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Understanding Self Harm; What Is It?

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Self-harm is the act of self-mutilation, where an individual purposefully harms themselves in hopes to alleviate stress, emotional pain, trauma, depressive feelings or find control. A large number of self-harmers are approaching or are in adolescence; using these methods to cope with new emotions, mental illnesses and overwhelming situations, though many are adults or progress into adulthood with these maladaptive coping skills. Some self-harm for short periods of time or in crisis, whilst others may become fully addicted or may not know that they are self-harming because the method isn’t widely known.

Self-mutilation is not a suicide attempt; it is a maladaptive coping strategy to find control in out-of-control situations and can be replaced by healthy ones. The individual self-harming is struggling and needs professional help. They may use a combination of self-harming methods.


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Cutting. Cutting is the most well-known self-harming coping mechanism and has been widespread on the internet over the last few years. It is the most heard of the bunch.

Most adolescents turn to cutting to cope with dysfunctional families, bullying, trauma, schooling and overwhelming feelings, though adults do also partake in this method. The act of cutting releases endorphins to the brain to deal with the emotional and physical pain, giving the cutter a high. It’s an exciting rush, followed by a sense of relief from what’s bothering them.

Cutting is often assumed as suicidal behaviour when, in actuality, it’s a very common way people cope with issues. The blood and mutilation factor frightens caregivers who feel they may have to bring their child to the hospital for an attempt, which is not a necessity.

It is important that, if the cutter chooses to continue, they use clean materials and clean their wounds to avoid infection and STD transmittal (as it can be deadly). They must monitor themselves; if they cut too deep, they need to request medical attention, as an excessive loss of blood can kill them.

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Burning. Burning is frequently used in combination with cutting. The individual takes a hot object and holds it to their skin until it cools down and a wound is formed. Some may use hot baths or tap water instead, which may not leave a mark, but is as serious. These burn wounds may bubble up and “pop”, oozing a liquid; it is important for the person self-harming to monitor this wound and ensure bacteria doesn’t contaminate.

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Scratching/Pinching. Someone may choose to scratch at their skin until blood surfaces for a quick sense of relief. This could be an occasional thing, develop into dermatillomania or be dermatillomania.

Dermatillomania (Excoriation Disorder or Skin Picking Disorder) is when the individual has an incessant need to scratch and pick at “imperfections” resulting in worsened bumps, wounds, acne or infection. This disorder can be combated through therapy and extreme efforts, but is not always noticed by the one doing it.

There is a difference between choosing to do it, and having a disorder. Someone with dermatillomania will scratch or pick during anxious or tense situations, but may not notice, while someone who is picking occasionally is constantly doing it on purpose. It must be monitored as the occasional behaviour can evolve into a disorder as they grow unaware of their actions, and lean on picking to cope. It becomes second nature.

Wound Interference. This ties in with dermatillomania and skin picking. The individual repeatedly picks at scabs which result in either blood or scars.

art piece watercolour trich trichotillomania bfrb sloth speed recovery

Hair Pulling. Hair pulling is because of a disorder called trichotillomania; a compulsive desire to pull out ones hair. The puller may notice bald patches from continuous pulling, self-esteem issues, and hair follicle changes (hairs growing in curly, thin or odd colours). Constantly pulling out one’s hair can increase anxiety, and affect their confidence, usually accompanied by depression. They may find flaws in specific hairs and feel that they do not belong, resulting in pulling it out.

Trich falls under the same umbrella as dermatillomania, (Body-Focused Repetitive Behaviour/BFRB) and is not always intentional. With over exposure to pulling, they become dependent on it and may not notice themselves acting out, and can be so severe that they pull in their sleep.

Photo: © Europen Parliament/P.Naj-Oleari
pietro.naj-oleari@europarl.europa.eu

Drugs/Alcohol. Substance abuse starts off as using drugs and alcohol to cope. Someone may reach for a bottle when they are upset to “lose themselves”. With repetitive use, they will become heavily addicted and full-fledged alcoholics or drug addicts.

Their body will be tolerant of the substance and require higher doses for the same effect, develop a psychological and physical dependency where they may not be able to function without it as their body and mind experience withdrawal, and addiction. Addiction is the compulsive need for the substance and effort required to avoid or reduce usage.

