One of the least helpful things you can say to someone who self-harms is, “well, just stop cutting.” Believe me, for most people who cut, if it were that easy, they would have done it already. People struggle with ending self-harm not because they don’t want to but because they use self-harm as a coping skill and you can’t just take away someone’s only or best coping skill. They won’t know what else to do without it. So saying, “just stop cutting” to a self-harmer is like saying, “just stop crying” or “just stop talking to your friends” or “just stop drinking” – if that’s the coping skill the person uses to deal with pain, telling them to “just stop it” doesn’t work.
And one commenter left a comment to the effect of,
. . . surely if you loved and accepted yourself, you wouldn’t want to self-harm.
Yeah, that’s bullshit.
Or, more politely, that’s a myth. Just because I have the desire to self-harm doesn’t mean I don’t like, love or accept myself.
(Yes, this gets a trigger warning.)
My History with Self-Harm
I used to self-harm, sometimes known as self-injury, self-mutilation or nonsuicidal self-injury. It started when I was 13. I remember the first time. I remember thinking that the point on a compass (used for geometry glass) was very, very sharp. And then I remember thinking what a bad daughter I was. And then I remember using the very sharp compass point over and over on my flesh until I had dug a line extending about two inches on my ankle. After that, it happened again and again. I remember thinking I deserved it. And when I got older, it became more apparent that I was using that behavior as a way of dealing with pain that I couldn’t control. At 13, I didn’t get this, but at 17, I did. At 17, I was aware of the acute, painful, depressed (although I didn’t know it was depression), suicidal feelings I was having but I had no way of dealing with them so out would come the Exacto knife (I had graduated to actual blades when I was quite young). But things got better when I graduated from high school and got away from my very sick family. Over time, I stopped self-harming without really trying. I knew I didn’t want to do it so eliminating the behavior was simple once the pain lessened.
The Pain of Depression Returned, and So Did the Self-Harm
Unfortunately, the pain came back a couple of years later. When I was 19 or so, the depression really hit, like being bludgeoned with a 2×4 with nails hammered into the end of it. The pain, in all its infinite darkness, had returned. And so did the self-harming behaviors. Self-harm was being driven by the pain.
Recently I wrote about why people with a mental illness shouldn’t be denied access to guns. My argument is, essentially, that it is a violation of their rights to judge the mentally ill based on a medical diagnosis and, in this society, we judge people based on what they do and not their medical conditions.
Some of the commenters on this post brought up the fact that with access to weapons, a person with a mental illness may be more likely to commit suicide. For example, about half of all people with bipolar disorder attempt suicide and certainly, an attempted suicide with a gun is very likely to be a completed suicide.
However, this doesn’t change my opinion one bit. While I have written and written about suicide and suicide attempts and I have said that, as a society, we should aim for zero suicides, that does not mean that we should violate people’s rights to do it.
I woke up one morning in 1994 crushed with depression. The first thing I thought of that morning was how much I wanted to kill myself, and if I couldn’t do that, then how much I wanted to hurt myself. I kept cutting implements and bandages near my bed just in case the feelings were too much to bear.
Of course, this was like every morning of my 16-year-old life. I was depressed, but I didn’t know it. I only knew that I wanted to die. I needed to die. I needed it like most people needed breath. And I knew that no one understood.
If you feel you may harm yourself, get help now.
I talked about dialectical behavior therapy (DBT) in the last post. Dialectical behavior therapy is designed to work specifically with borderline personality disorder and part of this disorder is often self-harm so DBT uses specific techniques to try to stop self-harm urges and prevent self-harm.
What is Self-Harm?
Self-harm is a huge problem for many people. It is typically a sign of borderline personality disorder (BPD) but it can occur with any disorder (or no diagnosis at all). Self-harm, also known as self-mutilation or self-injury, can be any form of self-abuse including cutting, burning, hitting and statistics often include those with eating disorders as well. Millions of people in the US practice some form of self-harm.
Self-harm is often practiced by teens and is more common in women than in men, but make no mistake about it, many adults self-harm and men do as well. It is a behavior to be taken seriously. Here are some techniques to stop self-harm urges.
Dialectical Behavior Therapy (DBT) and Self-Harm
A lot of DBT techniques are built on scientific principles. The idea is to work to change your own neurochemistry or autonomic nervous system in a crisis. This sounds complicated, but really it isn’t; the techniques are quite simple.
Dialectical behavior therapy uses many acronyms to help people remember techniques and this one is T.I.P. – Temperature, Intense exercise, Progressive relaxation.
