How do I deal with self harm?

[Akita]

My dBPDw self harms.  I would to be able to help her stop.  We have discussed it and she told me she does it to stop her pain.  She also likes how cutting feels and watching the blood.  It is like an addiction for her.  She doesn't just cut.  She pulls hair, eyebrows, and eyelashes.  She scratches, pinches, and bites herself.  She does this throughout the day to feel less anxious or angry.  I really want to the cutting to stop.  She cuts deep enough to need stitches sometimes.  She is embarrassed by her scars and feels ashamed after she has done it.  She is in counseling but so far he hasn't been able to help her stop this behavior.  Does anyone have any advice?

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[lbjnltx]

In DBT they teach alternatives to self harm.

Use a red washable marker to simulate blood

Snap the wrist with a rubber band

Hold ice cubes in the fist

these are only alternatives until coping skills take the place of the urge to self injure.  My daughter revealed in RTC that self injury was an addiction for her.

[Akita]

Thank you for the suggestion, but she has attempted all of these.  She says they don't work for her.  She isn't getting any emotional relief.  She says these are just weak methods to delay the inevitable. Is there anything else out there that has helped someone?  What can I do to keep her from getting to this point emotionally?

[lbjnltx]

She needs to develop coping skills, it is up to her to do it.

You can help her process her emotions through validation.  Here is some info on this skill:

Tools:  communication, validation, and reinforcement of good behavior

This info is amongst the Lessons on the right side of the page----->

lbj

[Akita]

Thank you.  I will look into this.  Please other posters add information if you have it.  The more I can gather the better chance I have at being successful.  This behavior is very distressing for me.

[Cloudy Days]

She needs to find a replacement that will have the same effect of getting rid of the emotions. To me I would see it like replacing any other destructive addiction, drug or alcohol abuse for example, they use for the exact same reasons your wife cuts. They use exercise a lot of the time to sort of distract from the pain and the uncomfortable feelings, negative energy is channeled into positive energy.

[Akita]

She has gone for walks.  Though one of these walks was her climbing out a bedroom window so she wouldn't have to see me.  I have offered to walk with her and we use to go on 2 miles walks a lot.  We probably need to start walking again.  I'm sure she would be willing and I have actually asked her to ask me to go for a walk if she feels like she needs one.  The big problem is she spirals down so fast and then can think of nothing but the knife.  It's just set.  Nothing can divert her from the path she is on.  I need to figure out how to keep her off this path.  Thank you for all the input.  I am starting to feel like I have options.

[Cloudy Days]

Can you have a sort of intervention and take anything she would cut with away from her. If she doesn't have the tools to do it then she will have a harder time running strait for that.

[Akita]

I have taken her knife.  She gets angry and hunts for it.  Says it's hers and I have no right to take it.  She will use kitchen knives.  She has also used regular objects around the house... .paperclips, staples, scissors, broken plastic, and utility knives.  It just feels impossible to remove all sharp objects from her.  I will consider it though... .thank you for the thought.  I appreciate all this help.

[Akita]

She was in DBT therapy but couldn't get past chapter 2 with her therapist.  She has since left that counselor.  Her new counselor doesn't believe in using a program but addressing each problem as its own thing.

[lbjnltx]

If she is determined to self harm she will find a way.  Even the kids in residential treatment who have no access to sharps find a way.

It isn't healthy for the non in the relationship to shift the responsibility onto themselves regarding things out of their control.  I realize you are trying to help her and there is a difference between helping her help herself and trying to stop something you don't have the power to stop.

You can be a source of support and encouragement for her, ongoing as well as in the moments when she has the urge to self injury.  As difficult as it is for us to comprehend, self injury is a coping mechanism, a maladaptive coping mechanism.

lbj

[Akita]

Thank you.  How do I support her in the moment?

[lbjnltx]

Listen to understand, validate the feelings she is having, encourage her to talk through those intense emotions, ask her validating questions to keep her talking.

These are urges she is having, when the intense feelings find relief and begin to dissipate the urge of the moment will too.