Depending on the substance, risks include:

  • STDs from needles and injectors
  • Irregular heart rate or heart failure
  • Infertility
  • Lung damage
  • Memory loss
  • Periods of psychosis and disconnection from self
  • Seizures
  • Organ failure
  • Irritability, anxiety, jumpiness, sweating and shaking
  • Violence
  • Insomnia
  • Depression

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Hitting. Hitting involves violence towards oneself, where the individual hits and punches themselves for relief. This can result in bruises and painful areas.

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Disordered Eating Behaviours. Disordered eating is a common gateway to eating disorders. They feel they have lost control when it comes to food or their body, finding flaws in their figure or eating patterns. There are heavy influences in media and they could turn to Pro Anorexia Websites for tips on weight loss. Disordered eating can be controlled and restrictive (anorexia), strictly healthy foods only (othorexia), use of laxatives and vomiting after binging (bulimia), over eating (binge eating) and other, personalized methods.

This behaviour must be heavily monitored as a traumatic change in diet can remove years off their life, become extreme with no way back or fatal. They must seek out medical attention and learn not to use food to cope. The recovery process is not short and may take years; it’s best to catch and treat it early.


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“Suicide Attempts” (Testing the Grounds). These types of suicidal behaviours are parasuicidal, meaning it is suicidal in its nature, but suicide wasn’t the intent. This is very common with individuals diagnosed with Borderline Personality Disorder as they experience chronic suicidal feelings and use this to cope. They do not wish to die, but to control an out-of-control situation. Facing death but not dying can be satisfying to some.


Remember: Self-harm is used to gain control in out-of-control situations. It isn’t use to get back at or punish anybody.

Self-mutilation should be avoided, discouraged and discussed in therapy. Overcoming self-harm will take time, but can be done when trauma, pain and other factors are discussed, and healthier coping mechanisms are implemented. When an urge arises, they should consider journaling, going for a walk, drawing, calling a friend, etc. Constant denial to these urges will improve their quality of life, as they ween off of their need.

Relapse is inevitable, but self-mutilation can be conquered.

If you are a worried guardian or friend, do not demean them. It may not seem logical to you, but it is necessary you open the conversation, lend an ear once in a while, and tell them that it is acceptable to talk about self-harm. If you use it against them, they will lean on the behaviour more, and could hurt themselves further. Don’t overreact, don’t under react. Finding a balance can be complicated, but worth it. They are dealing with a serious problem and need your support.

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My Loved One Is Parasuicidal (Parasuicide and BPD)

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There are times when our lives get out of order and our decently stable environment unravels. We may have an intense life occurrence or we reminiscence on some horrible experiences, but either way, we are left trying to make sense of it and to cope with the chaos around us. A mentally healthy individual may have minimal difficulty, but for those with the Borderline Personality Disorder diagnosis, this can be hell.

In times of fear of lack of control, parasuicidal behaviours could be exercised by one in major turmoil. Parasuicidal being defined by the act of self harm or suicide attempt with no end goal of killing oneself. The individual participating in these may not care if they die in the process, but they do not exactly wish to harm themselves to that extremity.

A good portion of those with a borderline personality disorder diagnosis may take this to the ultimate extreme, losing entire control of their behaviour, or choosing to let their emotions take over. The intensity in which they feel natural emotions can bring to the brim of what they believe they are capable of enduring. The idealistics of someone with this diagnosis, especially those with a strong form of it, may be using this unhealthy coping mechanism because of the following:

Lack of control. A lack of control to one struggling with this diagnosis may lead them to practicing parasuicidal behaviours, sometimes just self harm which can have no relation to parasuicide, to gain what they feel is missing. The behaviour may give them a sense of satisfaction or gratification, giving them the feeling of power. For that moment, they have all the control in the world. Whatever they do, they made that decision and they can be responsible for the intensity of their actions. The concept of making a decision, living it through and seeing the consequences can feed that fear of lacking control. They may lead themselves to fear if they hurt themselves passed what they had originally intended, or be upset with themselves if they didn’t attain their “goal”, and in this fright, they may seek control by scaring those around them.

Negative Life Events. An upsetting life event is natural, unpredictable and out of the hands of the “victim”. A relative being diagnosed with cancer or a suicide close to us isn’t our responsibility, though one may blame themselves, and to justify this, they may practice violent acts towards their bodies. Their goal may be to numb the pain or bring forth the pain on themselves, and at times, to gain sympathy from those around them.

