BEHAVIORS: Self injury and self harm

[BPDFamily.com]

my partner has a long history with self injury... that hes been working on and writing about...

*rubbing his hands on gravel to cut up his palms

*biting... mostly hands wrists arms... leaves bruises or has bitten through calluses... on his hands

*burning hands onhot metal... cars... slides... anything hot and metal...

*pushing a needle into his skin

*burning hand withcigarettesand lighter

*punching walls

*hitting his head... squeezing temples with hands

punching arms legs

*cutting... hands... arms legs

*he has a bunch of tattoos... so do i tho... dont know whichthat is

*is a recovering addict

... most of that stuff is a lot lot better with therapy... hasnt cut in a long time... most stuff is better...

[dados76]

my partner has a long history with self injury... that hes been working on and writing about...

*rubbing his hands on gravel to cut up his palms

*biting... mostly hands wrists arms... leaves bruises or has bitten through calluses... on his hands

*burning hands onhot metal... cars... slides... anything hot and metal...

*pushing a needle into his skin

*burning hand withcigarettesand lighter

*punching walls

*hitting his head... squeezing temples with hands

punching arms legs

*cutting... hands... arms legs

*he has a bunch of tattoos... so do i tho... dont know whichthat is

*is a recovering addict

... most of that stuff is a lot lot better with therapy... hasnt cut in a long time... most stuff is better...

[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).

[ennie]

Maybe this has already been said, but the DSM IV criteria distinguishes between self-injury and reckless behaviors like reckless driving, reckless sex, abuse of drugs and alcohol, and others.  I think that these are two different DSM criteria for borderling PD, but the link to the criteria is on this board somewhere... .I will post it another day when I am not almost late!

[shefiled]

I'm trying to understand the ROOT CAUSES OF A CUTTING EVENT in order to see what can be done to stop it. I can think of some basic reasons that might drive someone to do it:

1) TO GET ATTENTION - Either from one person or a group for "social emotional" needs.

2) TO EXERCISE CONTROL - To manipulate others to attain some desired outcome. More than just getting attention, it is a no-bluffing threat used as "blackmail"  or "control" tool.

3) TO ATTAIN A FEELING OF PEACE - Through some physiological mechanism, release of some "feel good" chemicals like the classic "runner's high" could result from either

a) Feeling pain or

b) Feeling the end of pain (slightly different).

Note a: A mix of the above stated reasons might exist.

Note b: BPD behavior seems to be extremely well devised but is not ususally a concious misdeed.

Someone who's been through this please help.

Thank you in advance.

Short and to-the-point answers for now please.

[truefriend]

okay short and to the point... .at times they feel numb... .they cut in order to feel something... .

[peacebaby]

People who self injure do it to try to gain control of their emotions by focusing the pain to one spot they can understand. They cannot control the emotional pain they are feeling, but they can choose to give themselves physical pain that they can control.

Your first two ideas of where cutting comes from show a lack of looking at it from the Cutter's side. Self-injury is not about other people. It's about the Self. A bad coping mechanism that MANY people have.

Peacebaby 

[dados76]

ok...

theres a lot of kinds of self injury... as a first thing... my partner has a really long history of a lot of kinds of injury that include cutting. burning... biting... punching... lots and lots of different things...

and ah... for him anyway... the first two are wrong. just... yeah... not like that... its not about other people...

the simplest way i think... that ive heard him put it... is that when something hurts him... he hurts himself... b/c he doesnt have tools  or he didnt have tools to deal with pain... some specific kinds of injury would come out when he was angry... and didnt know how to express it... other stuff... when he feels hurt or rejected or upset and doesnt know what else to do... and is looking for some hurt he can control... like peacebaby said... the point... for him wasnt to feel good... it was to hurt... even after he stopped cutting... if he had a ___ day... and there was a car out in the sun all day-- hed put his hands on it and hold them as long as possible... hit things and bruise his knuckles... elbows...

here:

I cut when I need to punish myself, or when I’m lacking any other sensation and feeling numb. I bite when things are too much, and I’m overwhelmed and angry, and I don’t have any other way of expressing it.

[DKC]

My BPD is not a cutter, although she has taken to self injury in the form of hitting her head on the headboard and beating her body just lately after 25 years together.

This link is to a friend of my kids who they went to school with. She has had a hard life, but is really a great kid. I think part of the reason that my oldest daughter is considering a career in psychology is she saw what a difference a good T could make in her life when she was in an inpatient setting one summer quite a few years ago.

