|More Information on Self Hurt|
safe while hurting yourself
A few things to keep
in mind should you decide that you do need to hurt yourself:
Don't share cutting
implements with anyone; you can get the same diseases (hepatitis, AIDS,
etc) addicts get from sharing needles.
Try to keep cuts shallow.
Keep first aid supplies on hand and know what to do in the case of
Do only the minimum
required to ease your distress. Set limits. Decide how much you are going
to allow yourself to do (how many cuts/burns/bruises, how deep/severe, how
long you will allow yourself to engage in SI), keep within those
boundaries, and clean up and bandage yourself later. If you can manage
that much, then at least you will be exerting some control over your SI.
is "fake pain" and why does it matter?
The concept of
"fake pain" helps to explain why distress-tolerance skills are
Observation of myself and interviews with others have convinced me that
one of the reasons people self-injure is to deflect unknown, frightening
pain into understandable, sort-of-controllable "pseudo" or
"fake" pain. Calling this phenomenon "fake pain" is in
no way intended to suggest that it doesn't hurt; it hurts like hell. When
memories or thoughts or beliefs or events are excessively painful, instead
of facing them directly and feeling "genuine" pain, we sometimes
deflect distress into pain that seems understandable and controllable,
like that of self-injury. The real feelings associated with the event
you're avoiding get overridden by those of the situation you create to
distract yourself. It still hurts like hell, but it's a controllable
familiar hell, whereas the real pain you're avoiding seems scary and
poised to take over your world like the monster who ate Detroit.
It's easy to revert to "fake" pain. Trying to find the source
of your distress can be scary as hell, because you often don't know what
you're going to unleash. Fake pain, although very painful and traumatic,
is something that you understand and can control and can handle. It's
familiar, not mysterious and scary like the real pain behind it. You might
feel that if you ever exposed yourself to the real pain you'd lose
control: "If I ever start crying, I'll never stop" or "If I
let myself get mad about that, I'll never stop screaming."
Instead, you unconsciously deflect the distress away from the memories
or feelings that generated it and into self-injury. SI is seductive: you
control it. You know the boundaries, even when you feel out of control. It
makes sense and it makes the distress go away, at least for a while. It's
a clever mechanism -- it takes what seems unbearable and transforms it
into something you can control. The only problem is that when you deflect
pain, you never face up directly to what it is that has caused this much
tumult in your life. So long as you channel distress into fake pain, you
never deal with the real pain and it never lessens in intensity. It keeps
coming back and you have to keep cutting.
You have to deal with the unbearable if you ever want to make it
lose its power over you. Every time you can meet the real pain head-on and
feel it and tolerate the distress, it loses a little of its ability to
wipe you out and eventually it becomes just a memory. The process is like
building tolerance to a drug. Narcotics users take a little bit more of
their drug every day as tolerance builds, until eventually they're
routinely taking amounts of drug that would kill an ordinary person. The
poisonous events in your past work in a similar way. Exposure (with the
help of a trained therapist) over time will build your tolerance to these
events and enable you to lay them to rest. The key is learning to tolerate
Marsha Linehan's Skills
Training Manual has several helpful worksheets for getting through
crisis situations. Though they are best used as part of a DBT program with
a trained therapist, you might find some of them helpful.
This concept focuses
on learning to accept reality as it is. Accepting it doesn't mean you like
it or are willing to allow it to continue unchanged; it means realizing
that the basic facts of the situation are even if they aren't what
you'd like them to be. Without this kind of radical acceptance, change
Letting Go of
In this worksheet,
you learn ways to observe and describe your emotion, separate yourself
from it, and let go of it. One of Linehan's basic principles is that
emotion loves emotion, and this worksheet is designed to help you
experience your emotions with amplifying them or get caught in a feedback
simply doing other things to keep yourself from self-harming. Most of the
techniques mentioned above are distraction techniques; you bring something
else in to change the feeling. Using ice, rubber bands, etc, is
substituting other intense feelings for the self-injury. Other things
Linehan suggest substituting include experiences that change your current
feelings, tasks (like counting the colors you can see in your immediate
environment) that don't require much effort but do take a great deal of
concentration, and volunteer work.
focuses on ways to make the present moment more bearable. It differs from
distraction in that it's not just a diverting of the mind but a complete
change of attitude in the moment.
Pros and Cons of Tolerating Distress
As the name implies, this worksheet leads you through an evaluation: what are the benefits of doing this self-harming thing? What are the benefits of not doing it? What are the bad things about doing it? About not doing it? Sometimes writing this down can help you make a decision not to harm.
This, like improving
the moment and distracting, is a distress tolerance technique. It's pretty
straightforward: use things that are pleasing to your senses to soothe
yourself. Some people find that active distraction works better for
violent angry feelings and soothing is more effective for soft, sad ones.
Vulnerability to Negative Emotion
Prevention of states
in which you are likely to self-harm is covered in this worksheet, which
suggests ways of taking care of yourself in order to minimize the times
when you feel the urge to hurt yourself. If you're balancing eating,
sleeping, and self-care, you're less likely to be overwhelmed by emotion.