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?
Image provided by Wikipedia, author: Hendrike
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.
If this woo-woo nonsense worked I would have to mummy bandage my arms just so people wouldn’t know i’m defective.
Hi Posey,
I know you don’t know me, but I have to say, I’m the least “woo-woo” person you can imagine. I’m a fan of things that work as told by the evidence. I’m a fan of science. I’m a fan of research. There’s absolutely nothing “woo-woo” about it.
That said, not everything works for everyone. No matter how effective something is, it will never work for 100 percent of people. I’m sorry if you haven’t found what works for you yet, but you can. Self-harm is a very real thing but it has very real treatments, too. I don’t know if you’ve had actual DBT but people tend to find the tools they learn there work very well — and yes, they are science-based. Not every tool will work for you but they teach many and something will.
I hope you’re getting help. You’re not defective, you just need some help in certain areas — like we all do. It just so happens that the way in which you need help is visible. Don’t give up. You can fight it.
– Natasha Tracy
I have started to self harm recently as a relief method of my anxiety I also attend therapy sessions.
I have urges to “scratch” myself all the time, I learned in therapy to put an ice pack on my arm where I want to scratch and that suppresses my urge. That numbness that you feel one you’ve scratched, cut or whatever comes flooding back. But there’s no blood. For this afterwards I draw on with a red felt tip pen lines to simulate blood. This helps me. What you’ve got to think about is that cutting In the long run only has negative consequences. It might feel good for the few seconds afterwards but then that feeling goes away. I find placing the ice pack works especially because you can keep it on for as long as you want too…. Hope this helps people xxxx
Hey I see you explained your use of the photo in the above article by saying that you personally have scars and they aren’t anything to be ashamed of or stigmatised. I quite agree, I have scars too. However this article was the first that came up on google when I searched: dbt self harm urges. I’m currently struggling with urges to self harm and I googled that so I could find advice on dealing with sh urges using dbt skills. Please be responsible and aware that for people like me looking for help the last thing you need to see is a picture of it. Its very triggering, and it really would not be detrimental to the article to remove the image. Its not necessary and other people using the same search term as me are going to see an image of sh when they are trying to avoid self harming. Thank you
I have since age ten done things to myself that had nurses crying in hospitals……I am now 55 and miracously am still alive…I’m starting dbt next week so I can only pray it helps..my past in mental illness has seen abuse outlawed now but I still real, reseacrh as well as question people I hold in esteem..please post this to let people know not to give up hope….there’s always hope not for a cure but a way to maintain and lead a meaningful life….danny sammons
Hi, Im katy. I have a friend who does that things. I have to admit that im worried and a little angry with her, however i want to help, because i dont know what to do. I have depression and with the notice that i have received from her, im worried to fall in a relapse.
In my country there is no information about this behavior, also there is no special centers for this
So i dont have any idea what to do. I feel bad.
Please reply me, she is a person that i love very much.
Hi Natasha, I’ve just found this topic and it is pertinent to me. I have both bipolar as well as borderline traits. I’m 56 and have been self-harming on and off since I was a teenager. I say on and off because for a number of years I was reasonably stable and did not get that incredible urge to harm myself. I’ve cut, burned and broken bones in my hands.
While I’ve witnessed DBT making a huge difference in others’ behaviour it has not, sadly, helped me gain control over my self-harm behaviour. I’ve experienced three courses of DBT, both group sessions and one private. I’ve tried very hard and with willingness to follow the techniques taught to me. I so wish that these techniques did work for me and I admit that I feel a bit of a failure after taking three courses and really WANTING them to work only to self-harm once again. Currently the only thing that is helping me is that I regulary see my psychiatrist/psychotherapist and I have a contract with him week to week. It’s the best method I’ve found so far and I find it puts me in greater control of my behaviour because I’m conscious of making a choice. If I slip up we discuss why I made that choice.
As for scars, I’m not embarrased by them although some of my family members can be very probing and judgemental which makes things unpleasant. I’m aware that, for instance, retail assistants notice when I hand over money and that the phlebotomists see them during my regular blood collection but no one has actually said anything. I usually have an excuse ready in case. Once when I went to a 24 hour medical centre to be sutured and the Dr asked what happed I just said “is it enough that I tell you I have bipolar and am seeing my psychiatrist tomorrow?”. He just said “yep, but make sure you do!” A different reaction to hospitals.
Sorry this has been so long.
I haven’t done any self harm in a long time, although I had 2 bad episodes a few years ago and still have some major scars on my wrists from it.
I did an intensive 6 month DBT treatment course 4 years ago and it helped a LOT.