Many therapists teach the visualization processes to deal with intense emotionality moments.  You can encourage her to do this as well.  It is like self hypnosis.  It works well with PwBPD because they are very imaginative and creative.

In a time of calm, you 2 can do it together.  Think of a place of calm, natural, beauty.  There is a place there to sit and rest (lounge chair or a patch of cool green grass as soft as lambswool), there are wild flowers blooming 3 feet tall of every color and aroma imaginable.  Visualize yourself lounging there, you can hear a stream trickling over the rocks and birds chirping in the distance.  On the other side of a large oak tree a doe and her fawn are feasting on the wild flowers, they see you and you see them and neither of you want to disturb the other.  The clouds are floating by on the gentle breeze that you feel on the bottoms of your feet.  This is your safe place and you can come here anytime.

It is up to her to decide what her safe place looks like, how she gets there, and what she finds there.

In times of intense emotionality remind her that she has a safe place and encourage her to go there in her mind.

Many people also journal or do art to ease their emotions.

Whatever works best is what she can do and you can participate with her as well as encourage her to do it alone.

lbj

[Akita]

That really sounds like something we could try.  If she will cooperate.  Thank you for the suggestions.

[Bpdsupporter]

Poor darling she must be hurting do bad. My heart goes out to her... and you must be so worried. Is she at all open to medication for her anxiety? My pwBPD and myself both take a natural supplement called Inositol also known as viatimin B8. He said he's been feeling more balanced since taking it. I struggle with anxiety too and its been really helpful. Of course check with your physician. And do your own research about it... .I discovered it because I was looking for natural supplements that are good for those struggling with BPD and it came up in my search that it's actually beneficial.  It's natural so there aren't any side effects you can get it at most health food stores. Because maybe if there is a way to reduce her anxiety and internal pain she might cut less. I'm not the biggest fan of pharmaceuticals  but there are tons of natural supplements and teas you can get at your health food store that promote an overall sense of well being.Like camomile tea, passionflower tea... st johns wort is really great for depression. Anything that will promote and calm nerves should just be in stock at your home. Again please make sure you check with your doctor on anythung you try... i m not a physician and wouldnt want you to take something off my word alone. But inositol has really been helping both of us. Peace to ya!

[Akita]

She was on Celexa for awhile but stopped taking it because she didn't like how it made her feel.  She attempted to get back on a medication but the PA-C who helped was no longer willing to help her.  She doesn't want to go to a new person so she is currently not interested in medication.  I will google the natural remedies you suggested and see how she feels about that.  Thank you for your thoughts.  She is in a lot of pain.  She can be doing fine and then something will set her off and I can't bring her back.  I never know what will start this spiral.  I've asked her and she doesn't understand either.

[Akita]

She has a new best friend she met on Facebook.  This friend also has BPD.  Yesterday they had an argument or something and her friend stopped messaging her.  It was for 9 hours that the friend didn't respond.  My dBPDw became very distressed.  She had also tried to make plans with her sister and her sister didn't respond immediately.  She has a difficult time waiting for information.  She ended up hurting herself.  It was fairly deep and could have used stitches.  She didn't discuss any of her feelings with me.  I would like her to be better able to wait, that may help reduce some of her self harm behavior.  I of course don't know that for sure but it's something I would like to try at least.  Plus it's probably a good life skill.  Anyone have thoughts on this?

[lbjnltx]

Behaving impulsively is a trait of BPD.  Learning to delay gratification is a skill that she can develop.

Does she ever seek help for herself online?

Here are some online resources for pwBPD:

www.bpdresources.net

If she uses online resources, talking openly about whether or not these resources are helping or making her feel worse is advisable.  My d found the members on the forums frustrating and invalidating because they weren't working on self at the level she does nor offering much support in return.