Since I am anonymous and her site is an anonymous name on public poetry-writing site, I feel comfortable sharing it here. There IS some pretty dark stuff there, but she is really a gift writer in getting the emotion across too.

Hope it helps some of you get a better feel as to "why"

www.writers-network.com/index.cgi?m=1&do=work&who=1547

DKC

[shefiled]

I started this post to investigate the need for cutting and what I think I've learned so far is the very important point that it is done for THEM; some privare need of theirs rather than to get someone else's involvement.

With that in mind I think I got a small sense of it the other day. I was outside walking in the cold, no hat, and the wind started blowing. I had somewhere to go but was not in a hurry. I could have stopped along the way to go inside but instead I tried a "pain experiment".

I have a lot of intense "issues" in my life right now and instead of evading the cold wind, I surged forward in my walking with heightened ambition. The pain of the cold hurt but the sense of persistance to my cause became a reward in itself.

I can't actually imagine violating my body with cutting but maybe I did get some sense of the motivation.

[MyBigMouth]

I have a lot of intense "issues" in my life right now and instead of evading the cold wind, I surged forward in my walking with heightened ambition. The pain of the cold hurt but the sense of persistance to my cause became a reward in itself.

As a former cutter, when I was 16-18 I am now 40, I can tell you that the pain on the inside was so bad, I had no one who understood or any way that I could get it out.  There were no words at that time, so I cut. The pain from cutting released endorphines, then the red from the blood made me see the pain was more than just emotions, more than just in my head, it was real. It wasn't that I was crazy any more because it was right there for me to see.  I never showed anyone.  I never told a soul.  Until my daughter started doing it too.  She cut because she was numb on the inside from being abused as a child. I was full of pain.  She couldn't feel at all.

You felt the pain of the cold chill made you concentrate less on the intense feelings mabe or mabe it made you "push" through it as an athlete pushes through the pain to get to the next hurdle.  Cutting is in no way a comparison of the heroics an athlete performs. It's another addiction.

[united for now]

Cutting normally begins to occur in the teenage years and peeks in the early 20's, with most people stopping in their 30's. The estimates are that about 2 million people have engaged in some form of self harm to cope with their emotions at least once in their life.

When we find out that our loved one has self harmed or self injured themselves, we often experience shock, anger, frustration, and guilt.  

* Our shock may lead us to judge them as doing something "wrong" or "bad".

* Our anger may erupt because we feel "manipulated" and that it is "unnecessary".

* You may feel guilty for not "being there for them",  for not "helping them enough", or for not being a "good enough parent".

You will find yourself filled with questions - "how could you?" - "Why did you do this to yourself?" - "what's wrong with you?" - "you're doing this to manipulate me" - "you're not who I thought you were" - and the biggest question of all "what should I do or say?

* ":)o" discuss this with them. Self injury flourishes in secrecy, since it is typically performed when the person is alone and feeling overwhelmed by their emotions. Trying to ignore it or control it (which you can't anyway) only sends the signal that you don't care about their emotions or feelings. It diminishes them even more and adds to their shame and poor self esteem. This will be tough to do, but don't judge them. Stay neutral and calm and away from negative comments. Maybe ask some nonjudgmental questions, such as:

   * "How long have you been hurting yourself?"

   * "Why do you hurt yourself?"

   * "How do you hurt yourself?"

   * "When and where do you usually hurt yourself?"

   * "How often do you injure yourself?"

   * "How did you learn to hurt yourself?"

   * "What is it like for you to talk with me about hurting yourself?"

   * ":)oes it hurt when you injure yourself?"

   * "How open are you about your self-injurious behaviors?"

   * ":)o you want to change your SI behaviors?"

   * "How can I help you with your SI?"

* Be available. This means that you offer to discuss their need to self injury at any time, within reason (ex: not in the middle of the night or during your work day or if you feel threatened and manipulated). You are offering to be their support person so that they don't have to engage in self injury to cope with their emotional pain.

* Help them find other sources. Make suggestions for them to talk with a therapist or to join an online support group. Offer to help them surf the internet for available resources, since the more support and understanding they receive, the less shame they will feel and the better the odds that they will learn to control and stop it before it starts.

* Don't discourage self injury. The emotional pain that someone feels that drives them to hurt themselves is so overwhelming, that to offer the advice "just don't do it" trivializes and mocks the pain they are in. It will damage your relationship with them and reduce their desire to seek your support and create further shame inside of them. For some, engaging in self injury is the only alternative they see besides ending their painful life.

* Don't push. Now if they don't appear to want to discuss this with you - don't push them to. Insisting that they do only further damages the relationship and trust between you.


