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SELF-INJURIOUS BEHAVIOR (SIB)  SELF-HARM

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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.

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 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.
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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."
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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

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You are here among friends!

From one who has fallen into the hypnotizing ritual of cutting myself, I welcome you to read what others have shared about this mysterious behavior.  I no longer cut, but I am one razor-blade away from this self injurious behavior.  I don't cut
One Day At A Time.