[Akita]

She is part of a DBT group on facebook.  That is how she met her new friend.  She has told me she likes the online forums.  Helps her to not feel alone.  The flip side is that if the other people are unresponsive or disagreeable she can become overwhelmed with negative feelings.  She easily falls into the everyone hates me mode.  She has a lot of difficulty viewing herself in any positive way.  I think this helps feed her self harming behaviors.  It's also hard on me as she gets into a very depressed mood and I can do nothing right.  I will have her check the resources you listed.  It's always advantageous to have more options.  She really likes this new friend, has called her her best friend.  I get that this other person has more insight into what BPD feels like but I also worry about how a relationship between two borderline people will work out.  It makes me pretty nervous.  This other BPD person doesn't self harm so I see that as a positive but I'm still anxious about how the communication between them will be... .I don't want her to lose her friend but I don't want the friend to just be a new source of emotional distress.  My wife doesn't have any friends in person.  She doesn't trust people and feels like people can see through her and can tell she is different.  I guess I just don't want any fuel added to the stress level so she won't have more reasons to hurt herself.  Any advice on this?

[lbjnltx]

It seems like you are trying to manage her life to minimize any negative affects she might suffer.

It really isn't possible nor advisable to do this akita.  She will make her own choices about where, what, who, when, and how.  Your job is to be her husband and support her in the positive choices she makes and validate her feelings.  It is important that you have healthy boundaries and that she does as well.

She could become resentful of your attempts to protect her.

I know you mean well

[Akita]

I'm not sure where to draw the line.  She says she cant do it alone.  She wants my help.  She tells me that all the time... .I just don't know how what when or where.  She can't help me with that.  When she has spiraled she has a hard time discussing anything and usually just more angry.  How can I spot situations I can help with and how do I know when to stand back?

[waverider]

self harm is only one side of the bigger picture of a disordered mind. Focusing too much on the self harm will distract from caring for her in the wider picture. It is just one highly visible aspect and you wont be able to solve it in isolation.

If you word on building self esteem, reducing anxiety and delay immediate gratification of impulses they need to self harm will dissipate.

You will not be able to physically stop it or blocks access to means. My wife did this on and off for most of her life ad reached a peak following diagnosis of BPD. She need plastic surgery on her lips after she had continuous bitten her lips and inside of her mouth. She was hiding this and blaming it on a rare ulcerating disease. We had close to 30 trips to ER in ambulances due to ODs, Endless amounts of cutting. Forcing herself into sleep depravation, starving. Lots of other destructive behaviors.

Most was driven by a need to make unseen emotional hurt into an identifiable physical one. The doctors can fix a physical injury, but they can fix an emotional one.

Me getting into a flap over it only stressed her even more and increased the need to do it. Do not attempt to wrap her in cotton wool. Do not allow her to project the drama in her head onto you via using self harm as a link in the soothing chain. If you both gets stressed it normalizes stress. Stress shared is stress halved.

The direct self harm has gone now, mainly do to feeling more secure and being able to more openly discuss the distorted stuff that is going in her head without me just dismissing it as being "silly' (thanks to bpdfamily).

It is an evolution though.

[Akita]

How do I build her self esteem.  She tells me I'm lying if I attempt to compliment her.  I tried to reduce anxiety by setting up routines for her.  She says I'm controlling her or that I am treating her like a child.  I'm not sure on the impulsiveness.  I know she is impulsive, I just don't know how to help with it.  Any thoughts?

[waverider]

  She tells me I'm lying if I attempt to compliment her.

pwBPD often believe others are superficial and are only trying to appease, words have little weight. This can often be a projection of themselves. The best complements are usually to listen and ask questions. This is showing genuine interest and validates their opinions even if they can be way out at times

 

I tried to reduce anxiety by setting up routines for her.  She says I'm controlling her or that I am treating her like a child.

 

Trying to fix is seen as controlling and brings about a push reaction. It also highlights their inabilities and is therefore invalidating. best way of achieving this is asking her how she might be able to organize things better, then reinforcing the good ideas. This way it is instigated by herself and brings more reward and self satisfaction.

I'm not sure on the impulsiveness.  I know she is impulsive, I just don't know how to help with it.  Any thoughts?

