figure out how Ceci’s problems originated. (Both Cory and Charlie were instrumental in getting Ceci to S.A.RE., and both have played an active role in her treatment.)

“I was the one who was picked on a lot, teased,” Ceci recalled. “I was the one who did everything everybody told me to do.”

Charlie agreed. “I think that Ceci was treated differently. Cory was always the perfect one, the one everyone admired. Our mom says we were all raised the same, but I don’t think that’s exactly true.”

The differences were manifest at birth. Their mother had not been expecting twins—the second baby was tucked behind the first—and had vowed that, boy or girl, she was going to name her fifth child Cory. After Cory- a girl- was born normally, the mother learned with dismay as she lay on the delivery bed that a second child was about to be born, only this one was a breach birth. Ceci came out feet first, with one lung collapsed and her head highly molded from the birth canal.

“Mom remembers the doctor saying, “Well, you have one perfect baby, and the second baby has a long head.’” Charlie said. “People commented on how perfect Cory was and didn’t say anything much about Ceci. I believe babies understand that.”

Ceci agreed. “I always felt I was the unwanted one, unexpected, outcast. I was a surprise afterthought.”

Ceci and her siblings were not sexually abused, but life in their household was not easy. Their father was chief executive of a small electronics firm, an alcoholic who enforced strict and bizarre rules of conduct. Children were meant to be seen and not heard, and were not supposed to have feelings.

“He was very reserved,” Charlie said, “Everything was dictated by him. He was like the father of the Von Trapp family with the whistle, and everybody lines up. I remember his checking our nails before dinner- you had to go upstairs and wash them if they didn’t pass inspection, and if they still weren’t clean the second time, you’d get a pretty hefty swat.”

Dinnertime was an extraordinary event. The eight children sat at one table in the kitchen, and- for reasons that were never explained- none of them was ever allowed to speak during a meal. Laughter and other forms of interaction were also forbidden. The two parents sat at a separate table in the dining room, with the door open so the father could keep watch on the offspring and make sure no conversations took place. The parents did little talking themselves.

“If there were any outbursts at the children’s table, there was trouble,” Charlie said. “Our father’s spankings weren’t your average spankings. There was a room at the top of the house where we three boys used to compare the welts and red handprints on our bottoms.”

Ceci’s parents divorced when she was twelve- her mother initiated the rift in part because she disapproved of her husband’s child-rearing tactics- and the family fell into poverty as the mother moved to a new city and attempted to support everyone on her own. Ceci and Cory wore hand-me-downs and ate free hot meals at school. When their mother remarried, the family moved yet again. Shortly after, the children’s father died.

There wasn’t enough money for the family to fly to the father’s funeral- classmates tried to raise funds for the siblings but were unsuccessful- so the children had to grieve at a makeshift mass. Ceci was fourteen. “I remember we were supposed to say some type of prayer, and I was asked if I had said it, and I said no,” she recalled. ‘Well then,’ the priest told me, ‘Your father probably won’t go to heaven.’ I felt so guilty.”

Ceci was a straight-arrow during high school. She was shy and studious, got good grades, and stuck close to her small band of friends. Twin sister Cory, meanwhile, hung with a fast crowd and ended up pregnant. At age sixteen she was sent to a faraway home for teenage mothers. Ceci was devastated by the departure of her sister.

Not until Ceci reached adulthood did her self-injury start. Ceci had suffered a string of bad romances and several abortions and felt unloved and unappreciated. Though she was not overweight, she felt bad about her body and her sexuality. Her first experience was with an artist’s knife; she cut long slits along the sides of both legs, in a circular pattern. She immediately made up a cover story.

“I had stories for every day of the month,” Ceci recalled. “One time I said I had put up cyclone fences, and that’s how I cut my arms.”

Gradually and insidiously, self-injury became “an obsession” that “felt like an addiction,” Ceci said. “I used a knife, and once the blood came, I felt better,” she explained. “I had put knives all around my house, in my truck, on my nightstand. They were like a security blanket for me.”

Ceci said “self-loathing and rejection” were her two strongest feelings prior to self-injury. Far from relishing the attention the activity brought, she shunned medical care, failing to attend to her wounds even when, she admits, they could have used stitches.

Like many patients at S.A.F.E., Ceci began panicking when the soothing effects of self-injury started to wane. “It was scaring me because it wasn’t doing what it used to do, and I was thinking about suicide and how I could slit my wrists,” she said. “I felt like I wanted to die. I’ve talked to a lot of people here at the program, and they started out just like me.”
At S.A.F.E., Ceci enjoyed the camaraderie of being with fellow self-injurers. Her comments point out a common phenomenon in psychiatric wards, ours and everyone else’s. Some patients jockey to be the “baddest,” or sickest, and some take solace when they perceive others as sicker than they are.

“I think I have looked at people at S.A.F.E. and said, ‘I’m not that bad,’” Ceci said, “Depression is what I suffer with more than anything. I’m not psychotic.”

Ceci’s brother visited her nearly every day that she was at S.A.F.E., but other relatives were less supportive. Ceci and Charlie said their mother had reacted with disgust.

“My mother is so disturbed about it, but for the wrong reasons,” Charlie said. “She keeps asking, ‘How could Ceci be so different? “Where did I go wrong?’”

Ceci chimed in. “All she feels is self-blame. I’m sure she wants me to stop doing it so it’s not an embarrassment to her.”

As part of Ceci’s ongoing recovery, she is learning to handle the emotional pain that accompanies her mother’s rejection. “I’m grieving over having less than ideal parents, but I’m learning that you’re the one who needs to take care of yourself,” she said.

The rigid ways of thinking that pervaded Ceci’s family are quite typical among the self-injurers we see. Often, these inflexible attitudes manifest themselves in different forms. In Ceci’s case, they were cloaked in a mantle of military discipline.
- Conterio, Karen and Wendy Lader, PhD; Bodily Harm; Hyperion: New York; 1998

Personal Reflection Exercise #10
The preceding section contained information about the family history of a self-injurer. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Evidence review for involving family and carers in the
management of people who have self-harmed: Self-harm:
assessment, management and preventing recurrence

- Evidence review for involving family and carers in the management of people who have self-harmed: Self-harm: assessment, management and preventing recurrence. (2022). National Institute for Health and Care Excellence (NICE).


Peer-Reviewed Journal Article References:
Bustamante Madsen, L., Eddleston, M., Schultz Hansen, K., & Konradsen, F. (2018). Quality assessment of economic evaluations of suicide and self-harm interventions: A systematic review. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(2), 82–95.

Evans, C. M., & Simms, L. J. (2019). The latent structure of self-harm. Journal of Abnormal Psychology, 128(1), 12–24.

Hasking, P. A., Bloom, E., Lewis, S. P., & Baetens, I. (2020). Developing a policy, and professional development for school staff, to address and respond to nonsuicidal self-injury in schools. International Perspectives in Psychology: Research, Practice, Consultation, 9(3), 176–179.

QUESTION 24
When did Ceci’s self harm begin to escalate towards suicidal ideation To select and enter your answer go to Test.

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