Hi,
Great to hear. Keep up the good work :)
– Natasha Tracy
Rubbing in lotions or oils into scars is a lovely process which can be done daily to promote healing, both of skin and of psyche. Vitamin E is a great oil for this purpose. It’s usually cheaper to get the capsules and break them onto the skin, as long as you’re not allergic. I did this on my husband’s surgical scars which worked well. Paying special attention to your grooming and self-care is also a great thing to do. When mentally unwell I always had to force myself to do this but it was worth it. I don’t have any visual scars, but if I did I would usually keep them covered under the pretence of sun protection, and if I had to go bare-armed I would usually use make-up or some kind of decorative wrist band. If someone saw the scars I would consider lying to them. This is not because of shame. Mental illness is not shameful. I make no secret of my bipolar disorder. The reason I would cover up scars, if i had them, is for self-protection. The nasty people who judge and stare don’t bother me at all. It’s the nice ones who set me off my guard, who bring tears to my eyes, because their caring breaks down all of my defences and leaves me helpless.
HI Sarah,
Great suggestion about self-care and scars. It’s reinforcing all the right messages. A quick note though, a study was done on vitamin E and it has no benefit for reducing the appearance or healing of scars. (Sorry. Turns out it’s an old wives tale.)
I understand your point about hiding scars and if that’s the right solution for you then I would support it, of course. It’s about knowing yourself and what you need, and obviously you do.
– Natasha Tracy
http://www.ncbi.nlm.nih.gov/pubmed/10417589
How embarrassing. I learned that false information about vitamin E 12 years ago. It just goes to show the importance of updating one’s knowledge regularly, and also being careful to only believe things once you have checked out their credibility.
I pride myself on doing this in my profession at least, but I wonder how much false information is swimming around in my brain now on other topics that I think is credible? How can any of us be sure of what is the truth?
Hi Sarah,
Oh gosh, don’t be embarrassed; we all make mistakes. Me too. I try to do the best I can with research, but I miss things now and then. I just happen to know about vitamin E because I was trying to get rid of some surgery scars myself and looked it up. :)
I have this great job where all I do is research, you see. Not everyone has the time and inclination for such things.
– Natasha Tracy
Natasha, thanks for your recent posts about DBT. It’s been really great to read a layperson’s view of the treatment. I look forward to reading more from you!
The nice thing about DBT is that it works to help you understand your triggers for certain behaviors and identify patterns in your life that may lead up to those behaviors. We are, after all, creatures of habit and if we can figure out what might be causing certain patterns, maybe we can break out of those. A good DBT therapist will make no judgement on your self-injury and doesn’t think that you’re “trying to get attention” like many might say or believe. And with lots of hard work, ending the pattern of self-injury will be something everyone who wants to will be able to do.
-Sammy
Hi Sammy,
You’re welcome. I think DBT is a promising treatment for many so I encourage people to look at it as an option.
I agree, the focus on this, and cognitive behavioral therapy (which DBT includes) is identification of triggers and quite frankly I wish the whole population could take a bit of that. We’d all calm down a lot if we just understood ourselves better.
“A good DBT therapist will make no judgement on your self-injury and doesn’t think that you’re “trying to get attention” like many might say or believe.”
I didn’t mention this but it’s true. There should be no judgement around the behavior. It’s just a behavior and like many others, it’s not the best way of dealing with circumstances. No judgements. We all have behaviors like that.
And I agree, sometimes the process is very difficult, but anyone who wants to can work towards changing this behavioral pattern. No one should feel alone and no one should feel they have to self-harm forever.
– Natasha Tracy
I self harmed (cutting) when my illness was at crisis point, it’s what got me hospitalised, it’s what got me on the right course of treatment after slipping through the cracks for years. When I look at my scars I don’t feel ashamed, it’s because I was ill, (BP 2). I consider myself lucky because once the right regime of medications were found I automatically stopped the self harm. I have been free for three months now but see my scars every day, they remind me of how unwell I was.
From the beginning I didn’t cover my arms, I have been fortunate I guess, as not one person has ever commented to me about them, if they did I would politely tell them it happened when I was ill.
Quite right/ nothing to be ashamed of, it is what it is, a symptom /reaction to our being unwell.
Teresa,
Good on your for not feeling ashamed and not covering up. You seem to have the right perspective, “it happened when I was ill,” and that’s true.
It’s great you automatically stopped when you found the right combination of meds. That is my experience too.
