SAFELINE

Registered Charity Number 1070854

In spite of the title, there is no shame here. If you cause physical harm to your body in order to deal with overwhelming feelings, know that you have nothing to be ashamed of. It's likely that you're keeping yourself alive and maintaining psychological integrity with the only tool you have right now. It's a crude and ultimately self-destructive tool, but it works; you get relief from the overwhelming pain/fear/anxiety in your life. The prospect of giving it up may be unthinkable, which makes sense; you may not realise that self-harm isn't the only or even best coping method around.

For many people who self-injure, though, there comes a breakthrough moment when they realise that change is possible, that they can escape, that things can be different. They begin to believe that other tools do exist and begin figuring out which of these non-self-destructive ways of coping work for them.

How do you know if you self-injure? It may seem an odd question to some, but a few people aren't sure if what they do is "really" self-injury.

Answer these questions:

1. Do you deliberately cause physical harm to yourself to the extent of causing tissue damage (breaking the skin, bruising, leaving marks that last for more than an hour)?

2. Do you cause this harm to yourself as a way of dealing with unpleasant or overwhelming emotions, thoughts, or situations (including dissociation)?

3. If your self-harm is not compulsive, do you often think about SI even when you're relatively calm and not doing it at the moment?

If you answer question 1 and question 2 ‘yes’, you are a self-injurer.

If you answer question 3 ‘yes’, you are most likely a repetitive self-injurer.

The way you choose to hurt yourself could be cutting, hitting, burning, scratching, skin-picking, banging your head, breaking bones, not letting wounds heal, among others. You might do several of these. How you injure yourself isn't as important as recognizing that you do and what it means in your life.

Self-injurious behaviour does not necessarily mean you were an abused child. It usually indicates that somewhere along the line, you didn't learn good ways of coping with overwhelming feelings. You're not a disgusting or sick; you just never learned positive ways to deal with your feelings.

(Copyright 1996-2008 Deb Martinson or by Deb Martinson)

SUGGESTIONS OF THINGS TO DO IF YOU SELF HARM:

1. EVALUATE AND CHANGE YOUR LIFE CIRCUMSTANCES IF NECESSARY.
We put this first because as long as you are in a physically or emotionally unsafe environment, it will be much harder (maybe impossible) for you to stop providing yourself with relief through self-injury. Ask yourself how you feel about where you are living....who you are living with....how you spend your days. Are you comfortable with these things? If not, start focusing on changing them. Support groups or therapists can be helpful for this.

2. DECIDE IF YOU WANT TO STOP SELF-INJURING NOW.
For some people, the rewards that they get from hurting themselves so far outweigh the negative consequences that they have little desire to stop this behaviour immediately and the idea of doing so is very threatening. If this is the case for you, you may want to focus on longer-term suggestions for changing your life, rather than focusing on immediate control of your self- injury behaviour.

3. IF YOU DO WANT TO STOP NOW
Think about the times that you've hurt yourself and see if you can identify certain kinds of events that provoke the feelings that make you want to hurt yourself, or thoughts that you start thinking before you self-harm. Write these down. Try to recognise these events, or thoughts in the future, when they start to occur, rather than waiting till the feelings are overwhelming.

4. IF YOU FEEL LIKE YOU MIGHT HURT YOURSELF (or recognise events or thoughts that precede self-harm for you
• Stay in the company of others. People usually injure themselves privately. Spend as much time as possible in public places; stay overnight with a trusted friend or family member if you can.

• Try to delay the act in any way you can. You might try distracting yourself by calling a friend, going somewhere, writing in a journal, watching a movie, painting a picture, exercising, etc. Even if you end up hurting yourself, recognise that you made progress by delaying the act and try to delay longer in the future. This is a HARD thing to do. As in substance addictions, some people find that the longer they go without harming themselves, the easier it becomes to resist.

• Stay away from the materials that you know you might hurt yourself with, like razors, glass, pins, etc. Many people find it helpful in the short term to remove razor blades or other tempting items from their home.

• Some people find that the impulse to injure themselves passes if a loved one holds them tightly when they feel overwhelmed by feelings or out of touch with their bodies. Since many people who self-harm have been abused in some way, this may not work for them, or the choice of who can hold them should be made very carefully. Sometimes having someone hold your hand, or stroke your arm is helpful.

• Remind yourself of the long term consequences of self- injury (scars, having to wear long sleeves, and social rejection being a few possibilities)

• Some people find it helpful to say "NO!" or "STOP!" out loud to themselves when they think of hurting themselves, and this seems to interrupt the immediacy of their usual self-injury response to stress. In essence, it helps them think before acting and take responsibility for their self-harm.

• STAY AWAY FROM DRUGS AND ALCOHOL
Even caffeine, since these have been linked to self-harm behaviours. Unless your doctor has prescribed a medication (and is aware of your self-injurious behaviour), avoid all medications. Even if your doctor has prescribed them, I would recommend staying away from drugs that you know decrease your inhibitions or impulse control (like valium and other minor tranquillisers) when you feel as though you may hurt yourself. Many people have described them as contraindicated in the immediate prevention of self-injury.

5. IF YOU MUST HURT YOURSELF:
• Try to substitute more socially accepted methods such as piercing your ears (again), or better yet get your hair cut or your hair colour changed.

