Don't know how to respond to self harming

[Rockieplace]

My BPDd33 has been self-harming by cutting since going into crisis, the last event happening only last week. It appears that the mental health professionals believe that the way to react is to downplay such acts by using such vocabulary as blips and wobbles. Maybe it is easy for them to do as they have no emotional attachment to their patients

I find it extremely difficult to treat it in this way. In fact I struggle not to howl in anguish when my d tells me what she has done. I managed - just - to stay calm and not make things worse last time.

However my d told me today that she would not be meeting her friend as planned because her friend was in hospital. I asked why she was in hospital and my d (who seemed more concerned about not being able to meet up as she was looking forward to it) said it was due to said friend having cut her wrists but that it obviously wasn't serious and just impulsive as they were only keeping her in hospital for a few days! 

Now I just haven't got a clue how to respond to this. I know my d will tune in to any delay on my part and don't want to put my foot in it.

Any advice on suitable responses to self-harming like this would be very welcome. Thanks in advance.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[lbjnltx]

She is meeting a need through self injury.  What need is she trying to meet?

In Understanding and Treating Borderline Personality Disorder - A Guide for Professionals and Families, Gunderson presented survey information on why patients participate in self-injury:

--------- 59% 49% 39% 22% 22% 20% 17% 15%

------------------------------------------------------------------------------------ to feel concrete pain instead of overwhelming emotional pain to inflict self-punishment to reduce anxiety and feeling of despair to feel in control to express anger to feel something when numb or out of touch to seek help from others and to keep bad memories away

Cutting releases endorphins known as endogenous opioids.  Endogenous opioids are well known for their role in alcohol addiction. Alcohol (ethanol) exerts numerous pharmacological effects through its interaction with various neurotransmitters and neuromodulators. Among the latter, the endogenous opioids play a key role in the rewarding (or addictive) properties of alcohol .

 

We want to be careful in how we respond (not react) to self injury.  Has your d discussed with a therapist how self injury serves her?  Replacing the maladaptive coping skill of si with a higher level coping skill can be a  goal.  My d revealed in RTC that there was a level of addiction to cutting for her.

We don't want to "reward" si with emotional outbursts of our own, we want to avoid shaming them nor do we want to respond in ways that seem like it doesn't matter.  It is a balance.

There is an active topic on the Improving Board that you may find interesting: 

How do I deal with self harm?

Working openly and honestly with a t to identify what need cutting meets for your daughter would be beneficial.

lbj

[Rockieplace]

Thanks for this. I'm not sure I can answer what need she is trying to meet and I'm not sure that she knows either.  She may have discussed this with others but I am not privy to these discussions.

From my observations and experience of the timings of these events though, which I only hear about afterwards, they seem to be done to express anger at others. This last time for example followed her expressing her anger at her care coordinator who she said was making her ill.  She seems to be saying "look what you/she made me do".

I don't believe hers are actual suicide attempts though. She always calls for emergency services immediately after she has done something and has told me that, immediately upon doing something, she panics and feels so ashamed.

My greatest fear is that she may suicide 'by accident'. I have spoken to her about this and she admits that she has very nearly died a couple of times as she has taken lots of tablets at the same time on these occasions.

Last time I managed to stay calm but asked her for a few minutes 'time out' - we were on the phone. She got quite angry but I told her I would call her back in a few minutes and that I loved her. This seemed OK. I was able to collect my thoughts, had a cry, talk to my h.

I wonder, in relation to her friend, if it comes up, it might be appropriate to ask some question about her motives and consequences on her life (this f has a job) so that we can maybe raise these sorts of issues without it being specifically about my d.

[Agape76]

Hi,

My 21 yr old daughter also self harms (cuts) when she is having a severe 'emotional storm'. I'm certain I haven't always responded in the best way, whatever that is, as I've often felt angry, sad, frustrated, and also a sense of 'here we go again', which probably makes me sound awful! I've always managed to stay calm with her and usually, eventually, she has calmed down enough for us to talk. Often she just wants cuddles and for me to affirm and reassure her... .she's adopted and very insecure. It was worse when she was in active alcohol addiction, far better since she's been sober. She's also made many suicide attempts (pills), another way of self-harming, to which I've pretty much responded the same way. I know with her it's a way of dealing with a tidal wave of painful memories and feelings.

Although I've stayed calm with her, my own emotions have come out with my other children sadly and my husband. We're all doing pretty well but it's sad the impact my daughters illness has on our family... .I feel hopeful reading articles and posts on this website though and I hope you find the answers you need. I especially like your idea about chatting to your d about her f, going through something similar :-)

[Rockieplace]

Yes thank you for that. I struggle to even think about it let alone talk about it where my d is concerned. I feel a little more confident about discussing someone else's self-harming and asking questions so may try it if it comes up again in conversation

My d often tries to make me look at her wounds though which I resist. She says she is very ashamed and very self-conscious about the results of her self-harming but then wants to show us what she has done. Another paradox amongst many! 

[wendydarling]

Hi Rockieplace     well done for keeping calm and asking for time out from your conversation to collect your thoughts and feelings. Respond rather than react as lbj says - sometimes I just can not respond, I freeze on the spot, like an animal caught in headlights. My daughter cuts (over 10 years) she does not show me her wounds, that is so very hard for you, I would resist too. I hope you are able to have some you time, I know how difficult that is when your daughter is in crisis. It's taken me two months to start and recover, to start to feel me, feel calm. 

When I look at the reasons listed as to what need I guess my daughter is trying to meet I could tick almost all of them.   Of course the reality may not be the case.

Agape76, I'm glad your daughter is far better since she has been sober, my daughter is much better too and attends weekly meetings. She has recognised since her last crisis in February alcohol tips her into crisis, every single time.  Yesterday she chose to visit a friend rather than go celebrate a friends birthday in a bar.  She talked her decision through with me.  I hope she continues to share her new skills with me and my thoughts are with your daughter and you. 

I have hope.

WDx