– Natasha Tracy
Hi, I’m a 40 yo adult male. I am a cutter (or at least have been). This may sound strange, but I only cut when manic (diagnosed bipolar 2). It’s hard to live with at times (all the scars) but the hardest thing to get people to understand about it is that it’s not a suicide attempt. I’m long past covering my scars, and if someone asks I try to use it as an educational moment. I haven’t cut in a number of years (I was hospitalized in 2008 for the cutting). Sorry losing my thoughts (been going through depression and meds stopping working) thanx for listening.
Scott
Hi Scott,
It’s understandable that you do it when manic as I find that cutting is often due to extreme stress, irritation, or anger, all elements of mania for some people.
It is hard for others to understand it wasn’t a suicide attempt. I just assume that’s what people think when they seem my arms, but that’s fine. Their opinion is none of my business. If they really wanted an honest answer, they would ask.
Good for you for finding educational moments in such tough conversations.
– Natasha
I agree about the picture, having just gotten my daughter out of the hospital for the umpteenth time, it’s rather upsetting.
The article is excellent though, I just wish I could do something to help her. Unfortunately my therapist and any other mental health professional, and cutters for that matter, tell me there’s nothing I can/should do.
HI Sheri,
Please see my comment below about the picture.
I would never suggest you should listen to the professionals around you, but I will say that I linked to an article about parents of cutters here http://www.teenhelp.com/teen-health/cutting-stats-treatment.html if that helps you.
I think being supportive _is_ doing something. It’s doing everything.
– Natasha Tracy
I appreciate your explanation about the picture, it makes sense. And thank you for the link, I’m going to forward it to my other daughter who’s reaction right now is pure anger and frustration.
Great techniques, BUT I was really taken aback to see that image (of the arm) when I opened your blog just now. As a recovering self-harmer (specifically cutting), I am well aware that the internet is not my “safe space” or anything of the sort, but I come to expect a certain degree of understanding/respect for common triggers on blogs/sites that deal specifically with mental illness. At the very least a trigger warning/placing the image behind the text cut (though I question the wisdom of including the picture at all to accompany an article on STOPPING) would have been more appropriate.
Hi Tara,
I appreciate your concern, I really do. I carefully considered the image. I have been a cutter too. My arms are not the nicest in the world.
But here is my though – people with this problem have nothing to be ashamed of and how they look is nothing to be ashamed of either. This is a _medical_problem_ like any other and shouldn’t be treated with secrecy which I think promotes stigma.
I’m sorry if it hurt you. That’s not my intention, of course. I do understand your feelings.
– Natasha Tracy
Natasha, how do you deal with the stigma of scars? My body is riddled with them and I can’t cover them all the time but I was reminded of just how visible they are and how much people judge me by them last week when a mother of a cutter adressed me about them after a class last week and asked me really personal questions about them in front of some of our fellow students. She wanted help with her daughter and I tried to help but her approach bothered me so much I’m part dreading my favorite class now because I felt exposed. I’ve had customers at old jobs harrass me about my scars and even had an ex “friend” of mine use my scars to garner pity for herself because she perpetuated the idea that I still self injured when she knew that I didn’t. It makes me feel like I’ll never be able to stop hiding. Have you had any experiences like this?
HI Patti,
I’m sorry to hear you had that experience, I know how shaken that can make a person.
I will say that this topic deserves it’s own post, but I will encapsulate a couple of thoughts for you here.
1. I think it’s important that sometimes you cover the scars simply because if they’re really obvious, people _will_ judge you. It isn’t fair, and it isn’t right, but it does happen and it’s reasonable to protect yourself from that. I fall back to this position for work-related activities and other formal occasions.
2. Scars are nothing to be ashamed of. I know it can seem otherwise, but honestly, what you have is a _medical_ problem and that problem has left a scar, just like if you had had surgery. And there’s nothing shameful about that. So most often I don’t even think about them. For me, I also have them on my ankles and for a long time I refused to ever not wear socks, but I got over it. People can look, people can stare (and they have) but I’m not hiding a medical problem just because it makes someone _else_ feel uncomfortable. That’s their problem, not mine.
That being said, if someone asked me direct and personal questions about it, I don’t know that I would feel comfortable either. But it’s OK to say that. Simply say, “I’m sorry, that’s personal. I don’t want to talk about it.” Because even though you might want to help someone, it’s important to remember to help yourself first.
And believe me when I tell you, you are not alone with your scars. More people than you would think have their own, whether they cover them or not, and know exactly what you’ve been through. But you’re stronger now and part of that strength is starting up and confidently saying, this is my body, and I’m not ashamed.
Because there is nothing to be ashamed of.
– Natasha Tracy