BPD BEHAVIORS: Self injury and self harm

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GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[tired_mom]

Has anyone else had experience with their BPD ingesting foreign objects - on impulse or on purpose?

I have searched the internet and found an article called
"Foreign-Body Ingestion in Patients With Personality Disorders" in Psychosomatics journal April 2007, but don't have a subscription to read the findings and outcome.

My daughter started swallowing glass (broke Ipod, found bits etc) last year, then metal pieces broken from a drain. This January she swallowed disposable razor blades...tonight she has swallowed "AA" size batteries - so they'll be x-raying her in the morning.

Don't know why she does it or how to help, and wondered if anyone else here has any knowledge of this bizarre behavior?

tired_mom

[IQU]

I don't have any suggestions but wanted to give you a  xoxo. You've been through so much.

[beachgirl]

Hi Tiredmom,

No I have no experiance with my S swallowing objects.  He does self harm by extinguishing cigarrettes on his inner arms (sometimes his arm looks like raw meat) and he once jumped off a 2 story stair well and scalped himself.

Swallowing objects as a way of self injury is rare but not unheard of.  If you read below, swallowing foreign objects is on the list of self injury in the following article:

SIB is the deliberate infliction of harm to oneself, either internally or externally, without suicidal intent.1 This behavior is also known as impulsive self-injury, non-suicidal self-injury, self-mutilation, cutting, and self-harm. Once reported primarily in adults with borderline personality disorder, SIB is becoming common among adolescents:

Among 663 teens in community-sample survey, 46% engaged in some form of SIB in the past year, and 28% engaged in serious, repetitive behaviors.2

13% to 23% of teenagers have engaged in SIB, according to literature review.3

Children as young as 9 have presented with SIB.

Not just cutting. Besides cutting, other methods of self-injury include:

burning

swallowing objects or substances

hitting oneself with the fist or against an object

cutting circulation to a digit

picking at skin

pulling out hair.

Adolescents with SIB frequently experience anger, and their self-harm can result from turning this anger inward because they are unable to express it toward others.

In another article I read, it also listed swallowing objects as a form or self abuse:

Self-harming behaviours can include:

cutting their skin with knives or any sharp object
burning their skin
hitting their body with an object or fists (like punching the wall)
deliberately falling when doing something like extreme sports
picking at their skin
swallowing sharp objects
pulling at their hair (hair pulling can also be a habit).

I don't know if this will be helpful to you or not, but I wanted to share it.  I have said this before, but you are amazing.  I can't imagine how stressful or painful it would be to have your child swallow random objects. (or wondering if, when and what they will swallow next) Your unwaivering support and concern for your D is inspiring.  My heart goes out to you AND your daughter, as she must be in such pain. Have you found this new RTC a good fit for your D?  I hope so.

BG

[GENERAL ANNOUNCEMENT]

GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[A.J. Mahari]

Self harm in those with BPD, while it serves many functions, for most has some element of attention-seeking to it. Now, this may not be something that many with BPD are aware of when they do self harm. But self harm, for the different reasons it is engaged in, used, and done, is in many ways about the borderline saying - through actions - "Look how much I hurt", "help me", "I can't take the pain", "I don't know who I am or how to cope" among many other things.

Self harm gives the borderline a sense of control when the reality is that emotionally they are out of control and unable to cope. The focus on physically self harming oneself does give the illusion of a type of pseudo-mastery if you will. A pseudo mastery that attempts to make up for what is the absence of emotional mastery or competence.

Self harm, for me, when I had BPD, was a way of converting my pain (a lot of which, back then I was clueless about) from the emotional where I had no competence to deal with it, face it or feel it, to the physical where I felt that I had some control over it.

Self harm, in many with BPD becomes an addiction of its own. I think even more than any physical or biological response to it or relief gained through it, the real addiction is in defending against the intra-psychic pain - the pain of the core wound of abandonment - abandonement trauma - that is experienced by those with BPD as being something that feels as if it will kill them if they touched it, acknowledged it or even felt a bit of it.

It is what I refer to as the "abandoned pain of BPD". It is the source of not only self harm but so much of the borderline defense mechanisms that definitely interfer with any and all attempts to relate.

Self harm is a cry for help while at the same time it is often self punishment. The cry for help comes from the reality of the abandonment trauma no matter how dissociated from. The self punishment essentially comes out of the shame of the core wound of abandonment. Borderlines have often learned to associate need with shame.

[ColAbb]

When I was in nursing school and did the psyche part, I was taught that cutting was attention seeking behavior.  They may do it for different reasons, but the bottome line was "hey look at me I need help." 

