SELF-INJURIOUS BEHAVIOR (SIB) SELF-HARM
Getting a handle on self-harming behavior
More on Self-Injury
A
facility for recovery from SIB
Why Teens Cut
Teen Health, Cutting, Shame
Treatments for
self-harm
Why Do Some People with Borderline Personality Disorder
Self-Injure?
by Becky
Oberg
It
seems to make no sense. Why would any individual self-injure?
Self-injury is so closely associated with borderline personality
disorder (BPD) that some psychiatrists will make that diagnosis
automatically if a patient self-injures. But why would someone
self-injure? There are three main reasons: to punish themselves, to
regulate their emotions, and to express their pain.
Self-injury as a form of punishment
Some people with BPD self-injure as a form of punishment. For
example, if one does something perceived as bad, that person may
self-injure as compensation.
A
video on YouTube talks about this. “You’re ugly, you’re stupid, any
kind of failure, then I thought I deserved the pain,” says the woman
in the video. “And I know a lot of other people who use it as a
punishment and, or, see it that way. One of the reasons to punish is
because I deserve the pain.”
I used
to self-injure as a form of punishment when I was in college.
Self-injury was a way for me to punish myself for drinking too much.
It was a way to deal with the guilt I felt over my alcoholism.
Self-injury as a way to regulate the emotions
This is where the vast majority of self-injury falls, based on my
experience. Self-injury is a way for many people with BPD to cope
with overwhelming emotions. It is a way to deal with unbearable
emotional pain. As Fiona Apple once said, according to self-injury.net,
“It just makes you feel.” She also said “It was never, like, ‘I am
going to hurt myself and put myself in the hospital.’ …It is that I
am going to give myself the pain that I need to feel to put the
punctuation on this (expletive) that’s going inside.”
Jessika Addams wrote on her web page ” I initially started cutting
myself at an early age out of frustration. Cutting tends to relieve
anger. Many self-injurers like myself have enormous amounts of rage
within and are sometimes afraid to express it outwardly, we injure
ourselves as a way of venting these feelings without hurting others.
When intense feelings built, I became overwhelmed and unable to deal
with it. By causing pain, I could reduce the level of emotional
stress to a bearable one.”
I
started self-injuring after witnessing an assault on my brother. I
blamed myself for not being able to stop it. By my twisted logic, if
I could overcome my fear of pain by inflicting pain on myself, I
could overcome the fear I felt in certain situations and take
action. Self-injury was a way to gain courage. It was a way to be
strong.
Self-injury as a way to express pain
Princess Diana said it best: “You have so much pain inside yourself
that you try and hurt yourself on the outside because you want
help.”
Richey
Edwards, of The Manic Street Preachers, spoke often about his
self-injury. “When I cut myself I feel so much better,” he said.
“All the little things that might have been annoying me suddenly
seem so trivial because I’m concentrating on the pain. I’m not a
person who can scream and shout so this is my only outlet. It’s all
done very logically.”
When I
first started self-injuring in college, it was a way to deal with
the pain of my past. It was a way to express that I was hurting.
How to overcome self-injury
Therapy teaches how to replace the negative coping skill of
self-injury with positive ones. We can learn to say no to
self-injury. (read: Treatment of Self-Injury)
Tell
yourself that you’re not a bad person, even if you don’t believe it.
Tell yourself you don’t deserve pain but deserve happiness. Tell
yourself that there are other ways to regulate your emotions and
express your pain, then practice those ways (meditation, talking
about it, etc.) Eventually you’ll learn how to live without
self-injury.
Top
ScienceDaily — The notion
that cutting or burning oneself could provide relief from
emotional distress is difficult to understand for most
people, but it is an experience reported commonly among
people who compulsively hurt themselves.
-------------------------------------------------------------------------------------
Individuals with borderline personality disorder experience
intense emotions and often show a deficiency of emotion
regulation skills. This group of people also displays high
prevalence rates of self-injurious behavior, which may help
them to reduce negative emotional states.
Niedtfeld and colleagues studied the effects of emotional
stimuli and a thermal stimulus in people either with or
without borderline personality disorder. They conducted an
imaging study using picture stimuli to induce negative,
positive, or neutral affect and thermal stimuli to induce
heat pain or warmth perception. The painful heat stimuli
were administered at an individually-set temperature
threshold for each subject.
In
patients with borderline personality disorder, they found evidence
of heightened activation of limbic circuitry in response to pictures
evocative of positive and negative emotions, consistent with their
reported emotion regulation problems. Amygdala activation also
correlated with self-reported deficits in emotion regulation.
However, the thermal stimuli inhibited the activation of the
amygdala in these patients and also in healthy controls, presumably
suppressing emotional reactivity.
Dr. John Krystal, Editor of Biological Psychiatry,
commented, "These data are consistent with the hypothesis
that physically painful stimuli provide some relief from
emotional distress for some patients with borderline
personality disorder because they paradoxically inhibit
brain regions involved in emotion. This process may help
them to compensate for deficient emotional regulation
mechanisms."
Top
A person diagnosed with Borderline Personality Disorder
could be involved with harming themselves - often by
cutting, burning, punching, or head-banging (to name a few
of the practices) themselves. (also called "cutting").
