Chrisine M. A. Courbasson, Ph.D
If you tend to harm yourself when you experience emotional stress or other difficulties, you are not alone. Individuals rely on various coping strategies based on their past learning experiences, and some may turn to self-harming as an attempt to improve, change or numb painful emotions, especially when they do not feel understood by others.
Self-harming behaviours fall on a continuum of severity and include any behaviour that intentionally causes physical harm to one’s body, for example, cutting or burning oneself, overdosing on substances without the intent to die. Sometimes someone might binge on food or starve her or himself to intentionally cause physical harm, and so it becomes a form of self-harm. Both self-harming behaviours and problematic eating can be attempts to momentarily manage distressing emotions. They are maladaptive ways of escaping and not dealing with stressful situations and emotions. Both are actions that may be soothing in the short-term, but which have long-term negative consequences.
People who engage in problematic eating or self-harming behaviours may be unaware of the severity of their problem. They may minimize the problems or be ambivalent about treatment, possibly because of shame or fear about admitting their problematic behaviours and participating in treatment, or because the behaviour appears to work for them.
A temporary solution
Many women who have previously engaged in self-harming behaviours however, eventually develop alternative coping strategies and are leading fulfilling lives. You can make these changes too! There are things that you can do that can help you break away from this problematic coping behaviour. The first step is to break the silence. Talk to someone you trust about your situation so that you can receive support. If you feel that you cannot trust someone at this time, the following suggestions may help you work towards more effective coping strategies.
Self-harm is the opposite of self-care. In this article, other ways to take care of your thoughts and feelings without harming yourself to address your needs are discussed so that you can try some new, more helpful tools to deal with difficult feelings. Notice that self-harm is only a temporary solution to your problems. It is not a good solution and a better one can be found. Recognize that although this method of relieving stress might appear effective at the moment when you are in a very difficult situation, there are nevertheless disadvantages to engaging in it, disadvantages that outweigh its short-term effectiveness. Make a list of these negative consequences both short and long term so that you can read it when you feel the urge to self-harm. Also make a list of how more effective coping strategies will help you. You have more power than you may be able to see! You can learn to control your emotions instead of letting them control you. The first step is to identify the factors that make you vulnerable to self-harm, the second is to identify the events that prompt you to engage in self-harm behaviour, the third is to identify the links between them, and the fourth is to reduce the factors and break the links so that you can prevent self-harm fromoccurring and cope with stress more effectively.
In order to reduce the factors and break the links, identify your areas of vulnerability. Vulnerabilities are things within you or within your environment that create or heighten urges to self-harm. Examples of vulnerabilities include low self-esteem, being highly critical about yourself, experiencing distressful emotions, physical discomfort, busy thoughts, physical hunger or having conflicts with others.
Identify prompting events. Prompting events are things that happen in your mind or in your environment that spark off urges to self-harm. Examples of prompting events include arguments with others, stressful experiences, failing at something or doing something less well than you had planned.
Then identify the links between your vulnerabilities and typical prompting events. In general, the more vulnerabilities you have at a given moment, the more susceptible you are to prompting events. For example, if you are rested and had breakfast, snack and lunch and have a mutual liking for your co-worker, you will probably not feel the urge to self-harm if you have a disagreement with her. However, if you did not get enough sleep last night, have physical pain, missed breakfast, snack and lunch, then the same disagreement may become a prompting event.
Strategies for change
To stop self-harming behaviours, you must work at learning from them. One strategy to begin this learning is to observe the feelings, thoughts, sensations and situations that come before these behaviours. Through observation, you can learn that things don’t “just happen.” Be an investigator and observe when these feelings, thoughts, sensations and situations occur, whether a particular situation triggers certain feelings, thoughts and sensations. This process of observation is similar to following a chain, beginning with the self-harming behaviour, and working your way backwards to the feelings, thoughts, sensations, and situations that triggered the behaviour. By learning the triggers for your self-harming behaviour, you are in a better position to do something about it. You can begin this process of awareness by recording in a journal or keeping a record of your self- harming behaviours, writing down when they occurred, whether anyone was present, what were your feelings, thoughts and sensations, etc . . . Also record when you had thoughts to self-harm and when you tried other self-care strategies. You want to learn and note on your journal what strategies you have used to delay or prevent self-harm behaviours from occurring so that you can do more of what works the next time urges come up.
