Supporting Someone Who Self-Injures

I have a diagnosis of borderline personality disorder (known in the UK as emotionally unstable personality disorder). BPD is sometimes known in the Netherlands as emotion regulation disorder, because it causes people to be unable to deal with intense and rapidly shifting emotions. BPD sufferers get stressed much more easily than those without mental health problems. They also tend to cope with stress ineffectively. One destructive coping mechanism that is common in BPD is self-harm.

Self-injury is not unique to people with BPD. In fact, starting with DSM-5, non-suicidal self-injury is its own diagnosis in the psychiatrist’s manual. Before then, if a person self-harmed, they were often incorrectly diagnosed with BPD, which has many more symptoms than just self-injury.

Self-injury is also common in people with autism, which is my other diagnosis. It is thought that people with autism, particularly those with a co-occurring intellectual disability, self-harm as a way of self-stimulatory behavior (to regulate sensory input) or as a way to communicate. For example, they might start to self-harm when they are overloaded sensorially or cognitively, or when they are in pain.

People with BPD are thought to self-harem to regulate their emotions. For instance, they may feel intense hopelessness or rage, or they may conversely feel numb and self-harm to have any sensation at all.

Self-harm is commonly thought of as a way of manipulating or attracting attention. This may be true, but isn’t necessairly. Many people feel a lot of shame about their self-harm. I, for one, don’t tend to self-injure to garner attention of others. I self-harm for many reasons, one of them being expressing emoitons to myself.

It is important to realize that people who self-injure, no matter their diagnosis, are in distress, be it physical, sensory, cognitive or emotional. It is important to find out what precedes the self-injury and what follows it. Don’t make judgments about what goes on inside the self-injurer’s mind. For example, I commonly start self-harming when I get frustrated trying to communicate my needs to my staff. It may then be easy to assume I do it “for attention”, because the staff give me more one-on-one attention when I self-injure. However, if I am able to communicate my needs effectively, I don’t self-injure to get attention. Behvior is communication, but bad behavior is not always intended to be malicious.

There are different ways of supporting self-injurers. Prevention is the first step. Some people, particularly those with emotion regulation disorders, may benefit from mindfulness and other skills training in a form such as dialectical behavior therapy. Others may benefit from augmentative or alternative communication methods to signal they’re in pain or overloaded. I need a little of both. I practise emotion regulation skills and mindfulness, but sometimes I also need support in the area of communication. For example, I cannot always communicate when I need a staff member to help me with something, be it emotional support or a practical task. Signaling cards, gestures or other alternative or augmentative communication may help in this situation.

When someone self-harms, it is of course important that their physical wounds be taken care of if they cannot do this themself. I find it helps most when someone doesn’t make a big deal out of my self-injuring when taking care of my wounds. Some professionals advocate limiting contact for a day or more after a person has self-injured, reasoning that in that case they have solved their problem already, albeit in a destructive way. Though I find that a bit of distance is good shortly after I self-harm, it is still important to make sure the person is safe from further harm. I do also find that I want to discuss the situation later when I’m calm, so that I can learn what better strategies will help me in the future.

Everyday Gyaan

27 thoughts on “Supporting Someone Who Self-Injures

  1. I suffer from the same thing. I found DBT to be extremely effective. I love that the internet gives us all an opportunity to come together and discuss things like this! Keep on fighting the good fight, my friend.

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  2. Thank you for sharing this information. I’m not sure that I know anyone that self-harms, but now I can be on the lookout and know what to do. I think this post can really help others.

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  3. I know a few people who do/have self harmed and it’s really useful to be able to read posts like this to know how best to help and support those people. Thank you x

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  4. I was unaware of this as I don’t know anyone who self harms. Thanks for sharing this and bringing awareness to people who did not know this exists. Dropping by from the #SeptemberChallenge.

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  5. Thank you for sharing this, I’m really really passionate about opening up a conversation and being more up front about mental health. I have had anxiety disorder for 8 years, and have struggled with other problems along the way. It’s too true that stigma exists, but posts (and people like you!) like this are helping to make perceptions so much more positive. Thank you again ❤

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  6. This is a great topic to discuss. I’ve had friends self harm in the past and I’ve never known what to do or how to approach them. It’s such a fine line of wanting to help and being intrusive and making them dorset hat often as a bystander we’re scared to really help. x

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  7. I am not aware that anyone around me suffers from this problem and that is in itself a problem. Until more people, like you, explain what is going on and how to help the rest of us will remain unwilling ignorant. Thank you for sharing

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  8. Thank you for this post. Mental health needs to stop being a taboo subject. It’s very complex and each case is individual. Assumptions often do more harm than good to the sufferer and can also be frustrating when you don’t understand how to ‘deal’ with a persons needs. Very honest well written post x

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  9. So much more needs to be done to raise awareness about mental health issues, and I think the first change is that people need to stop viewing mental illness as a weakness or a choice! I have suffered with depression and the amount of people who thinks it’s a case of pulling yourself together is quite shocking!

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  10. This is such a lovely, well written post. Thanks for sharing it. I had a close friend who self-harmed for many years and she’d never speak about it until one day I told her I’d always be there for her and she needs to get it off her chest and I’m here to help, not judge. She hasn’t done it since. I wish there was more awareness about self-harm and mental illness.

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  11. Thanks so much for sharing this little talked about subject – I found this post really interesting and I hope it helps raise awareness

    Laura x

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