How do I help a friend who has some self-destructive tendencies?
March 17, 2008 7:13 AM   Subscribe

I have a friend who's definitely not suicidal or anything like that, but has inflicted pain on themselves in the past. Nobody else knows, and I'd like be as helpful as I can.

I have a close friend who has some issues with harming themselves. From sometime in middle school all through the first few months of college they routinely dealt with many situations by inflicting pain on themselves. This never took the form of cutting or anything that extreme but suffice it to say that they found relatively safe ways of inflicting pain and short-term physical harm on themselves.

From what I understand, it has a lot to do with extreme guilt over very small things. Think of a situation where you accidently offended someone and apologized for it. My friend would likely spend hours or days feeling intensely guilty over it and in the past would likely hurt themselves as a result. They have told me that in the past they felt like there was no reason to live, like they were taking from the world and could not give back, and wished they would die in an accident or something similar. I do not know if this ever got to thoughts of suicide.

My friend is currently in college and seem to be doing a lot better simply because they didn't have such a great time of it in middle school and high school and now pretty much every aspect of their life is getting better - doing better in school, making more friends, feeling more confident, better relationships, etc. The thoughts of inflicting self-harm have not gone away completely but I was told (and believe) that my friend has not actually done anything to themselves in over a year.

I am the only person who knows about this currently. The last time someone knew was a friend in middle school.

My friend sometimes expresses a desire to seek help (psychologist/psychiatrist) for this and I encourage them. Due to their situation however (parents who would not be supportive or understanding in a situation like this and no independent financial resources) I can understand why they might not want to see someone right now. I don't know if there's any way to force someone in this situation to get help but even if there was I would not want to because I do not believe that my friend is suicidal or would ever cause long-term harm to themselves (in the past, they have been very careful about what methods they used to avoid this possibility). Basically, they just don't realize what talents they have and how good a person they are in general and nobody deserves to go through life with thoughts like these.

I have a few questions.

1) First, out of curiosity, is this the kind of thing that people can ever work through themselves (as I explained, there's been definite improvement in the last couple years) and eventually maybe "outgrow"?

2) Secondly, out of curiosity, is the tendency to inflict harm on one's self (but NOT an imminent risk of suicide or something like that) usually something that can be dealt with through counseling only, or are drugs usually involved? The reason I ask is from my conversations with my friend I think there would be much more of a psychological barrier to someday taking psychiatric type drugs rather than getting counseling.

3) Any advice (experiences or links) on talking to someone in this situation and helping as much as I can?

Anything else you think might be relevant would be greatly appreciated as well. Thanks!
posted by anonymous to Human Relations (12 answers total) 1 user marked this as a favorite
"My friend is currently in college" ... "My friend sometimes expresses a desire to seek help (psychologist/psychiatrist)"

Most schools have free counseling for students via the student health center or student wellness programs. If your friend needs a push to make it easier for him/her, look up all the information on the university's website and then all he/she has to do is call and make an appointment.
posted by Jacqueline at 7:20 AM on March 17, 2008

My friend sometimes expresses a desire to seek help (psychologist/psychiatrist) for this and I encourage them.

In response to your third question: I think that if this person is expressing a desire to seek help, but somehow never actually getting that counseling, you absolutely can help by taking a more active role. From the perspective of your friend, he or she probably feels a bit paralyzed or unable to carry out the steps necessary (looking up on- and off-campus resources, calling around to each to find out how to set up an appointment, finding out if insurance is needed or if paying out of pocket will be necessary, and actually selecting the place to go and setting the appointment).

If your friend has a hard time coming out and directly asking for help--like most of the rest of us!--the comments about wanting help may be his or her way of asking you to help. The next time that they bring it up, say something like, "Hey, that sounds like a really good idea. Do you want to look up places online right now? Let's call up the campus counseling center and make you an appointment, okay?"

Obviously, don't force the issue if they resist. But my suspicion is that they would feel quite relieved to have someone 'take charge' and help start sorting through all the details that feel so overwhelming and un-doable.
posted by iminurmefi at 7:42 AM on March 17, 2008

No it is not something you can "outgrow", it is something you can learn to deal with over the years, generally with the help of a therapist.

It is very heartening to see the cycle, guilt-self-harm-relief, interrupted, and as you point out, improvements in the general enviornment will help, but ask yourself one question:

If for any reason things go pear shaped in your friends' life, bad relationship, problems with grades, hassel at home, whatever, what will happen?

The likelihood is they will seek to use that cycle again to punish themselves, generally because their view of themselves is deeply flawed.