In a way I believe it, unless the person doing the cutting never shows or tells anyone.  If they seek help for it, it simply is attention seeking behavior.

[methinkso]

And doesnt' this also manifest for the same reasons as suicide attempts? I read moe than once that when a ubpd committs suicide it is by accident, aka not meaning to go so far.

I think that when this happens, it's not so much that they want to commit suicide, but that their twisted attempt for attention escalates because past attempt's did not get the results they sought.

[reneeth]

My exbdp said she cut to be able to feel...did it right in front of my once, after stopping at a 'few' bars on the way up to see me..
the scary part for me was she than turn the knife toward me and asked if I wanted her to cut me, see what it felt like scared the hell out of me, I fell to the floor crying and it never happen again. guess she showed me how to keep in line!

[united for now]

I remember reading somewhere that one of the problems with self harming is that while it can start out as a coping mechanism, it can quickly become addictive.
Pain releases a lot of chemicals in your mind as a response, and some of them feel pretty good. The feel good part is a sort of release after the initial sensation of pain.
They learn to look forward to the release. Sort of like a runners high?
Also, since they look for quick fixes to their emotional pain, they never learn to understand that all pain goes away eventually. No crisis lasts forever. If we hold out, things will begin to look better.
They don't develop normal coping mechanisms, and cutting becomes a crutch for them.

This is where DBT really comes into play to help them cope, since it teaches self soothing exercises.

[Grace]

My d cuts but she hides it - if she is hiding it from everyone, I can't think that she is looking for attention from anyone else.  She did tell me once that cutting made her feel "alive" and that it took away some of the pain she felt.  When she went away to school, she started getting all kinds of piercings and I kind of thought that it was tied into the self-harm behavior.  She WANTED people to see those piercings though.  And she continued cutting and wearing those long sleeves to cover the scars.

Grace

[geroldmodel]

Hey Grace,

Your 22 yr old daughters cutting and piercings are probably 2 seperate things, since she was diagnosed with both OCD & anxiety.
I do not think the piercings are a form of selfharm as a lot of young girls are wearing piercings to be seen and to rebel.

[kate30]

my uBPh did his "cutting" with food. He was a binge eater and quickly ballooned up to 275 pounds, then did the opposite when that wasn't having the same emotional affect and consumed no more than 300 calories a day while exercising 3+ hours a day running/bike/lifting and cut down to 180 within a few months. His ideal weight is about 210- totally looked emaciated at 180. Then when that wasn't working anymore he started binging/starving cycles staying around 240 then hit a low and went to 300. In less than a year he's now back down to 200 and still trying to cut more weight.

It's so hard to be proud of him and happy that he's lost weight because he's doing it for all the wrong reasons. I can tell him he looks great and he says no, he's still got a long way to go. I can ignore his efforts and he gets mad that he's worked so hard and I don't notice. I can't win!

I think each borderline has their own method of self harm. Cutting just seems to be the most noticible because it lands you in the ER. Extreme dieting won't.

[tired_mom]

Does anyone here have a BPD in their lives that has been successful in limiting or stopping their Self-Injurious Behavior? How long has it taken for them to overcome or minimize? Did therapy work (how long)? Medications? SIB has a severe grip on my 16yBPDd. I know these are NOT suicide attempts. Its like an addiction, and becoming more severe. Cutting and inserting metal into open wounds, swallowing sharp objects, etc on an almost daily basis, stitches etc. I know their are resources/sites for those that engage in SIB, but what should/can the non-BPD (me) do if anything to help her get over this?

Any suggestions of what has helped would be greatly appreciated.

tired_mom

[Bitzee]

Is your daughter not in therapy, tired-mom?

Dialectical Behavior Therapy (DBT) is designed specifically to treat BPD... and it most definitely addresses self-injury.  Teaching clients the skills of emotion regulation, distress tolerance, and mindfulness is a major focus of this therapy.  Reducing and eliminating self-injury is definitely a goal.  Self-injury is an ineffective attempt at coping, DBT teaches more effective behaviors.

[dados76]

i have asked my boyfriends therapist what he suggests for this. his suggestions were to listen if he is willing to talk at all and to be supportive. listen is very important. when he is feeling so bad that he is at 'that place' my opinions are not heard or helping. sometimes happy distractions are good: asking if he would like to play a game, or watch a movie or a show or do a puzzle or blow bubbles. Anything that is distracting and positive. we also have very many red pens and markers in our home. i usually cary one or two. those are a end resort for when other things do not work. if he does not hurt himself he tries to do something nice to himself as a reward. those are not really changing how he feels they are just a distraction to help him not hurt himself. the therapy he is in (DBT) has been helping him to deal better with feeling so that he does not find that point where he feels so badly.