Self-injury is a result of not
having
learned how to identify or express
difficult feelings in a healthy way. It also
can be an alternative to a suicide
attempt. This ties directly into one of the
characteristics of BPD. Discovering that your loved one is
involved in this practice can be very disturbing. It
can be an ritualized activity where the person uses sterile
razor blades, or just a sharp knife, with no concern for
infection. Articles are being researched and compiled
that graphically describe the psychology, the ritual, the
reasoning, the relief, the and the payoffs to the
Borderline.
These links deviate away from self-injury
in Borderline behavior. These articles are about
self-injury: who does it, how they do it, why they do
it. Some of these links are not for those who get a
bit squeamish from the concept of hurting oneself.
In the movie "Girl, Interrupted", Winona Ryder said that she
cut to try to get at the monster inside her. Others
have said that they cut to see that they really are alive,
because they feel dead. BPD's may cut to let others
know just how terrible they are feeling about themselves,
Live, their situation.
Click on this
link (article) to read about how
the BPD has a higher threshold of pain if they are currently
cutting, compared to those in the study who are in treatment and
haven't self-injured for a period of time.
Why Do Borderlines Self-Injure? (the
reasons are surprising!)
from Psych Central blog,
Charles H. Elliott, PhD.
You’re
probably wondering what the
motivation is for these various acts
of self harm that seemingly would
result in no gains for the person
who does them. The answer to your
question is that there is no single
motivation for self harm. Both
mental health professionals and
those with BPD have suggested a
variety of possible motivations
including:
-
To
distract from emotional pain:
You can’t underestimate the
unbearable nature of inner pain
experienced by those with BPD.
Although the pain from self
injurious acts rarely matches
the internal, emotional pain, it
does pull one’s attention away
from the overwhelming emotions
for a little while.
-
To
meet other needs:
In most cases, it’s not so much
a need for attention as it is a
need for basic nurturance and
support from others. In some
cases, it appears that people
engage in self harming acts in
order to obtain care and concern
when they lack the skills or
knowledge for obtaining those
needs in healthier ways.
-
To
punish themselves:
Sometimes people with BPD appear
to harm themselves out of a
profound feeling or belief that
they deserve punishment and
abuse. Sometimes this belief
appears to be related to the
fact that they were abused as
children and believed they
deserved the abuse. Thus, they
continue the pattern of abuse on
themselves, thereby reenacting
the abuse over and over again.
-
To
get back at someone:
Many people with BPD have
trouble expressing anger in
healthy ways. Thus, they will
hurt themselves to make other
people feel badly for something
they did or said.
-
To
feel better:
When the body is injured, the
brain releases a type of pain
killer known as endorphins.
Endorphins are similar to
morphine and reduce pain and
distress. Thus paradoxically,
one may engage in self harm in
order to regulate emotions and
feel better. If that motivation
sounds bizarre, consider the
fact that many of us in New
Mexico report loving to consume
hot to really hot chili
peppers in abundance. Why? It
seems chili peppers causes a
release of endorphins.
-
To
feel almost anything other than
numbness and emptiness:
Many of those with BPD say that
they have a constant feeling of
“unrealness.” They say they feel
out of it and/or dissociate.
Pain feels “real” and allows
them to connect to the world for
a while.
Further research has revealed that the Self-Harm, Intervention,
Education, Learning and Development (SHIELD) program also
facilitates training for community professionals and
provides education regarding self-harm behaviors in the
community.
The
SHIELD program is based on the idea that early intervention is
critical to prevent lifelong emotional and physical scarring that
can result from self-injurious behaviors. Without early
identification and intervention, adolescents can develop an
addictive dependence on self-injury as a coping method.
The
biggest question for those in a relationship with a self-injurious
adolescent is, "Why?" Many myths associated with self-injurious
behaviors try to answer this question. One of the most common myths
is that adolescents self-harm for attention. Some assume self-injury
is perhaps a failed suicide attempt. Others believe self-injurious
behavior cannot be treated and is not a serious problem as the
wounds are "not that bad." While self-injury is not necessarily
suicidal, if left untreated it may lead to suicidal behaviors.
Because self-injurious adolescents share a proclivity for intense
behaviors with traits inherent to borderline personality disorder
(BPD), they often have not been taken seriously and get labeled as
"manipulators."
Marsha
Linehan, PhD, a pioneer in BPD, proposes a less judgmental
understanding of the adolescent who cuts. Teens who show these
emotional differences are often told their emotions are "wrong."
Linehan calls these types of comments "invalidating statements."
Problems begin when individuals believe these statements and stop
trusting themselves.
In the SHIELD program, intervention is
based on dialectical behavior therapy (DBT), which uses specific
skill-building training to directly target the maladaptive emotional
and behavioral responses that trigger the choice to self-injure.
Linehan developed DBT in 1993 specifically for the treatment of
people with BPD and non-suicidal intentional self-injury.
The Deepest
Cut
A shot to kill the pain.
A pill to drain the shame.
A purge to stop the gain.
A cut
to break the vein.
A drink to win the game.
by Unknown
Top |