How can you reduce your vulnerability? Start by eating a balanced and healthy diet. Not eating enough food and getting the nutrients you need can lead to mood swings, impaired judgment, problematic decision-making and increased binge behaviour. The resulting guilt and shame may lead you to self-harm. Get enough rest; acknowledge your emotions as they arise, to prevent build up of overwhelming ones; stay away from drugs and alcohol (these will prevent you from becoming in touch with your emotions, cloud your thinking, and may lead you to problematic decision making); make a list of advantages and disadvantages of acting on your urges; be a cheerleader: tell yourself that you can successfully cope with stress without self-harming; develop a support system, for example, have phone numbers of supportive people handy; find a safe place to go when you are stressed (library, park, store, friend’s place, etc.); get rid of self-harm paraphernalia; cultivate a healthy balance between work, play and self-care activities.
How can you avoid prompting events for self-harm behaviours? Avoid or minimize situations that can lead to prompting events. For example, terminate relationships linked to self-harm, avoid areas associated with self-harm (if this is possible), minimize friction in relationships by addressing problems early. Take time to become fully aware of the urge to self-harm without acting on it, and you will notice that the urge goes up and down like a wave – sometimes it is very strong and yet it eventually subsides. Notice the emotions behind the urge. If you can’t label them, use all parts of your experience: your emotions, thoughts, senses, “gut,” and intuition to describe how it feels.
What else can you do? Distract yourself with an activity unrelated to your problem. Try to do this mindfully, i.e., focussing all your attention on the activity itself. Distraction can provide you with a breather and allow you some time to step back to regulate your emotions and regain some energy to face the problem. Remember to use distraction as a short-term approach to bring down the intensity of the urge, not as a long-term solution to your stress. Try to provide assistance to someone in need. For example, visit an elderly person, offer to cook, clean or read a story to the person. Contributing to someone in need can shift your attention from your own difficulties to helping others with theirs, and it can help you to feel good about yourself for helping someone who needs it. You can also compare yourself with those less fortunate than you. This can help you discover some positive aspects of your life. Distract yourself with different sensations so your body and eventually your mind are redirected with the new sensation as opposed to your reaction to your problem. For example, you can touch something that feels soothing, smell something that nurtures or comforts you, listen to sounds that you like, look at a picture or a plant, or anything that pleases your sight. Leave situations that make you vulnerable, practice deep breathing, engage in self-soothing activities, and imagine yourself resisting the temptation, and then feeling good about it.
Learning and implementing these kinds of self-caring strategies involves a lot of practice, creativity, and hard work. There is never only one solution to a problem, so it may take a lot of time and energy to explore new ways of taking care of yourself. Be aware that at times, you may still want to return to old behaviours that seem most familiar and comfortable, and you may on occasion return to these behaviours. Remember: perfectionism only exists in the dictionary. Life, things, events, and people are not perfect. We all experience some pain or distress in our life. It is what you do with it that is critical. Learn to accept the fact that no one is perfect, forgive yourself for your mistakes, and allow yourself to learn to experience emotions and strong urges to engage in problematic behaviours because, if you avoid them they will likely come back stronger and you can become more fearful.
Make a commitment to yourself to try alternative self-care strategies today and seek support from a friend, teacher, family member, doctor or therapist. Remember: you are worth it!
Moving forward from self-harming behaviours
- List how your self-harming behaviour limits you.
- Identify factors that make you vulnerable to self-harming.
- Identify triggering events, feelings and beliefs.
- Make the links between vulnerabilities and triggers.
- Identify alternative ways of thinking and behaving.
- Practice these alternatives when you are able to do so.
- Build on the changes that work to replace self-harming.
- Celebrate your new, healthier coping strategies!
Linehan, M.M. 2015. DBT Skills Training Manual, Second Edition. New York: The Guilford Press.
Linehan, M.M. 2015. DBT Skills Training Handouts and Worksheets. New York: The Guilford Press.
Louden, J. 2005. The Women’s Comfort Book: A Self-Nurturing Guide for Restoring Balance in Your Life. San Francisco, CA: Harper San Francisco.
© NEDIC 2001; reviewed and updated 2015 www.nedic.ca