[tammy]

My daughter engaged in frequent self injury as a teen... I read A Bright Red Scream: Self-Mutilation and the Language of Pain by Marilee Strong (it was at our local library and they definitely have it on Amazon).

That book was exactly what I needed to help me understand why she cut and burned herself. My daughter read it too and said it was an accurate depiction of what she felt. Honestly, read it...

[Bitzee]

Hi tired-mom,

I understand your daughter is going to begin DBT soon?  Hopefully you will receive a little coaching on how best to handle this problem.  I believe they think it's important not to re-enforce the cutting behavior itself with your attention, but I'm not sure exactly how that plays out.  I believe it's very important to re-enforce any attempts they make to avoid this behavior... such as coming to you first...  And for you to be Non-judgemental and Validating of their feelings when they do this.

I've seen other suggestions for cutting substitutes - besides the red pens dados mentioned.  The application of ice until it hurts, biting into hot chilis or a piece of ginger, cold showers or baths, applying dripping red food coloring to the skin, even Henna tattoos which form a crusty 'scab'.  The substitute varies with the reason for the cutting;  if it is to snap them out of dissociating, or if it is to punish themselves, etc.  I've also seen it suggested that they be encouraged to vent their anger on inanimate objects... tearing up phone books, slashing a cloth doll, things like that.  As well as 'acting the opposite' which I believe is the "happy distractions" approach dados mentioned.

I'm so sorry for this turmoil in your life, it must be beyond heart breaking for you to witness.  I hope all goes well with getting your daughter into the DBT program.  My best to you.

Bitzee

[tired_mom]

thank you all for your replies. To answers a few questions - my d has Major Depresive Disorder, PTSD, and BPD. She has been in DBT previously, and again currently while in yet another RTC. I have discussed this at length with her - she at times says she wants to stop, other times she adamantly says it will never stop, as she is comfortable with it. DBT doesn't seem to have much affect, maybe it will take years? I don't know. She admits it is an addiction and cannot seem or want to stop. Nothing motivates her to do so. Consequences do not seem have any affect either. She squirrels things away to have just for when she is in the need to cut (going so far as to hide them in her body), and if nothing is available, she will AWOL from the facility to find metal, glass, or whatever out in streets and gutters or go to a store to shoplift blades. She is on one-on-one staff, yet still manages to find things to use. it is no longer just cutting. Stabbing, punctures, swallowing items as well. Her body and arms are covered in kelatoid scars as she pulls stitches out and picks at the wounds. She will go days or on a couple of occasions a week or more with out SIB, then comes crashing back to daily activity and ER trips up to including hospitalizations because of the severity of this behavior.  Throwing ice, using ice, markers, rubberbands etc. don't work for her anymore. I just wish there was some miracle cure out there i don't know about yet that could get her to stop!

[tammy]

My 20 year self harms... she always has bandaids in her room... it has gotten less frequent but was off the charts when she was 16-17 years old. She was cutting and burning herself daily... she said it was because she felt worthless. Ultimately what toned it down was her then boyfriend and her made a pact; she'd quit self harming and he quit smoking... it worked for awhile but ultimately her need for whatever it is that doing this does for her returned...

I read "A Bright Red Scream: Self-Mutilation and the Language of Pain " and it changed how I addressed her self harming and it helped me understand a bit more where this was coming from.

Now she gets in physical altercations pretty often. She's a small girl 5' 4" and 115 lbs... yet she's been beaten up by 6'2" men and just about anyone else she can provoke... I'm not sure if this is a form of self harm or something else but she is covered in bruises, has had a broken arm... and it doesn't seem to deter her from getting in these situations repeatedly.

[serenityismine]

I was looking through some websites about self harm, and I found this definition:

"Perhaps the best definition of self-injury is found in Winchel and Stanley (1991), who define it as

...the commission of deliberate harm to one's own body. The injury is done to oneself, without the aid of another person, and the injury is severe enough for tissue damage (such as scarring) to result. Acts that are committed with conscious suicidal intent or are associated with sexual arousal are excluded. "

My question is this...

My husband bites his nails down past the quick, until they bleed.  His fingers are misshapened because of this, and his nails are grossly disfigured.  He cannot seem to stop, and I could tell by watching him, that he got an extreme release of anxiety when he'd make his fingers raw from this.
(He picks scabs, too)

Is this considered self injury?
 

[Skip]

Interesting question.  The pwBPD in my life (formerly) would do something like that to her one ear - compulsive picking - until it would bleed.