Advice for beating self-harming behaviour.

December 18, 2010 8:32 AM

Need help changing a worsening pattern of self-harm.

So lately I have realized that I respond to chaotic emotions with self-harm. For example, when I feel trapped and helpless in an argument with my partner I will leave the room and physically harm myself as a way of manifesting the emotional pain that I am feeling.

I do things like: punching myself in the face, whipping myself with my belt buckle. The other night it escalated to punching my hand through a mirror, which resulted in a trip to the emergency room for cuts on my hand. People have asked about them at work.

Last night at my office party I got absolutely oblitterated. I don't think I made too much of a fool of myself (other than maybe coming across as a lush). But I came home to a girlfriend who was crying. I made a mess of the bathroom, ruined her night of sleep, and further alienated myself from her; We have been having not insignificant relationship problems.

My pattern of self destructive behaviour has clearly gotten out of control and I would like to stop it. I've been drinking too much, and it seems to make it worse, so I will be not drinking for the next month or so.

I mutter to myself, sometimes outloud "I want to die. I hate myself." Even though I don't really want to die and I'm probably an OK person. It just becomes a relentless mantra of self loathing that just keeps getting worse and worse resulting in a wallowing dispair. I will imagine drawn out moments of my death like the minutia of being run over by a car, or being shot with a harpoon from behind. Generally quite morbid stuff that I don't like mentioning to people.

I'm generally pretty "high functioning". I have a career that I'm proud of, a band that's pretty awesome, am writing a novel that makes me really happy, in good health, have a dog that is so great and cuddly, and a wonderful partner, some good friends. I have lots of things to be grateful for.

I've made an appointment with a counsellor for next week through my work's employee assistance program. Apparently Christmas is a busy time for this sort of thing so it was the earliest I could get. In the meantime I'm going to get as much exercise as I can, not drink alchohol at all, read good books, and try to take care of myself.

I would like some tips from you good people on how to clear the negative thoughts from my mind and to re-focus my self destructive thoughts when they get out of hand.

[e-mail]

posted by anonymous to Health & Fitness (13 answers total)

Just throwing some ideas in here. I'd guess that the first thing you want to do is something you're already planning to do, and that's stop drinking. It'll help with controlling the sort of impulsiveness that has you hurting yourself before you really know what you're doing, or why your doing it.

Secondly, look into either a mindfulness or DBT based treatment program. You need to able to recognize what you're feeling, how it's connected to what you're thinking, and the circumstances that have given rise to those emotions and thoughts. Then you need to be able to reach some kind of moderation of, and balance between, your thoughts and emotions before you act. DBT and some mindfulness programs are specifically geared towards doing this for people who self harm.

Thirdly, think about some more general therapy. I'd guess you've got some self esteem issues, some impulse control issues, some anger management issues, and maybe some problems in your relationships with significant others. It's difficult, but there are senses in which you want to be working on all that stuff at once, even if it's only in small increments.

Good luck.
posted by Ahab at 8:44 AM on December 18, 2010 [1 favorite]

Sounds like you've already made the right decisions. You really need to just get through the holidays until you get some help designing a real treatment plan. See if you can add a yoga class into your work out, that might help you relax and get out of your head. Mindfulness/mediation would also help with that. Also, you probably need a psychiatrist who can prescribe antidepressants but most likely your therapist can help you pick one. They usually work in tandem.

Oh yeah, you should get rid of all the booze in the house. It'll make quitting much easier.
posted by chairface at 8:59 AM on December 18, 2010

Yes, it sounds like you're doing all the right things. Being aware that this is a problem is a BIG step.

Delay, Distract, Breathe. That's what helped me get through the urges.
posted by sunshinesky at 9:15 AM on December 18, 2010

The steps you are taking sound great. However, you might spend some time when you feel calm and relaxed thinking about what is really behind all this. What strikes me in your question is a dissonance between your description of your life and your description of your emotional reactions. The two don't really seem to match. You say you have a "wonderful partner," yet "when I feel trapped and helpless in an argument with my partner I will leave the room and physically harm myself as a way of manifesting the emotional pain that I am feeling." If you actually have a wonderful relationship, you should not have arguments that are this painful and upsetting.

There are two explanations: either your relationship is actually not wonderful, or your anguish is only partially related to what's actually going on with your partner (or the other immediate situations which lead you to self harm), and largely fueled by other issues. Is there some aspect of your life which is making you unhappy? Even if it is something which other people might be happy and grateful about, if it's making you miserable, change it. If not, do some introspection about what inside you is triggered by these relatively harmless situations and makes you feel so bad. Who or what gave you the idea that you deserve to be hated? What standard of judgment are you using on yourself, and is it reasonable? Once you begin to understand the powerful but unhealthy beliefs and attitudes that are causing you to be so unkind to yourself, you can begin to question and diminish their hold on you.