The fact that they are hurting themselves isn't a reflection on you - it is a signal that your loved one is in extreme emotional pain and that they need to find a release for it. They aren't deliberately trying to manipulate you. This isn't a game they play to control you. It is a severe and unhealthy coping mechanism for them.

Accepting them isn't the same as condoning what they have done. Try to connect with the fact that they are hurting, and offer them empathy and sympathy based on that. Judgments and negative criticism will only make it worse... .

Our job is to offer nonjudgmental support and acceptance of them - as hard as that seems, it is nothing compared to the shame they feel inside themselves.

Threats to self harm and how to care for ourselves

If they are making threats to self harm to stop you (for example: to stop you from going somewhere) or in an attempt to control you - this "can be" an attempt at manipulation. We can't allow ourselves to be manipulated in this fashion. Your response should be to offer them healthier options while also not being controlled by their threats. Don't give in to this and think that by staying and talking to them more, that you are helping them. You are giving them the green light to threaten you every time they want to get their way. In this form of crisis, we can't allow them to emotionally blackmail us, since that only guarantees that they will do it again (threaten us) as a way to control us. It doesn't mean that they won't hurt themselves, since they probably will "to show what you made them do to themselves",. It means that while our loved one is a lot of emotional pain, we still can't allow them to control us in this unhealthy fashion.

~ We can't lose our own sense of self trying to save them. We can't allow their pain to dictate whether we go out bowling or to see family members or to work. We can't stop living our lives because of their pain.

references: www.self-injury.net/

[united for now]

My son learned to use SI from his then gf. He sliced up his arms with so many scratches that his scars will be permanent. To make matters worse, he then added tattoos on his wrist to supposedly remind him not to cut anymore. The left wrist reads "final" and the right wrist reads "cut". They didn't help, since he admitted to me last month that he cut himself again  :'(

Honestly, I didn't know how to respond at the time.

I challenged him and questioned why he needed to do that.

If there is a next time, i will know better how to respond... .

[lbjnltx]

my BPD13 started cutting in sept. of 08.  only superficial but the scars are still visible.  she also burned and scraped herself as well as pulled her hair out right in front of me once.  

she  learned about cutting from her bi polar cousin.  last summer, in the midst of a calm rage (if you know what i mean), she tried to burn herself in my presence.  she had also been having suicidal thoughts (what it would be like to die, how it would happen).  i made the decision to put her into an acute care facility as i was afraid she would attempt to hurt herself permanently!  she was there 2 weeks and was put on Prozac and Abilify for depression and mood stability.  she is still on those meds 7 months later and has had NO s i incidents and is no longer depressed.  i'm still paying the hospital bill but am thankful for the improvements that she has made...

gotta love those meds ... . now she has a more even playing field for her therapy (DBT now!) to be affective.

lbjnltx

[MyBigMouth]

I have to agree with the plan here that UFN posted. My daughter had a chart that her therapy team made for her, a safety plan of what to do when she felt like cutting, distractions she could use. She refused to talk to me ever about it, and I didn't pressure her, I did tell her I was worried about her. Honestly I did feel like a failure as a mother especially since I myself had gone through some cutting at 17 for about a year. I felt like I knew what she was going through and tried to talk with her the way I wish anyone would have spoke to me, but she was in different place than me. She was numb to feelings and for me it was a way to let the pain out and not hold it in. I just kept trying to be supportive of her and kept telling her how much I loved her and tried not to focus on her just cutting, but I did take away any thing she could use to cut with, but she found things, little broken pieces of hard plastic, broke off pieces of the hospital's formica and used it too, disasembled part of a pocket pencil sharpener and took the blade out.  Mine finally stopped at the RTC, she would be supervised during bathroom, shower, etc, 24/7, and wear an orange jumpsuite, she worked on DBT skills, etc.  She has no desire now and is still using her plan it's on her wall today.

[oceanheart]

Children show scars like medals. Lovers use them as secrets to reveal. A scar is what happens when the word is made flesh.

—Leonard Cohen

From this interesting blog from "shadowlight".

After I finally stopped allowing myself to use cutting as a coping technique, I seriously toyed with the idea of getting the following 2 latin phrases tattooed on my wrists: Vincit omnia veritas (truth conquers all) and Sub specie aeternitatis (under the aspect of eternity). They would be reminders not to cut, to honor a promise I made to myself NOT to kill myself, and as a commitment to heal.

Here's a really good website form I used in the past when I was still struggling with wanting to cut:

Assessing your immediate need to self-injure.