• Don't beat yourself up about it. That will only make matters worse. This is a VERY hard behaviour to change. Try to focus on longer-term ways to decrease your stress, finding new ways to communicate and express your feelings, or increasing your control over self-harm instead of on the fact that you hurt yourself again.

• NEVER SHARE razors with other people who cut themselves, since this has been identified as a potential new route of HIV transmission. Here's one place where you could cross the line and accidentally turn a non-lethal act into a lethal one. Because many people who self-harm also abuse substances, those who cut might be at higher risk for carrying HIV.

6. LIFESTYLE CHANGES TO DECREASE SELF-INJURY OVER THE LONG TERM:
• Find new ways to cope with your feelings. Learn new ways to calm, soothe, and comfort yourself. These may not work when you are aroused to the point of feeling overwhelmed, but may be effective if practised on a regular basis or when you feel tension beginning. Meditation, physical exercise, relaxation exercises, visual imagery, relaxing music, deep breathing, warm baths, and playing a musical instrument are just a few examples of ways that people can soothe themselves.

• Several people have said that learning to nurture and protect themselves was an important part of their recovery This is not an easy thing to do, and may take many years of work. Try doing things to take care of yourself and make yourself feel pampered and loved. Buy a beautiful journal and write in it. Sit under a big soft quilt and read a good book.
Whatever it is that makes you feel loved, do it. Realise what strength it takes to live through what you've lived through. Next time you think of hurting yourself tell yourself that you deserve to be protected.

• If you feel a lot of anger, you might try vigorous activities like handball, running, swimming, yard work or martial arts, or squeezing a rubber ball till your hand hurts. Some people told me that it helps them to tear up rags, smash bottles in a “bottle bank” punch pillows, or paint when they feel anger rising.

• Practice communicating your feelings instead of engaging in impulsive, addictive behaviours like self-injury or substance abuse to escape them. Find someone safe to communicate your feelings to and try letting someone be there for you. This might be a very close friend, loved one, or therapist. For many of us who have experienced abuse or been raised in households where negative feelings are not expressed verbally, this is not an easy thing to do. Try letting someone you trust comfort you when you are upset. Try expressing your anger directly through words and see what happens. A therapist or counsellor can often help you with this.

• Assertiveness training groups or self-help book about developing assertiveness skills can also help you learn to get your needs met more directly.

• As a general rule, avoid over use of caffeine, alcohol, and other non-prescribed psychoactive substances. People who self-injure sometimes experience mood swings and these substances can enhance this. If self-injury is an attempt to decrease or increase arousal, these substances might really throw us out of kilter.

• Try not to spend time with others who self-injure or engage in self-destructive lifestyles. Self-injury sometime has a "contagious" quality to it, and your behaviour might be triggered by the company of others who are harming themselves.

• Seek out a therapist to help you make changes in your life. Be a consumer and PROTECT yourself. Victims of abuse or neglect are often highly sensitive to invalidating therapists/approaches to therapy since their earlier abuse or neglect was the ultimate in invalidation. Some therapists place themselves in a superior position to their clients, and act as though their approach is the only one that works, and as though they know more about you than you do. If your therapist doesn't hear you or respect your needs for information, control, feelings of safety, and respect, find another therapist! Ask a prospective therapist (or your current therapist) about his or her views on self- injury: why people do it, how to approach it therapeutically, what to expect in terms of outcome. Make sure the answers are ones that feel comfortable to you. Although there is no shortage of theories about why people hurt themselves, no form of therapy has been shown to work better than any other for helping people to control this behaviour. Find a therapist that you can TRUST and work WITH, preferably one who makes you feel empowered rather than sick. Find someone who views this behaviour in a way that is comfortable for you, and gives you hope.
• Self-help or support groups can be helpful, especially when geared specifically towards people who self-injure. Crisis lines, women's resource centres, and rape or sexual abuse organisations may be sources of information about such groups in your area.

HOW CAN I HELP MY FRIEND/CHILD/LOVED ONE CONTROL HIS/HER SELF-HARM?

1. Maintain an accepting, open attitude about the self- injury. Most people who self-harm have problems with low self-esteem and are disgusted by their own self-injury behaviour. Try to make him/her feel safe discussing it, and accepted regardless of it. Try not to pay more attention to the self-injury behaviours than the healthier things that this person does.

2. Recognise the severity of this person's distress and the inability to stop hurting him or herself. Try not to get angry at him/her for self-harm behaviours, since this merely reinforces the self-disgust and discouragement that is already there. If he/she could stop, he/she would. Don't minimise how much distress a person is in, regardless of how insignificant the stressor might appear to you, with statements like "it's not that bad," or "you can't be that upset about it." Acknowledge that the person is under a lot of stress, and that you are there if there's anything that you can do to help. Don't shame the person for failed attempts at controlling self-injury, and praise any success in delaying the act.

3. If he or she is not already doing so, encourage the person to find a professional therapist that meets her/his needs, preferably one with knowledge and experience with repetitive self-injury. Encourage self-injury support groups if such a thing exists in your area.

4. If you think this person is in immediate danger of cutting or other superficial or moderate self-injury, stay with him or her until the impulse passes or encourage him or her not to be alone. Physical contact through hand holding or hugging can sometimes be helpful if the relationship is appropriate and trust is sufficient.

5. Self-injury is an extremely stressful, frustrating, and anxiety-provoking thing for everyone involved. Get support for yourself if you need it, through a counsellor or therapist, preferably one with knowledge and experience with self-injury.