To answer your question more directly, can you decide in advance on a specific thing to do before acting when your self-destructive thoughts get out of hand? For example, if you have the urge to punch yourself in the face, tell yourself, "OK, but first I have to X (e.g. take a walk around the block, do a household chore, call a friend and talk about what I'm feeling), and then I can if I still need to." Sometimes it can be easier to delay an impulse than deny it completely, and the intervening activity should be something that is likely to calm you down.
posted by unsub at 9:33 AM on December 18, 2010

Choose some self soothing techniques that are not destructive. Hum a song you like, stroke a small piece of something with a calming texture - a fabric, a stone to rub, a ,feather, anything small that you like that fits in your pocket- have a response for the unpleasant things that you mutter to yourself, practice saying "I am strong" or something about yourself that is TRUE and comforting. Practice it before you start muttering the negative things and it will be easier to repeat your chosen "good" mantra.

Have at least one activity every day that you truly enjoy. A walk with your girlfriend through the neighborhood, a bowl of ice cream, a phone call with a person you admire and respect but who is too far away to see regularly, a sport.

Keep written track of the self destructive behaviors. What exactly did you do? How much forethought went into the action? What was happening just before? How did you feel during and after? Fear? Shame? Anger? Embarassed? Relief? Pride? Release?

My email is in my profile. I've never self harmed physically, but I know those thoughts, intimately. Feel free to contact me if you need to.
posted by bilabial at 9:37 AM on December 18, 2010

Unsub, this If you actually have a wonderful relationship, you should not have arguments that are this painful and upsetting.

is realllllllly not helpful here. That's the part of mental distress that is so awful. It's quite possible that the reaction isn't matching what's going on in the relationship or the argument. There were times when trying to decide what kind of breakfast to have pushed me over the edge into self loathing.

It's not necessarily the arguments, or their intensity, that is causing the OP to feel helpless and self destructive. (Granted, it may be, but let's not assume one way or the other.)

So, let's not call the OP out for misrepresenting a relationship that we know nothing about. That kind of reaction to self harm puts a lot of pressure on the partner to be able to prevent these kinds of feelings.
posted by bilabial at 9:44 AM on December 18, 2010

Your alcohol use, your negative self-chatter, and your physical self harm are all coping mechanisms. You've focused on the coping mechanisms in your post, so I don't know what they're helping you deal with, but you should keep in mind that you're using them because they relieve your pain and anxiety in the moment.

They're all addictive, in the sense that using them to cover up pain and anxiety halts you from learning how to deal with pain and anxiety productively; so you may be using them for totally mundane stuff, or for massively overwhelming trauma, or both and all points in between.

I bring this up because you're looking at cutting off one coping mechanism entirely (and I celebrate the self-awareness and determination), and cutting down on others. With that point in mind:

-- Some of the effects of quitting alcohol may be paradoxical. Please be prepared for that. You'll be feeling lots of bad feelings you've been protecting yourself from. This may result in an uptick in your other coping mechanisms (negative self-talk, negative imagery, physical self-harm). This doesn't mean you're failing! Unfortunately, success will feel like shit for a while.

-- Try to actively and intentionally replace your dysfunctional coping mechanisms. Trying making a list of comforting and de-stressing activities: exercise, sex, food, favorite books, movies, and board games, time with valued friends, petting your dog (clinically demonstrated to reduce cortisol levels in both of you!), cleaning and organizing your home, knitting, whatever's on your list.

Exercise, sex, and food can all be abused as well as used. If you're prone to abusing those things, don't put them on the list.
posted by endless_forms at 10:08 AM on December 18, 2010 [7 favorites]

I've gone through something similar, although it really isn't linked to drinking in my case and it's confined to horrific fantasies about other people injuring me. What's really helped is mindfulness meditation and learning how to self-soothe. There can be another voice in your head that counters the "I hate myself" talk and tells you it'll all be okay. Think of someone who unconditionally cared for you as a child - maybe a grandmother? How did he or she react when you were sad or hurt? Be that for yourself.

