BEHAVIORS: Self injury and self harm

[BPDFamily.com]

People can cut to feel something because they are so psychologically NUMB.  *OR* they can cut because there is such a bottleneck of so much psychological pain that it RELEASES some of that pain.  And maybe that goes back and forth from day to day in an individual.
 
When our daughter was doing this, I was told it's a coping mechanism.  Much like her eating disorder.  It's a hard thing to see, but I had to come to look at it as a way for her to SURVIVE.  She was so suicidal at times, I was almost, sickeningly, "grateful" for the release/coping even though it sucked to see her clothes and sheets bloodied and these horrible scars on her now.
 
Once the total downhill mental slalom began, she was covered with cuts.
 
There are "better" things to do - like rub ice on your wrists, or pop a rubber band on them.  My daughter tried these and none of those seemed to compensate like the actual bloodletting.
 
All I can recommend, as a teenaged girl's mom, is that the LESS you refer to the cutting, the better.  That sounds so creepy and enabling,maybe, but really, it only stresses the cutter more.  When my daughter would see me even LOOKING at her arms (how can you NOT? you know?) she'd freak.  I'd have to tell her, "You can't blame a mom for being scared, hon."  When I mentioned my feelings to her about what she was doing, she could handle it.  If I in any way acted grossed out or the "right or wrong" of it, that would be when I could see her stress level zooming up.
 
Your other kids won't copy this, I don't think, unless they get a crisis mode going themselves. 
 
TIME mag ran a great article about the "trendy" CLUBS at American high schools doing this! I guess that is what I can't get at all - doing this as a trend.  Smoking, yes, that will hurt you in the long run, but actually cutting?

[Cosmo]

People can cut to feel something because they are so psychologically NUMB.  *OR* they can cut because there is such a bottleneck of so much psychological pain that it RELEASES some of that pain.  And maybe that goes back and forth from day to day in an individual.
 
When our daughter was doing this, I was told it's a coping mechanism.  Much like her eating disorder.  It's a hard thing to see, but I had to come to look at it as a way for her to SURVIVE.  She was so suicidal at times, I was almost, sickeningly, "grateful" for the release/coping even though it sucked to see her clothes and sheets bloodied and these horrible scars on her now.
 
Once the total downhill mental slalom began, she was covered with cuts.
 
There are "better" things to do - like rub ice on your wrists, or pop a rubber band on them.  My daughter tried these and none of those seemed to compensate like the actual bloodletting.
 
All I can recommend, as a teenaged girl's mom, is that the LESS you refer to the cutting, the better.  That sounds so creepy and enabling,maybe, but really, it only stresses the cutter more.  When my daughter would see me even LOOKING at her arms (how can you NOT? you know?) she'd freak.  I'd have to tell her, "You can't blame a mom for being scared, hon."  When I mentioned my feelings to her about what she was doing, she could handle it.  If I in any way acted grossed out or the "right or wrong" of it, that would be when I could see her stress level zooming up.
 
Your other kids won't copy this, I don't think, unless they get a crisis mode going themselves. 
 
TIME mag ran a great article about the "trendy" CLUBS at American high schools doing this! I guess that is what I can't get at all - doing this as a trend.  Smoking, yes, that will hurt you in the long run, but actually cutting?

[Aloha Lady]

My daughter cuts, which is really when we started to get very alarmed about her.  Firstly, understand that there is a EPIDEMIC of this behaviour out there - not just confined to BPD people but many, many of our young people.  Secondly, understand that it is a LEARNED behavior - my daughter found out about it from a friend, then saw a made for TV movie about it which just validated what she was doing.  Thirdly, understand that it is an ADDICTIVE behavior - not easy to give up.  It is crucial that other coping skills are learned through professional therapy.  All this was taught to me by professionals in the mental health field.  It is scary, but it is also a way to release tension and anxiety build up - the trick for the person who does it is to find healthier behaviors.

Just some info I've learned along the way.  If it is any consolation at all at least you know the person is trying to help themselves - albeit in a very unhealthy way

Take care and regards.

Aloha

[lasagna]

Self-mutilating does release endorphins, so the person does feel better-for a while. Seeing your own blood does make a borderline feel '"real" when they are depersonalizing. It's all part of the illness. Such a sad, sad disorder.

I don't agree that it is always learned behavior. there are a lot of kids getting off on it these days but some are purely driven by their amygdala disorder.