It "talked me down from the ledge" many times. I self-injured because it acted like a light-switch, turning off the too-painful feelings of emotional pain. Physical pain is manageable and controllable: I'm in charge. Recently I've been struggling with the urge again after years of not cutting. But I'm working with my T on that. I find I think about it more when I'm not using my healthy coping mechanisms (proper sleep, nutrition, exercise, healthy relationships).

 to all the people who are struggling when their loved one SI's. It was really hard for my mom, I know.

[hell0kitty]

The BPD in my world suffers from Dermatillomania. I was just wondering how common this was here. I see that BPD is mentioned along with OCD in many write ups about the disorder. They liken it to cutting and self harm. Anyone else dealing with this? Is it something that the kids might mimic later?

Here is a link about it if you are unfamiliar:

www.psychology.wikia.com/wiki/Dermatillomania

[happylogist]

I have a question regarding self - harm. I have a close friend who is diagnosed BPD and she harms herself with a needle. I understand her behavior, since this is for her a way to numb her pain and distract herself from the obsessive dark thoughts.

However, my ex uBPD was never hurt himself in any of those classic ways (cutting, burning).   He plays soccer and he enjoys falling down, hurting his body.  He took some kind of pride in it, and always was proud to show his wounds, which very pretty impressive for an amateur playing once a week with other pals.   Interestingly he always claimed that he played with more devotion than others did and he did not mind the hurts, actually even liked them.

So would you consider this as a self-harm or it is a rather accident-prone behavior, or just a risky behavior because of the desire to get some adrenaline?

[Clearmind]

self harm is only one criteria of the nine to be diagnosed BPD. To be diagnosed a person needs to meet five.

I would consider it a guy who likes to play sport. My ex didn't self harm.

[Skip]

So would you consider this as a self-harm or it is a rather accident-prone behavior, or just a risky behavior because of the desire to get some adrenaline?

1. accident-prone behavior

2. risky behavior

3. macho - showing aggressive pride in one's masculinity

Could it simply be #3

Interestingly he always claimed that he played with more devotion than others did and he did not mind the hurts, actually even liked them.

This may be the best clue - pride.  Most people that self harm are not seeking pride.

Is there any reason to think he was not being truthful?

[BPDFamily]

The website appears to have gone off the air... .

Here is the information that was on that cited page:

This section contains a variety of ways that you can stop yourself from making that cut or burn or bruise right now.

Am I ready to stop?
How do I start stopping?
What to do RIGHT NOW instead of SI
What if I do all this and I still want to harm?
"Fake" pain -- Understanding the urge
DBT skills
More suggestions
BCSW
S.A.F.E.
First Aid
Dealing with intrusive thoughts after stopping

How do I know if I'm ready to stop?
Deciding to stop self-injury is a very personal decision. You may have to consider it for a long time before you decide that you're ready to commit to a life without scars and bruises. Don't be discouraged if you conclude the time isn't right for you to stop yet; you can still exert more control over your self-injury by choosing when and how much you harm yourself, by setting limits for your self-harm, and by taking responsibility for it. If you choose to do this, you should take care to remain safe when harming yourself: don't share cutting implements and know basic first aid for treating your injuries.

Alderman (1997) suggests this useful checklist of things to ask yourself before you begin walking away from self-harm. It isn't necessary that you be able to answer all of the questions "yes," but the more of these things you can set up for yourself, the easier it will be to stop hurting yourself.

    While it is not necessary that you meet all of these criteria before stopping SIV, the more of these statements that are true for you before you decide to stop this behavior, the better.

        I have a solid emotional support system of friends, family, and/or professionals that I can use if I feel like hurting myself.
        There are at least two people in my life that I can call if I want to hurt myself.
        I feel at least somewhat comfortable talking about SIV with three different people.
        I have a list of at least ten things I can do instead of hurting myself.
        I have a place to go if I need to leave my house so as not to hurt myself.
        I feel confident that I could get rid of all the things that I might be likely to use to hurt myself.
        I have told at least two other people that I am going to stop hurting myself.
        I am willing to feel uncomfortable, scared, and frustrated.
        I feel confident that I can endure thinking about hurting myself without having to actually do so.
        I want to stop hurting myself.

    [Alderman (1997) p. 132]

How do I stop?
And anyway, aren't some of these techniques just as "bad" as SI?
There are several different flat-out-crisis-in-the-moment strategies typically suggested. My favorite is doing anything that isn't SI and produces intense sensation: squeezing ice, taking a cold bath or hot or cold shower, biting into something strongly flavored (hot peppers, ginger root, unpeeled lemon/lime/grapefruit), rubbing Ben-Gay® or Icy-Hot® or Vap-O-Rub® under your nose, sex, etc. Matching reactions and feelings is extremely useful.

