Am I ready to stop?
How do I start stopping?
What to do RIGHT NOW instead of SI
What if I do all this and I still want to harm?
"Fake" pain -- Understanding the urge
Dealing with intrusive thoughts after stopping
How do I know if I'm ready to stop?
Deciding to stop self-injury is a very personal decision. You may have
to consider it for a long time before you decide that you're ready
to commit to a life without scars and bruises. Don't be discouraged if
you conclude the time isn't right for you to stop yet; you can still
exert more control over your self-injury by choosing when and how much
you harm yourself, by setting limits for your self-harm, and by taking
responsibility for it. If you choose to do this, you should take care
to remain safe when harming yourself: don't share cutting implements
and know basic first aid for treating your
Alderman (1997) suggests this useful checklist of things to ask yourself before you begin walking away from self-harm. It isn't necessary that you be able to answer all of the questions "yes," but the more of these things you can set up for yourself, the easier it will be to stop hurting yourself.
While it is not necessary that you meet all of these criteria before stopping SIV, the more of these statements that are true for you before you decide to stop this behavior, the better.
[Alderman (1997) p. 132]
- I have a solid emotional support system of friends, family, and/or professionals that I can use if I feel like hurting myself.
- There are at least two people in my life that I can call if I want to hurt myself.
- I feel at least somewhat comfortable talking about SIV with three different people.
- I have a list of at least ten things I can do instead of hurting myself.
- I have a place to go if I need to leave my house so as not to hurt myself.
- I feel confident that I could get rid of all the things that I might be likely to use to hurt myself.
- I have told at least two other people that I am going to stop hurting myself.
- I am willing to feel uncomfortable, scared, and frustrated.
- I feel confident that I can endure thinking about hurting myself without having to actually do so.
- I want to stop hurting myself.
These strategies work because the intense emotions that provoke SI are transient; they come and go like waves, and if you can stay upright through one, you get some breathing room before the next (and you strengthen your muscles). The more waves you tolerate without falling over, the stronger you become.
But, the question arises, aren't these things equivalent to punishing yourself by cutting or burning or hitting or whatever? The key difference is that they don't produce lasting results. If you squeeze a handful of ice until it melts or stick a couple of fingers into some ice cream for a few minutes, it'll hurt like (to quote someone I respect) "a cast-iron bitch" but it won't leave scars. It won't leave anything you'll have to explain away later. You most likely won't feel guilty after -- a little foolish, maybe, and kinda proud that you weathered a crisis without SI, but not guilty.
This kind of distraction isn't intended to cure the roots of your self-injury; you can't run a marathon when you're too tired to cross the room. These techniques serve, rather, to help you get through an intense moment of badness without making things worse for yourself in the long run. They're training wheels, and they teach you that you can get through a crisis without hurting yourself. You will refine them, even devise more productive coping mechanisms, later, as the urge to self-injure lessens and loses the hold it has on your life. Use these interim methods to demonstrate to yourself that you can cope with distress without permanently injuring your body. Every time you do you score another point and you make SI that much less likely next time you're in crisis.
Your first task when you've decided to stop is to break the cycle, to force yourself to try new coping mechanisms. And you do have to force yourself to do this; it doesn't just come. You can't theorize about new coping techniques until one day they're all in place and your life is changed. You have to work, to struggle, to make yourself do different things. When you pick up that knife or that lighter or get ready to hit that wall, you have to make a conscious decision to do something else. At first, the something else will be a gut-level primitive, maybe even punishing thing, and that's okay -- the important thing is that you made the decision, you chose to do something else. Even if you don't make that decision the next time, nothing can take away that moment of mastery, of having decided that you were not going to do it that time. If you choose to hurt yourself in the next crisis time, you will know that it is a choice, which implies the existence of alternative choices. It takes the helplessness out of the equation.
So what do I do instead?
Many people try substitute activities as described above and report
that sometimes they work, sometimes not. One way to increase the
chances of a distraction/substitution helping calm the urge to harm is
to match what you do to how you are feeling at the moment.
First, take a few moments and look behind the urge. What are you feeling? Are you angry? Frustrated? Restless? Sad? Craving the feeling of SI? Depersonalized and unreal or numb? Unfocused?
Next, match the activity to the feeling. A few examples:
Get out the questions Kharre asks. It's a good idea to have several copies of these printed out and ready to use; you can also answer them online; your responses will be mailed privately to you and no one will see them except you.
Answer these as honestly and in as much detail as you are able to right now. No one is going to see the answers except you, and lying to yourself is pretty pointless. If, in all honesty, you see no other answer to #8 but yes, then give yourself permission, but set definite limits. Do not allow the urge to control you; if you choose to give in to it, then choose it. Decide beforehand exactly what you will allow yourself to do and how much is enough, and stick to those limits. Keep yourself as safe as you can while injuring yourself, and take responsibility for the injury.