This is a hard one, inserting questions like "what do you think the consequences of doing that will look like?" . Its a way of linking cause and effect. You are unlikely to stop it but by inserting a "pause" between thought and action you get the chance to redirect harmful actions. Talking about the consequences of what they are doing rather than focusing on the "emergency' of stopping it.

Getting worked up about what they are doing is taking the focus away from their feelings which is invalidating. eg They are trying to cause physical pain, you are trying to stop this is in conflict with that, and invalidating. It is their choice to inflict pain. What they need is for you to focus on the feeling that is driving this (Support and Empathy), and also adding a dose of reality about the ongoing consequences, such as leaving visible scars, causing an infection etc (Truth).

They are focused on the act, it is almost a dysfunctional action akin to Mindfulness, a point of focus, you want to take the focus away from the action and back to the bigger picture

[Akita]

Thank you for the advice.  I will work on it.  Her cutting seems to be an urge that takes hold.  Sometimes I can tell by how she is behaving that she is likely to cut.  Other times she appears to be fine and then I find out later she cut minutes after I left.  Sometimes I'm home sometimes I'm not.  I'm just suppose to ask her what the consequences of cutting are when she appears to want to cut?  What if I'm wrong and she was going to do it?  What if I put it in her mind?  What if she does it out of spite for me thinking she might cut?

[waverider]

Thank you for the advice.  I will work on it.  Her cutting seems to be an urge that takes hold.  Sometimes I can tell by how she is behaving that she is likely to cut.  Other times she appears to be fine and then I find out later she cut minutes after I left.  Sometimes I'm home sometimes I'm not.  I'm just suppose to ask her what the consequences of cutting are when she appears to want to cut?  What if I'm wrong and she was going to do it?  What if I put it in her mind?  What if she does it out of spite for me thinking she might cut?

Dont bring it up unless you see it happening, or has happened, or she is talking about it. Dont attempt to preempt it. With most repetitive behavior the effects of how you react are more reflected on future episodes than the current one. You are planting thought seeds for the future.

Everything is long term, rather reacting to the moment.

[Akita]

Is there a way to encourage her to talk about it.  She generally doesn't come right out and say I'm going to cut.  A few times I have asked her if she wants to hurt herself and she has nodded but becomes more upset i.e. she starts crying.  She has a difficult time talking about what she is feeling.  She is more of an acting in type of borderline.  She will yell and display anger and has screamed in the face of our 16 month old son using profanities.  I would say she mostly goes quiet.  She stops talking or responding or just gives short answers.  Many times I feel like she just tells me what I want to hear so I'll stop talking to her.  One acting out behavior she has is leaving without letting me know she is going anywhere, she also drives recklessly at times.  Overall I would say she uses her body to deal with how she is feeling, and cant or wont share to let me into her world of hurt.  She has told me when she does try to share I make her feel worse.

[waverider]

  She has told me when she does try to share I make her feel worse.

Vocalizing her feelings is obviously hard for, probably self harm is an easier form expression for her. When you talk to her she probably feels pressure to vocalize what she can't.

I told my wife that if she ever feels that way she can come and sit on the sofa next to me and tell me she is in a bad place and we can have a hug and i wont question her but she is free to tell me anything she wants to. It gives acknowledgement and support without pressure.

Has she ever written her thoughts down?

[Akita]

She is currently trying to journal.  She  wrote about one incident she was angry about and hasn't written in it since.  She has said she's not sure what to write.  She had a couple of hard sessions with her therapist recently and cancelled half her appointments.  Instead of going twice a week she is only going once a week.  She has done a lot of cutting since this happened, can't identify what's wrong.  Just feels anxious, sad, fearful and angry.  Can you give more specifics with the journal?

[waverider]

Can you give more specifics with the journal?

Make a time of the day to do it. start  off with one word description of how she feels, without going into details. Start each day answering one word questions to kick start the ordering of thoughts. If that is all that is entered for the day it is the start of structuring. There is no need to write an entire essay everyday.

eg:

Emotion now: sad

Emotion when I woke up this morning: excited

Best thing that happened today: Met mum

Worst thing that happened to day: Fought with H



Things on my mind today (expand here on anything): XYZ