Self cutting behavior precipiated by Abilify and the psychology of self cutting

A woman in her mid forties, who suffers from extensive psychiatric problems, the core of which is her extremely high level of anxiety, reported that on being put on Abilify 10 mg., instead of getting better, began cutting herself.

She at once added that it is not a suicidal behavior, though everyone is viewing it that way, and repeatedly hospitalizing her when she goes to the ER to get the cuts stitched.  She had had four admissions in two months. After a little reflection she said that it could be suicidal behavior too, because at one point, in between the cuttings, she tried to hang herself.

On stopping the Abilify, the thoughts to cut herself went away.

When I stated to her that Abilify by itself could not have caused the behavior, and some other experiences in the past must have set the stage for Abilify to enable the self-destructiveness, she said that she was constantly hearing the warning that they blare at the end of drug commercials as to what the drug can do to you and Ability commercial tells you that it will make you suicidal.

"Maybe it was the commercial playing at the back of my mind impelling me to cut myself."

This conjecture was, of course, rejected by both of us. The commercial alone could not have had such a powerful effect, and the psychogenic roots of self-cutting had to be searched for elsewhere.

Patient then recalled that the self-cutting had began 10 years ago, and after a few years had gone away, only to reemerge on being placed on Abilify.

She could recall the very first time she cut herself.

"I was fighting with my husband and could not defend myself. So I broke a bottle and cut myself with it, and it felt so good. Cutting relieved myself of anger."

"Why did you not cut your husband instead?"

"I wanted to hurt him. But he was huge. In one move he would have strangled me. So I had no choice but to take the anger out on myself. I cannot describe the relief it gave me. After that anytime something would upset me very much I just knew how to end it. You know I have psoriasis. Whenever I get bad nerves I break out terrible. But cutting myself helped with the nerves. If I did not cut myself the psoriasis flared up even worse."

"Why would cutting yourself help with nerves?"

"If you cannot win them, join them. If I get really pissed off with someone, that person sits in my chest like a knot. The only way to get relief from that knot is to create a split in myself and see my body as somebody else's body and to cut it up. Once it becomes an alien then I can cut it and I feel no pain. Just tremendous relief. Though the next day its hurts."

"What do you mean you see your body as somebody else's?"

"I have to treat my body as a non-self before I can cut it. But before I turn it into non-self, I have to see myself as evil and full of hatred towards others that must be destroyed. In fact sometimes I do destroy my whole house. From one end to the other. The house symbolizes me. I am destroying myself for being evil. I even hit myself. I don't feel any pain while doing it. Just relief from anger. And when it is over calm. Though tired and sleepy. Only the next day I feel as if a truck has ran over me."

My construction that this beating herself up and getting a great release from it could be a form of sexual discharge, and the immense relief and calmness and falling asleep afterwards a form of orgasm, was rejected by the patient.

Another girl confirmed that what you are cutting in yourself is the person you hate but to whom you cannot do anything by stating the following: "When I get real mad I cut my wrist and that takes away the pain. It started with my parents. I was so angry at my father that I went to stab him with the pencil I was holding but at the last minute I stabbed it on my own self. It was a tremendous relief. After that whenever my parents made me mad, I would see myself stabbing them, but it would be my wrist that I would be cutting."