These strategies work because the intense emotions that provoke SI are transient; they come and go like waves, and if you can stay upright through one, you get some breathing room before the next (and you strengthen your muscles). The more waves you tolerate without falling over, the stronger you become.

But, the question arises, aren't these things equivalent to punishing yourself by cutting or burning or hitting or whatever? The key difference is that they don't produce lasting results. If you squeeze a handful of ice until it melts or stick a couple of fingers into some ice cream for a few minutes, it'll hurt like (to quote someone I respect) "a cast-iron bhit" but it won't leave scars. It won't leave anything you'll have to explain away later. You most likely won't feel guilty after -- a little foolish, maybe, and kinda proud that you weathered a crisis without SI, but not guilty.

This kind of distraction isn't intended to cure the roots of your self-injury; you can't run a marathon when you're too tired to cross the room. These techniques serve, rather, to help you get through an intense moment of badness without making things worse for yourself in the long run. They're training wheels, and they teach you that you can get through a crisis without hurting yourself. You will refine them, even devise more productive coping mechanisms, later, as the urge to self-injure lessens and loses the hold it has on your life. Use these interim methods to demonstrate to yourself that you can cope with distress without permanently injuring your body. Every time you do you score another point and you make SI that much less likely next time you're in crisis.

Your first task when you've decided to stop is to break the cycle, to force yourself to try new coping mechanisms. And you do have to force yourself to do this; it doesn't just come. You can't theorize about new coping techniques until one day they're all in place and your life is changed. You have to work, to struggle, to make yourself do different things. When you pick up that knife or that lighter or get ready to hit that wall, you have to make a conscious decision to do something else. At first, the something else will be a gut-level primitive, maybe even punishing thing, and that's okay -- the important thing is that you made the decision, you chose to do something else. Even if you don't make that decision the next time, nothing can take away that moment of mastery, of having decided that you were not going to do it that time. If you choose to hurt yourself in the next crisis time, you will know that it is a choice, which implies the existence of alternative choices. It takes the helplessness out of the equation.

So what do I do instead?
Many people try substitute activities as described above and report that sometimes they work, sometimes not. One way to increase the chances of a distraction/substitution helping calm the urge to harm is to match what you do to how you are feeling at the moment.

First, take a few moments and look behind the urge. What are you feeling? Are you angry? Frustrated? Restless? Sad? Craving the feeling of SI? Depersonalized and unreal or numb? Unfocused?

Next, match the activity to the feeling. A few examples:

angry, frustrated, restless
    Try something physical and violent, something not directed at a living thing:
    Slash an empty plastic soda bottle or a piece of heavy cardboard or an old shirt or sock.
    Make a soft cloth doll to represent the things you are angry at. Cut and tear it instead of yourself.
    Flatten aluminum cans for recycling, seeing how fast you can go.
    Hit a punching bag.
    Use a pillow to hit a wall, pillow-fight style.
    Rip up an old newspaper or phone book.
    On a sketch or photo of yourself, mark in red ink what you want to do. Cut and tear the picture.
    Make Play-Doh or Sculpey or other clay models and cut or smash them.
    Throw ice into the bathtub or against a brick wall hard enough to shatter it.
    Break sticks.
    I've found that these things work even better if I rant at the thing I am cutting/tearing/hitting. I start out slowly, explaining why I am hurt and angry, but sometimes end up swearing and crying and yelling. It helps a lot to vent like that.
    Crank up the music and dance.
    Clean your room (or your whole house).
    Go for a walk/jog/run.
    Stomp around in heavy shoes.
    Play handball or tennis.
sad, soft, melancholy, depressed, unhappy
    Do something slow and soothing, like taking a hot bath with bath oil or bubbles, curling up under a comforter with hot cocoa and a good book, babying yourself somehow. Do whatever makes you feel taken care of and comforted. Light sweet-smelling incense. Listen to soothing music. Smooth nice body lotion into the parts or yourself you want to hurt. Call a friend and just talk about things that you like. Make a tray of special treats and tuck yourself into bed with it and watch TV or read. Visit a friend.
craving sensation, feeling depersonalized, dissociating, feeling unreal
    Do something that creates a sharp physical sensation:
    Squeeze ice hard (this really hurts). (Note: putting ice on a spot you want to burn gives you a strong painful sensation and leaves a red mark afterward, kind of like burning would.)
    Put a finger into a frozen food (like ice cream) for a minute.
    Bite into a hot pepper or chew a piece of ginger root.
    Rub liniment under your nose.
    Slap a tabletop hard.
    Snap your wrist with a rubber band.
    Take a cold bath.
    Stomp your feet on the ground.
    Focus on how it feels to breathe. Notice the way your chest and stomach move with each breath.
    [NOTE: Some people report that being online while dissociating increases their sense of unreality; be cautious about logging on in a dissociative state until you know how it affects you.]
wanting focus
    Do a task (a computer game like tetris or minesweeper, writing a computer program, needlework, etc) that is exacting and requires focus and concentration.
    Eat a raisin mindfully. Pick it up, noticing how it feels in your hand. Look at it carefully; see the asymmetries and think about the changes the grape went through. Roll the raisin in your fingers and notice the texture; try to describe it. Bring the raisin up to your mouth, paying attention to how it feels to move your hand that way. Smell the raisin; what does it remind you of? How does a raisin smell? Notice that you're beginning to salivate, and see how that feels. Open your mouth and put the raisin in, taking time to think about how the raisin feels to your tongue. Chew slowly, noticing how the texture and even the taste of the raisin change as you chew it. Are there little seeds or stems? How is the inside different from the outside? Finally, swallow.
    Choose an object in the room. Examine it carefully and then write as detailed a description of it as you can. Include everything: size, weight, texture, shape, color, possible uses, feel, etc.
    Choose a random object, like a paper clip, and try to list 30 different uses for it.
    Pick a subject and research it on the web.
    Try some of the games and distractions at digibeet's page; she's assembled a lot of distractions.
wanting to see blood
    Draw on yourself with a red felt-tip pen.
    Take a small bottle of liquid red food coloring and warm it slightly by dropping it into a cup of hot water for a few minutes. Uncap the bottle and press its tip against the place you want to cut. Draw the bottle in a cutting motion while squeezing it slightly to let the food color trickle out.
    Draw on the areas you want to cut using ice that you've made by dropping six or seven drops of red food color into each of the ice-cube tray wells.
    Paint yourself with red tempera paint.
wanting to see scars or pick scabs
    Get a henna tattoo kit. You put the henna on as a paste and leave it overnight; the next day you can pick it off as you would a scab and it leaves an orange-red mark behind.

Another thing that helps sometimes is the fifteen-minute game. Tell yourself that if you still want to harm yourself in 15 minutes, you can. When the time is up, see if you can go another 15. I've been able to get through a whole night that way before.

I tried all of that. I still want to hurt myself.
Sometimes you will make a good-faith effort to keep from harming yourself but nothing seems to work. You've slashed a bottle, your hand is numb from the ice, and the urge is still twisting you into knots. You feel that if you don't harm yourself, you'll explode. What now?

Get out the questions Kharre asks. It's a good idea to have several copies of these printed out and ready to use; you can also answer them online; your responses will be mailed privately to you and no one will see them except you.

Answer these as honestly and in as much detail as you are able to right now. No one is going to see the answers except you, and lying to yourself is pretty pointless. If, in all honesty, you see no other answer to #8 but yes, then give yourself permission, but set definite limits. Do not allow the urge to control you; if you choose to give in to it, then choose it. Decide beforehand exactly what you will allow yourself to do and how much is enough, and stick to those limits. Keep yourself as safe as you can while injuring yourself, and take responsibility for the injury.

The questions (for more explanation, see kharre's post on the subject):

    Why do I feel I need to hurt myself? What has brought me to this point?
    Have I been here before? What did I do to deal with it? How did I feel then?
    What I have done to ease this discomfort so far? What else can I do that won't hurt me?
    How do I feel right now?
    How will I feel when I am hurting myself?
    How will I feel after hurting myself? How will I feel tomorrow morning?
    Can I avoid this stressor, or deal with it better in the future?
    Do I need to hurt myself?

Staying safe while hurting yourself
A few things to keep in mind should you decide that you do need to hurt yourself:

    Don't share cutting implements with anyone; you can get the same diseases (hepatitis, AIDS, etc) addicts get from sharing needles.
    Try to keep cuts shallow. Keep first aid supplies on hand and know what to do in the case of emergencies.
    Do only the minimum required to ease your distress. Set limits. Decide how much you are going to allow yourself to do (how many cuts/burns/bruises, how deep/severe, how long you will allow yourself to engage in SI), keep within those boundaries, and clean up and bandage yourself later. If you can manage that much, then at least you will be exerting some control over your SI.

What is "fake pain" and why does it matter?
The concept of "fake pain" helps to explain why distress-tolerance skills are so crucial.