The questions (for more explanation, see kharre's post on the subject):
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 distress.
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.
More information about Dialectical Behavioral Therapy can be found at DBT-Seattle.
Individuals' suggestions for self help
Kharre, a subscriber to the bodies-under-siege list, compiled an excellent
list of ways to cope with si. She covers topics such as:
Questions to ask before you hurt yourself
A letter to my SI
Things to help you through the bad times
Important tips for those who interact with someone who SI's
Kirsti, who has assembled an incredible page on self-injury, dissociation, and abuse, has some very useful coping ideas.
An anonymous poster, email@example.com, put together a great deal of information about self-injury. Included was this useful list of things to do. It contains suggestions both for self-injurers and for their friends and loved ones. I've added a few of my own, noting them with [brackets].
A shorter list of 12 things you can do to try to climb out of a mild to moderate depression or urge to cut can be found here.
Another bus member, Tammy Bucklew, adapted these suggestions for families and friends of abuse survivors from Kubetin and Mallory (1992).
You may at some point want to find professional help for this problem. I've collected sources in the USA, UK, Canada, and Australia. If you know of people or organizations I've left out, contact me.
There is also a DBT skills discussion list. To subscribe, send mail to the listowner (Kieu) at firstname.lastname@example.org explaining your background and why you'd like to be on the list. It's intended to be a place to share experiences and get support while using DBT skills.
Bristol Crisis Service for Women
Crisis Service for Women is the leading UK (and as far as I know,
European) support organization for women who self-harm. They offer a
confidential help line, publications for self-harmers and for
professionals, and other services. They're empathetic, dedicated and a
valuable resource for women in the UK and Europe. Check out their Women and Self-Injury leaflet.
In 1984 Karen Conterio (then of Hartgrove) established a
support group for self-injurers called SAFE (Self-Abuse Finally
Ends). SAFE groups were not like 12-step groups or most self-help
groups; they were short-term groups run by a professional
facilitator. SAFE no longer offers these groups, but they do have a
30-day inpatient program; more details are on the resources page. SAFE operates on the belief
that the underlying emotional conflict is the primary problem, not the
self-injury. More information about SAFE can be obtained at
If you've already injured yourself and need to know how to
care for the wounds, this list of first-aid
basics might be helpful.
I stopped a few weeks ago, but I keep obsessing
about hurting myself. Help?
It's not uncommon for people to continue thinking obsessively about
self-injury for a while after they've made the decision to
stop. Hurting yourself has been a huge part of your life up until
recently, and you're used to dwelling on it. You might think that
you're supposed to be "cured" now and that all thoughts of SI should
magically vanish from your head, so when you catch yourself thinking
about that blade or lighter or whatever, you get angry and frustrated
and shove the thought away.
Foa and Wilson (1991) deal with intrusive thoughts by a combination of giving yourself permission to think about it and exposure/habituation techniques combined with ritual prevention. Exposure refers to repeatedly presenting someone with the situation about which they obsess, and habituation happens when, after much exposure without resulting to usual actions, the person gets used to the situation and it no longer distresses them.
To adapt these techniques, first make yourself safe. If you're in a mind-set in which self-injury seems very very likely, it might be better to use distraction techniques to get past that place. Line up a support person whom you can call if you get overwhelmed by this technique. Try to tolerate it for as long as you can, even if you're uncomfortable.
First, designate two 10- or 15-minute time periods daily. Choose times when you will be alone and able to think without being interrupted. To begin, set a timer for the designated amount of time. Then obsess about hurting yourself. Think about what it would feel like, how you would feel afterwards, how much you want to do this -- all those thoughts you've been trying to suppress. Get as distressed as you can, and stay focused on the topic of injuring yourself. You may find, especially after the first few times, that you get really bored toward the end of your time period. That's a good sign -- you're becoming habituated.
When the time is up, stop thinking about SI. If thoughts of wanting to harm come into your mind at other times during the day, acknowledge them and remind yourself that you will think about them later, when it's time. Then let them go. If they come back, repeat the process. Don't shove them away or try to ignore them; just acknowledge, remind yourself they have their time soon, and let go.
After a week or so you will notice an improvement (maybe even after just a few days). One crucial thing: no matter what, do not act on the thoughts of SI. They are just thoughts, and you can use the skills that you used to stop harming to get through these times. In order for habituation to occur, you have to get through the exposure without resorting to the old behavior. Use distraction and substitution for SI (ritual) prevention.