My niece finally stopped cutting herself when she started taking Seroquel (a new anti-psychotic) and Wellbutrin XL( dopamine agonist that helps her not over-react to perceived slights). Her parents tried everything else. It's a very low dose, so it does not impair her functioning. But it has opened up a whole new world for her. she is no longer consumed with thoughts of hurting herself. Alleluia!

[Cosmo]

Lasagna you bring up such a good point about the endorphins.  I remember reading it's like a runner's high, the *anticipated* cut.  Yet an unexpected paper cut will hurt like hell - no high.

I don't think it can be "learned" either.  But did read of, somehow, "clubs" at schools consisting of nothing else but cutters.  Chicken or the egg?

My daughter is on Zoloft and Wellbutrin combo and marked improvements in last two months.

[lasagna]

Let me share how we handle self-mutilation in a psych hospital. Of course, your it's your decision.

Unless an artery is burst, the patient (under nursing supervision) cleans, disinfects and bandages her own wound in a very matter-of-fact fashion. This is not done in a punitive way and the patient can certainly choose the nurse she is most comfortable with. The emphasis is strictly on wound care to prevent septicemia (a life-threatening blood infection). The patient is never made to feel shamed about the self-mutilation. Her motivation to cut is discussed at another time, in another place.

I would hesitate to physically nurture a family member after they've cut. It might be contributing to a cycle of feeling abandonment/ get reassuring nurturance.

Just my thoughts. I am not in the situation so I cannot say what I would do at home.

[damagedgirlygirl]

I am new to this group.  I am a 34 year old mother of one son.  I have severe issues with cutting.  I hide it the best I can.  I fight everyday not to do it.  it is like an addiction.  i know once i do it i will feel better, but i know it does not hep me in the long run. 

i was diagnosed with BPD 4 years ago.  i have been through more med combos than i can even begin to count.  right now i am on Cymbalta, Ritalin, and Klonapin. 

for the past three days i have been sad.  empty sad.  not wanting to eat or do anything sad.  i get up and go through the otions and take care of my child.  i homeschool him so i still keep up with his activities and get him to hockey and karate.  but inside i just feel sad and empty.  i think part of it is that he is getting older (7) and he does not need me as much any more.  i can't have any other kids due to infertility issues so i am just so sad about this i cry all the time.  and crying makes me want to cut.  cutting makes me feel better.  i feel the pain and know i deserve it.  i deserve it because i am so screwed up that i cant even get pregnant again.  dang... .most 15 year olds can do that with out even sneezing and i cant.  it makes me feel like a failure.

so i am messed up.  i cut.  it makes me feel better.  it makes all the icky feeling flow out of me.  and i feel better for a little while. 

damagedgirlygirl

[Chris]

From what I've read the probably best way to deal with cutting by a loved one is what is used in CBT.

If the person involved feels the urge to cut they can make contact (healthy behaviour), which may help them to avoid it.

If the person involved has already cut then no contact is allowed for say 48 hours. This means that the cutting is passively discouraged and the person involved has to learn to deal with their feelings in a different manner than giving in to impulse... .

The healthier behaviour is picking up a phone or going to see someone and discussing the feelings. The unhealthy behaviour is enhanced by cutting and then receiving attention for it... .band-aids and all... .

So my advice would be, if you are staying in contact with someone who does this to set up some rules about this behaviour along those lines. It also places the responsibility of the acting on impulse on the person who does it, rather than yourself!

[Skip]

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 .

 

[homemadecookie]

One might take note of the differencebetween self harming and  suicide attempts.

When one cuts, if the cuts are across the arm (right to left) they are cutting. If the cut is from wrist to elbow, that is a suicide attempt.

It is an attempt to control something. Usually a time of stress. Others here have described the addictive quality of cutting due to the chemicals released in the body.

I also think that people that insist on surgeries, and broken bones, accident prone, etc are also self harming.

Tattoos, piercings etc are the socially acceptable way of self harm.

This style of harm is from the Africans. Tribes would decorate and pierce their bodies as rituals.

[geroldmodel]

Tattoos, piercings etc are the socially acceptable way of self harm.

I think that is an overstatement. 

Its not because women wear earrings, that it is an act of self harm to cope.

Its defintily a cultural thing too.

To belong to a group or subculture or tribe involves markings and signs.

It has been that way for ages. If you are willing to have pain for the group, you are one of them.