Reminiscing. Reminiscing on past traumatic events leads the individual into a dramatic thought process. They will ponder on experiences, evaluate what they could’ve done better, where they went wrong and may sugar coat or diminish an individual party entirely based on their thoughts. This may lead them to reevaluate their decisions around that individual and seek some type of truth, even if they’ve already found it. They will want immediate responses and will create a castle of terror for themselves. This could even bring them to reinvite abusive partners into their lives, further harming themselves, and they will do everything in their power to make it work to not be alone and to align their perception of events and their hopes of that individual.

Triggering comments. “This will show them!” Sound/seem familiar? That’s because a triggering comment can hurt them, throw them into an intense emotion, and they may seek vengeance and revenge. Sometimes, they take the remark too personally and create a whole new world of horror. Maybe if they self harm or take dozens of pills, the “culprit” may be held liable for their actions. They use this to blame and target that individual and cause them the same, if not more pain for their actions. It’s almost like having the last word. If practiced around family, members may feel like they are walking on eggshells, trying to avoid offending them so they don’t end up self harming or landing themselves in the hospital.

Loneliness and Boredom. Boredom is like a traumatic event for people with borderline. Suddenly, things are stable or relaxed, their hands aren’t busy, things and thoughts aren’t racing and they may consider themselves lazy. In response, to get things going, they convince themselves that a parasuicidal act may be the answer to these feelings. They may even mistake boredom and loneliness for sadness and react as if it were true. Loneliness is perceived as abandonment and they shake things up to make people “come back.” They must keep busy, attend recovery groups and try to avoid these behaviours, knowing they won’t benefit them in any way.

Scare loved ones. This concept is mainly to be in control. By doing such violent things to themselves, they may feel they have control over you and your emotions. They can predict how you’ll react and they want to tell you because your fear could mean love and care in their eyes. It’s almost a test. How far can they push it? And if they don’t get the reaction they want, they make themselves worse. They will freak out and feel invalidated; making accusations that their loved ones just don’t care about them. That fear they can implant is such a strong form of power and they will abuse it until it runs out.

“They’ll love me when…” The main borderline trait is a fear of abandonment; seeking love is the result of that. They have noticed that when they are in a specific state, “everybody comes back.” They will take their already deteriorated and ill state and bring it to the extreme. If they are suffering from an eating disorder, that may be dropping 10 more pounds really quick. It could be a suicide attempt, believing that death will bring them love, or even just being hospitalized. The impulse thought tricks them into believing a total lie. They want the world to stop because things are too chaotic. They can’t possibly understand how “everyone” is so okay with the world, that they can cope with all these unbelievable experiences and come out okay. “They’ll love me when…” is a self-fulfilling prophecy that is very complicated to escape. Once it’s implanted, even through a good period, they may turn to that. It gives them a sense of validation and dominance when they notice that it “worked”. Suddenly, they are sick enough for treatment and they will have the support of family members that had been distant for a period.

Though being parasuicidal often leads someone to seek love and attention, it shouldn’t be seen in a negative way. That individual is trying to gain control of themselves and cope with their turmoil. At times, they lose complete control and may even feel a disconnect from their speech. They  will speak from the heart and try to feel less alone, as the chaos isolates them. They ultimately seek someone to love them and reassure them everything will be okay. Participating in this with your loved one may not be the healthiest thing you can do for them, as you could be feeding a rollercoaster that will persistently worsen.

It is not their fault, most of the time. Even when they forcefully try to worsen themselves, it still isn’t their fault. They must take responsibility for their actions and understand they were taught or demonstrated this behaviour and that control will come if they work on it and break it.

What to do now? As for advice, do not join them in the chaos. That is the worst thing that you can do for them. Be objective. Teach them they can handle being alone and that stability is not the enemy. Be there to support them, but do not be their dance partner. Remind them that things will be okay. Remind them that you will not abandon them, that you love them and that they need help. Encourage them to go to group sessions and get themselves out there. It cannot be stressed enough that they should be using the The Out-Of-Control (DBT-CBT Workbook) and need to complete it.

There is hope and they will gain control. They need to work at it. Recovery is possible.

On a personal note, I am guilty of all of these, and even in my recovery, I still participate in these. The outbursts are a lot further in between and I’m learning to keep some things to myself in order not to use someone’s fear as my control. I am learning that healthy relationships just don’t work that way.

Not everyone with borderline personality disorder or with a mental illness will display these actions as every mental illness affects people in different ways. And not fitting into these categories doesn’t diminish your mental illness in any way.