Observation of myself and interviews with others have convinced me that one of the reasons people self-injure is to deflect unknown, frightening pain into understandable, sort-of-controllable "pseudo" or "fake" pain. Calling this phenomenon "fake pain" is in no way intended to suggest that it doesn't hurt; it hurts like hell. When memories or thoughts or beliefs or events are excessively painful, instead of facing them directly and feeling "genuine" pain, we sometimes deflect distress into pain that seems understandable and controllable, like that of self-injury. The real feelings associated with the event you're avoiding get overridden by those of the situation you create to distract yourself. It still hurts like hell, but it's a controllable familiar hell, whereas the real pain you're avoiding seems scary and poised to take over your world like the monster who ate Detroit.

It's easy to revert to "fake" pain. Trying to find the source of your distress can be scary as hell, because you often don't know what you're going to unleash. Fake pain, although very painful and traumatic, is something that you understand and can control and can handle. It's familiar, not mysterious and scary like the real pain behind it. You might feel that if you ever exposed yourself to the real pain you'd lose control: "If I ever start crying, I'll never stop" or "If I let myself get mad about that, I'll never stop screaming."

Instead, you unconsciously deflect the distress away from the memories or feelings that generated it and into self-injury. SI is seductive: you control it. You know the boundaries, even when you feel out of control. It makes sense and it makes the distress go away, at least for a while. It's a clever mechanism -- it takes what seems unbearable and transforms it into something you can control. The only problem is that when you deflect pain, you never face up directly to what it is that has caused this much tumult in your life. So long as you channel distress into fake pain, you never deal with the real pain and it never lessens in intensity. It keeps coming back and you have to keep cutting.

You have to deal with the unbearable if you ever want to make it lose its power over you. Every time you can meet the real pain head-on and feel it and tolerate the distress, it loses a little of its ability to wipe you out and eventually it becomes just a memory. The process is like building tolerance to a drug. Narcotics users take a little bit more of their drug every day as tolerance builds, until eventually they're routinely taking amounts of drug that would kill an ordinary person. The poisonous events in your past work in a similar way. Exposure (with the help of a trained therapist) over time will build your tolerance to these events and enable you to lay them to rest. The key is learning to tolerate distress.

DBT-related skills
Marsha Linehan's Skills Training Manual has several helpful worksheets for getting through crisis situations. Though they are best used as part of a DBT program with a trained therapist, you might find some of them helpful.

Accepting Reality
    This concept focuses on learning to accept reality as it is. Accepting it doesn't mean you like it or are willing to allow it to continue unchanged; it means realizing that the basic facts of the situation are even if they aren't what you'd like them to be. Without this kind of radical acceptance, change isn't possible.
Letting Go of Emotional Suffering
    In this worksheet, you learn ways to observe and describe your emotion, separate yourself from it, and let go of it. One of Linehan's basic principles is that emotion loves emotion, and this worksheet is designed to help you experience your emotions with amplifying them or get caught in a feedback loop.
Distraction
    Distraction is simply doing other things to keep yourself from self-harming. Most of the techniques mentioned above are distraction techniques; you bring something else in to change the feeling. Using ice, rubber bands, etc, is substituting other intense feelings for the self-injury. Other things Linehan suggest substituting include experiences that change your current feelings, tasks (like counting the colors you can see in your immediate environment) that don't require much effort but do take a great deal of concentration, and volunteer work.
Improve the Moment
    This worksheet focuses on ways to make the present moment more bearable. It differs from distraction in that it's not just a diverting of the mind but a complete change of attitude in the moment.
Evaluating the Pros and Cons of Tolerating Distress
    As the name implies, this worksheet leads you through an evaluation: what are the benefits of doing this self-harming thing? What are the benefits of not doing it? What are the bad things about doing it? About not doing it? Sometimes writing this down can help you make a decision not to harm.
Self-Soothing
    This, like improving the moment and distracting, is a distress tolerance technique. It's pretty straightforward: use things that are pleasing to your senses to soothe yourself. Some people find that active distraction works better for violent angry feelings and soothing is more effective for soft, sad ones.
Reducing Vulnerability to Negative Emotion
    Prevention of states in which you are likely to self-harm is covered in this worksheet, which suggests ways of taking care of yourself in order to minimize the times when you feel the urge to hurt yourself. If you're balancing eating, sleeping, and self-care, you're less likely to be overwhelmed by emotion.
Interpersonal Effectiveness
    Being clear about what you want and about your priorities in an interaction are crucial to good communication, and this worksheet offers a series of questions and steps to follow to help you determine how to approach a difficult interpersonal interaction. It is truly amazing how much going through these steps can help.