Any help they can get with dealing with this flawed view or toxic core belief will help them through the hard times. This may be the very best time for your friend to go into therapy.
posted by Wilder at 7:57 AM on March 17, 2008

Listen to Jacqueline, she knows things. College is a very stressful place and the counseling is (typically, to some extent) free. Those are two huge reasons to get your friend in some one-on-one talk therapy. Unresolved, these issues will get worse, not better - it sounds like your friend has developed a self-destructive pattern, and even if he hasn't done anything to your knowledge recently, there's no telling when things could snowball into something quite serious, be it physical or emotional peril.

I don't think there's any reason to believe your friend has to be medicated, or that he has to run straight to a psychiatrist. Don't be afraid of such a thing, and don't make your friend needlessly afraid of such a thing. Talk therapy is extremely effective for dealing with this sort of thing. Make sure your friend knows that he is cared for, and encourage him to see a counselor.
posted by Sticherbeast at 7:57 AM on March 17, 2008

Just don't enable.
posted by scarabic at 8:01 AM on March 17, 2008

I have a friend who "outgrew" this. It took time, the support of many good friends, and repeated success. Encourage your friend to participate in activities outside of school that reward his or her talents or skills. Stay friends with him or her and be someone he or she can vent to without being made to feel guilty, tiresome, or crazy. Reassure your friend that little things don't matter. Include your friend in a larger circle of friends.

If you see things take a downturn, however, encourage your friend to take advantage of professional help.

Basically, it's possible to build self-esteem and confidence. It just takes time.
posted by prefpara at 8:10 AM on March 17, 2008

...parents who would not be supportive or understanding in a situation like this...

To go a little beyond Jacqueline's suggestion: every counselor I've been to, in school or out, has had an explicit privacy policy. Your school's counseling service will almost definitely have guidelines on what they'll tell a patient's parents, and when. If the privacy thing is a big issue for your friend, help them find out what those guidelines are. It can never hurt to know your rights, and it may let them feel more comfortable seeking help.

Just don't enable.

In particular, let your friend know they can have just as much advice, sympathy and attention from you whether they're hurting themself or not. Some people hurt themselves because it's the only way they can get their unhappiness taken seriously — don't put your friend in that position.

I have a friend who "outgrew" this.

Me too. It can be done.

On the other hand, counseling will almost certainly help. Don't take the possibility your friend will outgrow it as a reason they shouldn't talk to a professional. Look: you can fix your own car, and some people are good at it, but that doesn't mean there's anything wrong with going to a mechanic when you're stumped. This is a serious issue that's had your friend stumped for years and years — it's time to see a pro.
posted by nebulawindphone at 8:20 AM on March 17, 2008

I had a friend in college who was a cutter. She'd been a cutter in high school. She went through cycles where she didn't cut, because her life was going well; but when things got bad, she returned to cutting. She eventually got past it - with the help of a good therapist.

Encourage your friend to seek resources at school. If your friend is in a school in a large-ish city, there may be some sort of youth center which may offer individual or group counseling services for cheap.

Do what Jacqueline said.
posted by rtha at 8:22 AM on March 17, 2008

(The rest of prefpara's advice, mind you, is still good. Whether or not your friend is in counseling, everyday encouragement, support and friendship will all help.)
posted by nebulawindphone at 8:22 AM on March 17, 2008

The book everyone recommends is The Feeling Good Handbook. They could work through the exercises on their own and see if that helps.
posted by salvia at 8:29 AM on March 17, 2008

It sounds like you're doing a great job. Ditto everyone's suggestions about college counseling centers and helping your friend make an appointment. In my experience with friends--yes, it can be "outgrown," especially as your friend's life circumstances change, hormone levels balance out, and the brain matures a bit to control impulses. But that's still not a passive process; it's something your friend has to work hard on, and it'll be a lot easier with support from a counselor.

Remember that this is a form of self-medication. Every time your friend gets through something hard without hurting hirself, that's a victory. It means ze's building other coping tools, so next time it will be a little easier. Remind your friend of this often. If you can identify ways ze's coping, point them out--your friend may not be as able to observe them as you are. Keep an eye out for other unhealthy coping mechanisms like excessive alcohol/drug use and taking too many risks. Reinforce how proud you are when your friend is taking good care of hirself and highlight ways it enables your friend to keep up with schoolwork, pursue hobbies, and contribute positively to the lives of others.
posted by hippugeek at 1:06 PM on March 17, 2008

I had a nervous breakdown/total burnout a couple years ago or so and some my "self-medication" involved self-injury, including cutting. After some therapy (a lot actually) I stopped that and I would encourage you to steer your friend in that direction. This is usually pretty hard for folks to understand, but self-injury is a symptom of the problem and actually a kind of personal therapy as I related above. Not justifying it, mind you, just trying to explain it. The key for me was understanding the underlying issues so that I didnt need that release any longer. Hard to explain. Pain can be .. clarifying.. is about the best I can describe it. But it's not healthy, either for your body or mind. Please tell your friend to get some help and help them if you can. Good luck.
posted by elendil71 at 1:14 PM on March 17, 2008

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