Self-Harm Avoidance Techniques
T – Change your body temperature to change your autonomic nervous system (the part of your body that handles unconscious functions like breathing and heart rate)
- Take advantage of your dive reflex, seen when you dive into cold water. Hold your breath and submerge your face into ice water or hold cold packs up to your face. It’s important that you get the eye socket area and under the eye cold.
- Warm your body to relax. Soak in a warm bath or put your feet in hot water.
I – Intensely exercise to calm down a body revved up by stress and emotions.
- Engage in intense exercise even if only for a short time
- Expend your body’s pent up energy and strength by running, walking fast, walking up stairs, playing basketball, weightlifting, etc.
P – Progressively relax your muscles. (There are many relaxation and meditation techniques that work to do this.)
- Starting with your hands and moving to your forearms, upper arms, shoulders, neck, forehead, eyes, cheeks and lips, tongue and teeth, chest, upper back, stomach, buttocks, thighs, calves, ankles and feet – tense for 10 seconds the relax each muscle and move onto the next.
Putting Self-Harm Avoidance Techniques into Practice
Only you can stop your own self-harm. You have to trust that some of these techniques are going to work for you but you have to actually do them for them to work. You have to want to stop your self-harm. You have to reach out to others. You have to get help. You can stop self-harming, but you have to do the work to make it happen.
Note: TIP self-harm avoidance techniques provided by local DBT practitioners.
Stabbing is bad. It just is. If you have to pick self-harm options between cutting, hitting, and stabbing, don’t pick stabbing.
Unless you’re trying to kill someone, in which case I think stabbing would be pretty good. And satisfying. I’m surprised more murderers don’t pick stabbing.
Anxiety, Impulse Control Self-Harm and Stabbing
I’m having anxiety issues. And impulse control issues. And stabbing issues. Well, that last one is really a function of the other two, but it’s an issue nonetheless.
I’ve always been attracted to stabbing. I think that’s because when you start wielding a blade with force, you can’t change your mind. And it’s so easy to did deep. And draw a lot of blood.
Stabbing and Scars
And as I considered stabbing, I also thought it had the advantage of leaving a minimal scar. You cut down, not across.
This turns out not to be the case. Stabbing doesn’t produce a large incision, but the one it does produce tends to gape and cause more scarring than you think. Just trust me. Don’t try it.
And so, as much as I like the force, and blood, and bruising associated with stabbing, I’ve really written it off as a self-harm method. Death method, probably decent, self-harm, not so much.
Self-Harm, Stabbing is Bad
But as I’ve said, I’ve been having issues.
For whatever reason, for whatever cocktail, for whatever brain misfire, I seem to be turning in super-anxious-suicide-girl at night. Like, way more than usual. And on top of that there seems to be a real lack of impulse control on my part, last notably seen with the cutting of my wrist with broken glass.
Hitting is Bad Too
And so I had been hitting myself with a blunt object, went into the kitchen to cut up a yellow pepper, and then as I was removing the core I thought to myself, I wonder what it would be like if I hit myself with this knife. And then I just did. And then there was a lot of blood. I was standing next to the sink so I just tried to keep standing while the blood went down the drain.
It just kind of, happened. Like stubbing your toe. An accident.
And it’s fine. My arm is fine. There does seem to be some nerve damage going into my thumb, but it seems minor and may get better, I don’t know. This isn’t really my area of expertise.
Self-Harm Without Control is Really Bad
And I don’t know. It’s a scary thing. To do something, without intention. One of the problems is I really don’t care if I die. I mean, like, really don’t care. I’m so over it’s unbelievable. So when something pops into my head, whatever filter I did have doesn’t exist. So I just do it.
And then there’s the drinking. Crazy people shouldn’t drink. Crazy people on meds really shouldn’t drink. Crazy people on meds and tranquilizers really, really shouldn’t drink. But I feel so irreparably horrifically self-loathing and suicidal that I couldn’t care less that it’s a bad idea. I’ll take any idea at all that would mask the pain. Even a little.
Sigh. All roads lead to scar tissue.
Again, try not to worry, OK? You’re scared, I know. I am too. But there’s nothing you can do. There’s nothing I can do. I’m suppose to see my GP on Monday and maybe she’ll be able to get me in to see a psychiatrist. Of course the psychiatrist won’t have any answers so it’s a bit moot. More moot than usual. Ultra-moot. Now with more brightening power.
There are frequent reports that of the people who survive suicide attempts, they realized sometime after the pills, or the gun, or the jump, they didn’t want to die. This is obvious. No one wants to die. People who attempt suicide don’t want to die. They want to be out of pain.