The most important thing is not to fight the actual feeling. Go off by yourself, sit quietly and feel it fully. Give yourself time, don't be in a hurry to refocus. Don't force it. On the other hand, don't get hooked by negative thoughts. Picture them as trains passing by. You don't need to get on the train, but if you do, as soon as you realize it you can step off at the next station and sit calmly again. I find it helps to picture a literal train station with comfy couches and quiet music; a peaceful place I can always come back to.
posted by desjardins at 10:57 AM on December 18, 2010

bilabial, I don't think you and I really disagree. Please reread my comment. I was not assuming anything about the OP's relationship, or calling anyone out. In case what I said was unclear, my point was that what the OP tells us about the OP's daily life (wonderful girlfriend, satisfying and productive activities) does not match with the OP's emotional responses to these things (despair, self-harm). Therefore, either there is a serious problem in the OP's life that we don't know about (because even if one is already inclined toward self-harm, a bad job or relationship or whatever can make those urges a lot worse, and removing oneself from the damaging, negative situation can make them better), or the OP's problems are primarily internal, and normal stressors are triggering pre-existing emotions. Since, as you say, we don't know anything about the OP's relationship, I cannot guess what combination of internal and external factors may be at work here. When I wrote If you actually have a wonderful relationship, you should not have arguments that are this painful and upsetting., what I meant was that if the OP's reactions to a normal, non-abusive argument are this extreme, some introspection is in order to address where the disproportionate anguish is actually coming from. If the relationship is actually good, then something else is the problem, and it would be helpful to work out exactly what that is.
posted by unsub at 11:03 AM on December 18, 2010 [2 favorites]

endless_forms brings up a great point--what you're doing right now, via hurting yourself or abusing alcohol or pushing others away, is trying to manage the distress you're feeling. If you want to stop doing those things, you will need something to replace them. One thing to focus on is responding to the distress in a way that is meant simply to get you through the intensity of the moment by refocusing you, and not making anything worse. The goal is to distract your attention to something else in the short-term, to help de-escalate the intensity of feeling in the moment. Breaking it down into "what can I do for the next 60 seconds, and then the next ten minutes, and then the next hour" instead of fighting against the hugeness of the problem itself in the moment. This can involve lots of different tools, but here are some ideas to start:

- Distracting Activities/Thoughts: working out, cleaning the house, taking a walk or drive, play a board game, cook, read a book, make a to-do list for tomorrow, watch a documentary on the Science Channel, organize that stack/pile of _______ that's been sitting in chaos for a month
- Contributing: help a friend with something, volunteer, open a door for someone who is less able, talk to someone who looks upset
- Comparing the present moment to a time when you successfully got through something similar
- Sensations: use your five senses to self-soothe. Think about things you can do with your sense of sight: watch a movie, read a book, look at photos of family/friends, paint or draw, go to a museum; sense of smell and/or taste: cook something you love to prepare and eat, aromatherapy type stuff if it appeals to you; hearing: listen to your favorite music, talk to a friend; touch: play with a pet, hold ice cubes in your hand for a minute, build or construct something, get a massage, hug someone, etc. etc. (The possibilities with this one are pretty infinite.)

These are a few of what are called "distress tolerance" skills from Dialectical Behavior Therapy. If the concepts I mentioned are of interest to you, here's a website with more info on how to apply these and other skills: http://www.dbtselfhelp.com/html/distress_tolerance.html
posted by so_gracefully at 12:03 PM on December 18, 2010 [1 favorite]

Some self-harmers get through difficult periods with the help of a rubber band worn loosely around the wrist: when they recognize the signs of impending self destructive behaviour, pulling on the rubber band and letting it snap back on the inner wrist doesn't do lasting harm and smarts enough to help them pull themselves together.
posted by thatdawnperson at 2:59 PM on December 18, 2010

I found writing extremely helpful. It can be in a word document on your computer or a private (locked down tight) blog on the internet (wordpress.com is great for this).

It can get better. I'll second DBT. It was a life saver for me. You can also explore meds with a psychiatrist. I found a mood stabilizer to help even though I wasn't bipolar.

Feel free to mail me if you want to talk. I've been through the cycle and I've broken it.

I'm rooting for you.
posted by kathrynm at 2:17 AM on December 19, 2010

This may sound overly simplistic, but as far as the physical self-harm, take it off the table as an option. Decide that you do not engage in those behaviors anymore. As someone with a history of self-harm who still gets occasional urges toward this during my worst moments, it helps to tell myself that I Do Not Do That, and that it's not okay to do so -- any more than it would be okay to hurt someone else when I feel destructive. You may not actually believe at first that harming yourself is as negative as harming another person, but sometimes thought has to follow action (or repeatedly avoiding a certain type of action). And the truth is, you ARE hurting others who love you when you harm yourself.

Also, I find that chaotic emotions -- particularly in arguments with my SO -- feel like they're going to last forever, and that's the part that makes me want to do unwise things. It feels like without some sort of spectacular release, the feeling will never go away. In reality, feelings do pass or at least mellow out more quickly than we anticipate, if we allow that to happen and don't feed the fire. You may have to sit with some uncomfortable feelings for a while, but they will transform and eventually pass because no feeling is permanent.
posted by spinto at 9:24 AM on December 20, 2010