More information about Dialectical Behavioral Therapy can be found at DBT-Seattle.

Individuals' suggestions for self help
Kharre, a subscriber to the bodies-under-siege list, compiled an excellent list of ways to cope with si. She covers topics such as:
Questions to ask before you hurt yourself
Realistic acceptance
A letter to my SI
Things to help you through the bad times
Important tips for those who interact with someone who SI's

Kirsti, who has assembled an incredible page on self-injury, dissociation, and abuse, has some very useful coping ideas.

An anonymous poster, an22340@anon.penet.fi, put together a great deal of information about self-injury. Included was this useful list of things to do. It contains suggestions both for self-injurers and for their friends and loved ones. I've added a few of my own, noting them with [brackets].

A shorter list of 12 things you can do to try to climb out of a mild to moderate depression or urge to cut can be found here.

Another bus member, Tammy Bucklew, adapted these suggestions for families and friends of abuse survivors from Kubetin and Mallory (1992).

You may at some point want to find professional help for this problem. I've collected sources in the USA, UK, Canada, and Australia. If you know of people or organizations I've left out, contact me.

There is also a DBT skills discussion list. To subscribe, send mail to the listowner (Kieu) at busserv@u.washington.edu explaining your background and why you'd like to be on the list. It's intended to be a place to share experiences and get support while using DBT skills.

Bristol Crisis Service for Women
Bristol Crisis Service for Women is the leading UK (and as far as I know, European) support organization for women who self-harm. They offer a confidential help line, publications for self-harmers and for professionals, and other services. They're empathetic, dedicated and a valuable resource for women in the UK and Europe. Check out their Women and Self-Injury leaflet.

S.A.F.E.
In 1984 Karen Conterio (then of Hartgrove) established a support group for self-injurers called SAFE (Self-Abuse Finally Ends). SAFE groups were not like 12-step groups or most self-help groups; they were short-term groups run by a professional facilitator. SAFE no longer offers these groups, but they do have a 30-day inpatient program; more details are on the resources page. SAFE operates on the belief that the underlying emotional conflict is the primary problem, not the self-injury. More information about SAFE can be obtained at 1-800-DONTCUT.

First-Aid Basics
If you've already injured yourself and need to know how to care for the wounds, this list of first-aid basics might be helpful.

I stopped a few weeks ago, but I keep obsessing about hurting myself. Help?
It's not uncommon for people to continue thinking obsessively about self-injury for a while after they've made the decision to stop. Hurting yourself has been a huge part of your life up until recently, and you're used to dwelling on it. You might think that you're supposed to be "cured" now and that all thoughts of SI should magically vanish from your head, so when you catch yourself thinking about that blade or lighter or whatever, you get angry and frustrated and shove the thought away.

Foa and Wilson (1991) deal with intrusive thoughts by a combination of giving yourself permission to think about it and exposure/habituation techniques combined with ritual prevention. Exposure refers to repeatedly presenting someone with the situation about which they obsess, and habituation happens when, after much exposure without resulting to usual actions, the person gets used to the situation and it no longer distresses them.

To adapt these techniques, first make yourself safe. If you're in a mind-set in which self-injury seems very very likely, it might be better to use distraction techniques to get past that place. Line up a support person whom you can call if you get overwhelmed by this technique. Try to tolerate it for as long as you can, even if you're uncomfortable.

First, designate two 10- or 15-minute time periods daily. Choose times when you will be alone and able to think without being interrupted. To begin, set a timer for the designated amount of time. Then obsess about hurting yourself. Think about what it would feel like, how you would feel afterwards, how much you want to do this -- all those thoughts you've been trying to suppress. Get as distressed as you can, and stay focused on the topic of injuring yourself. You may find, especially after the first few times, that you get really bored toward the end of your time period. That's a good sign -- you're becoming habituated.

When the time is up, stop thinking about SI. If thoughts of wanting to harm come into your mind at other times during the day, acknowledge them and remind yourself that you will think about them later, when it's time. Then let them go. If they come back, repeat the process. Don't shove them away or try to ignore them; just acknowledge, remind yourself they have their time soon, and let go.

After a week or so you will notice an improvement (maybe even after just a few days). One crucial thing: no matter what, do not act on the thoughts of SI. They are just thoughts, and you can use the skills that you used to stop harming to get through these times. In order for habituation to occur, you have to get through the exposure without resorting to the old behavior. Use distraction and substitution for SI (ritual) prevention.