So it is not that simple.

however.

I had a friend who got a tattoo on her ankle - out of the blue.

I am certain that in that case it was indeed an act of selfharm.

To punish herself for the things she had done to other people.

[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

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[AJMahari]

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.

[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.

[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... .

[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. 

[Steph]

Picking behavior is common with BPd... esp to the degree you speak of...

Is it troublesome to him that he causes this harm to his body? I know he feels soothed by it, yet does he feel badly as well?

[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).

[Abigail]

Yes, compulsive picking to the point that you mentioned would be considered "self-mutilating" behavior.  However, it could also be part of OCD since it is a compulsive behavior.  I don't know if he meets all of the requirements for an OCD diagnosis--a psychologist or doctor would have to determine that.

[picturelady]

My 20-yr-old uBPD daughter used to dig her fingernails in her scalp until she had bloody patches.  She always made some excuse, like that she had a mosquito bite in her head and was just scratching it.  She also picked at scabs - especially on her legs, or if she had insect bites she picked them until they bled.  She had a lot of scars on her legs.

She eventually developed an eating disorder and alcoholism.

[truefriend]

yes... my friend's wife picks her face so hard and so much that twice she has gotten a staph infection. And she picks his face and mashes so hard it hurts if he will let her... .she doesn't self mutilate like cutting. Just the skin picking

[leaves08]

How about "accidents"? My ex use to accidentally injure himself after emotional episodes. One time after becoming severely despondant about missing his kids, he severed a vein in his hand while trying to slice open a bag of rice, requiring a trip to the emergency room and several stiches. What made me me suspicious was that he initially lied to me and said he was mugged in front of his house. When I asked why he lied, he told me because it was because he was ashamed. He also mentioned that, while at the hospital, he looked into psychiatric treatment. (This incident was actually the trigger for me to surf the net, where I came across BPD. After that much of his other behavior began to make sense.) The night we broke up he ended up in an "accident" resulting in a gash in his head. He also expressed anger that his ex-wife use to blame him whenever he accidentally injured himself to the point of being unable to owrk. Which made made wonder about the significance of repeated accidental injuries.

Anyone else experience this - blaming self-injury on accidents?

[bkay]

My exbf would also hit himself during his rages or when he was in an altercation with a stranger. 

I have a question- would injuries be considered as self mutilation/harming?  My ex was very frequently getting injured- falling and causing a deep cut in his leg, hurting his back, hurting his neck, hurting his arms, dislocating a shoulder, and many more... he just seemed wreckless when he was doing anything like snowboarding, and it seemed frequent.  He would be the only one who got injured each time.

So is being wreckless and hurting yourself during activities considered part of this? It just seemed excessive.

[DreamGirl]

What about tattoos?

[Abigail]

What about tattoos?

Tattoos can be considered self-injury in some cases.  I knew a man with BPD who had a substance abuse problem and he was trying to stay away from drinking.  He had been extremely upset because he had driven many miles to see his young son, but at the last minute his ex-gf changed her mind.  He was with another friend who was supporting him and his attempt to quit drinking.  He really wanted to drink but since he had his friend with him, he decided to go get a tattoo instead.  Getting the tattoo was an alternative to drinking and he was doing it to deal with the pain, as opposed to just deciding he wanted to get a tattoo that day.  He also had a tendency to burn his arms with cigarettes as a way of relieving the pain.

Excessive tattoing can be related to self-injury.  But obviously not everyone who gets tattoos does it for that reason.  It would most likely depend on why they were doing it and when they were doing it (when they were upset, for example). 

[BugsBunny]

I have read that dangerous, compulsive behaviors can be considered as being potentially self-injurious or potentially self-mutilatory. Examples of which are: Frequent dangerous driving while intoxicated; unprotected hypersexuality with a million different partners - most of which are complete strangers and/or one-night-stands; dangerous drug and alcohol addictions and/or experimentations; high-risk dangerous physical activities (race car driving, dare devils, death-defying circus-stunt air piloting, any kind of wild and obviously dangerous activities -- so called "death wish"-type behaviors.)

I hope this helps answer the original question.

[hopefulmom]

What about exercise to the point of pain?  My UBPD husband is a hard-core runner---rain, snow, no matter what.  He started running marathons recently and seems to have a long race (1/2 marathon or several miles) almost every other weekend.  Isn't this excessive to the point of being harmful?